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The Sensory Pathway presentation short version Feb21

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Sensory Processing, Coordination and Attachment 

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Sensory Processing, Coordination and Attachment 

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A few years ago, I would have never thought twice about it, but now when I see a child in this position my whole body cringes. I fight every urge in my bones to say "fix your legs, sweetie." I can't help it. It's engrained in me. It's in my blood. You see, my son struggled with core strength and commonly sat in the "W position" for many years. He wouldn't, no, he couldn't sit in any other position. Since our battle with W-sitting, I've been in the middle of many discussions with people about the validity and importance of w-sitting. Boy, can these discussions get really heated! That's why I've invited some pediatric therapists to discuss the when to worry about W sitting and share what you really should care about!

* This post may contain affiliate links for your convenience. Click here for my full disclosure.

While "W-sitting" is a common phrase for occupational, physical, and development therapists, there are a multitude of misconceptions regarding this particular sitting position to those not familiar with it.

What is W-sitting?

W-sitting is a sitting position in which children sit with knees bent, feet tucked under, bottom resting on the floor between their legs, and legs out to either side. The child's knees may be close to touching or may be splayed apart. Parents and therapists usually notice children W-sitting between ages 3 to 6, but you may also observe it with younger or older children.

In the therapy world, when brought to the attention of parents, typical responses generally include "I've never noticed that before" or "I used to do that; it's not a big deal." Since pediatric therapists routinely work to correct this sitting posture in order to prevent additional impairments, let's explore some of the reasons W-sitting is not recommended for children and when you should really worry.

3 Common W-Sitting Misconceptions Debunked

Misconception #1: It doesn't cause any long-term effects. There is no excessive stress on a child's joints, muscles or knees in the W position, because kids know how to avoid pain in their bodies.

The Truth: While your kiddo may find it more comfortable to sit in a W and will naturally avoid painful positions, W-sitting is usually a pattern that is used whenever the child is sitting on the floor. Over time, undeveloped bones and joints are affected by the routine stress on the hip and legs. Generally, I don't worry about adjusting the W-sit pattern until about age 2 to 2.5 due to increased flexibility and malleability of bones and joints in infancy. Internal rotation (twisting inward) of the thighbone (which is called "femoral anteversion") is fairly typical at a young age and tends to decrease after age 8. However, it is important to note that therapists see better results the earlier the problem is addressed. Age 8, or even 6 or 7, are considered advanced stages to discover issues with coordination and strength that could have been addressed or avoided altogether. Additionally, this pattern is also seen in kids who have other underlying issues, such as low tone, generalized muscle weakness, sensory concerns, and decreased fine and gross motor coordination.

Misconception #2: It's more stable than other sitting positions.
The Truth:
W sitting can be a more stable sitting position for children. , this is because in the W pose, children do not have to work quite as hard to engage their core and hold their trunks upright. Instead, they spread their lower limbs to create a wider base of support, relying on their joint structures (and not their muscles) to hold them up. In this position, the muscles are not stabilizing the hip joints. This causes increased posterior pelvic tilt (the front of the pelvis rises and the back of the pelvis drops) , which can result in poor sitting posture, decreased core activation, reduced trunk rotation, and delayed fine motor development .

Due to the wide base of support utilized in the W-sitting position, less core muscle (i.e. trunk extensors and abdominals) activation is required to stay upright. This wide base also limits a child's need to weight shift on their bottom from side to side during play, resulting in decreased use of balance responses. This lack of activation causes a cycle of muscle weakness, resulting in difficulty integrating the left and right sides of the body, leading to decreased coordination. These impairments can lead to decreased play involving crossing over the body's midline and poor progress with high-level fine motor tasks using two hands.

: Misconception #3"I sat like this all my life and I've never had any problems because of it."
The Truth:
According to Rebecca Cohen, DPT, PT, increasing the inward rotation of the hip while decreasing the outward range of motion can contribute to a pigeon-toed gait pattern. This walking pattern is correlated with excessive tripping, clumsiness, instability when walking and running, and decreased balance and body awareness.

Another joint abnormality that occurs is called tibial torsion , which is the outward rotation of the lower leg. While standing, this type of torsion causes the foot to turn outward and the knee to turn inward. This position can be painful. It also influences walking and running mechanics. With the foot facing outward, the last point of contact when walking becomes the outside ridge of the foot, which leads to abnormal gait mechanics. Walking can become tiring, slower, and painful. Children may also experience foot pain because of flattening arches. If untreated, adults can experience tight iliotibial (IT) bands, knee arthritis, and/or hip and back pain.

When Should You Worry About W Sitting?

You might be wondering, yeah, but when should I worry. When is it really a problem? The truth is that W Sitting by itself is not always a problem. In fact, when children use this position only rarely and don't depend on it for support, it can often be no cause for alarm. However, there are cases when you should seek professional help.
When Should I Seek Help?
If your child frequents the W Sitting pose and you notice any of the following in your child, an evaluation with a professional is advised:

If your child...

develops a limp,

has a a weakness in the lower extremities,

or uses a pigeon-toed gait

...visit a Physical Therapist for further assessment.

seems to have low muscle tone or weak core strength (as noted by slumping over in chair)

is unable to sit alone in any position other than a "W"

seems clumsy or uncoordinated

has trouble with fine motor tasks (such as tying shoes, zippering his/her coat, opening containers, maintaining a hold on objects)

....visit an Occupational Therapist for further assessment.

Alternative Sitting Options When You Find a Child W-Sitting

I provide simple cues to the children I treat, usually by lightly tapping their leg. Some children require verbal prompting, such as, " please rearrange/adjust your legs." Whatever the cue, it's important to prevent the position from developing into a pattern to avoid bigger issues in the future. Follow these tips for alternative sitting options:

Cross-legged, or "criss-cross applesauce": a common position, children sit with feet crossed and knees apart.

Side-sit: in this position, both knees are bent, weight is shifted to one hip, and both feet are out to the same side. This removes stress from the hip joint structures, allowing for easy transitions in and out of sitting. Encourage sitting on both the right and left sides to promote equal development.

Long-sit: feet are straight out in front of child. The back may or may not be supported by sitting with back against a wall or steady surface.

Short kneel: children sit back against heels in a folded kneeling position with their feet tucked together under their bottom. As long as they don't shift back into the W-position with their bottom on the floor, kneeling is a great way to strengthen hip and core muscles.

Half kneel: children position themselves with one foot tucked under and the other foot flat on the ground. In this neutral position, muscles will be active and get a gentle stretch without wear and tear.

Squat: I often create games that involve squatting as a great way to stabilize core and active quads, glutes, and hamstrings to increase overall strength.

Chair sit: If a child is having difficulty with the other positions, sitting in a low chair will still allow them to participate in play. Time in this position should be limited to encourage muscle activation.

For More on W Sitting:
The Real Reason Your Child W-Sits, Toe-Walks, or Wets the Bed W Sitting and Young Children: What is it? W Sitting and Your Child's Growth Alternative Sitting Positions for W-Sitting What's Wrong with W Sitting? W Sitting- Common Questions and Concerns The Risk of W Sitting and When to Fix It
Jen Brown is an Occupational Therapist with a passion to help kids realize their full potential and strengthen families through collaborative therapeutic intervention. Jen earned her BS in Child Development from the University of Illinois at Champaign-Urbana and her MS in Occupational Therapy from Temple University in Philadelphia. Prior to her career in OT, Jen taught preschool and Kindergarten. Jen has worked in various therapy settings, including Early Intervention, outpatient pediatrics, adult day programs, and acute care. She has experience treating children with ASD, SPD, developmental delay, ADHD, ODD, hemiplegia, behavioral concerns, and fine/gross motor delays. When she is not traveling, Jen can be found enjoying nature, baking, or at the gym!

For More Adventures in Sensory Processing:

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Experts Reveal the Truth About When to Worry About W Sitting

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A few years ago, I would have never thought twice about it, but now when I see a child in this position my whole body cringes. I fight every urge in my bones to say "fix your legs, sweetie." I can't help it. It's engrained in me. It's in my blood.

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This dinosaur brain break activity is a set of free proprioception activities that provides heavy work with a dinosaur theme, making movement and proprioceptive input a fun way to address dinosaur -sized needs. Whether you are looking for heavy work activities for the kids to add to distance learning or heavy work activities for OT teletherapy programs, these free dinosaur movement cards are a great sensory activity to add to your therapy toolbox. Scroll all the way to the bottom of this post to grab your Dinosaur Movement Activity Cards ...and check out the Dinosaur OT activities too!

This post explains more about proprioception sensory activities but to better understand why and how to incorporate movement breaks into learning, check out this post on brain breaks for kids.

This freebie was originally created as part of October's Sensory Processing Awareness Month, however, for a kiddo that loves anything dinosaurs, it works out great any time of year. Kids with sensory integration needs are those kiddos who are bumping into everything and everyone. The little ones who fall out of their chairs, press too hard on their pencils, are clumsy, fidget, or seek extra movements. They might flap their hands or slap their feet when they walk. The thing about kids is that everyone is different and everyone will have different needs, interests, and abilities. This Dinosaur Sized Feelings sensory movement activity is perfect for kids seeking sensory input and kids who just need to move!

Now, it's important for me to note, that when I say Dinosaur-Sized feelings in this post, I'm talking about the child's feeling of hyposensitivity to their environment. They are seeking out extra stimulation from people, walls, cushions...anything really and are feeling a big need to improve their central neural system functioning in order to complete tasks and function.

(Read more about the Central Nervous System below!)

What I'm not talking about in this post is the emotional side of feelings. There has been at least one study done that attempts to determine whether emotional feelings can be influenced by proprioceptive input. I'm not talking about the big emotional feels we all have. In this activity, I'm focusing on the big feelings of sensory needs kids might have, and how to stomp those sensory needs out with proprioception. It's all about the ability to regulate those giant, dinosaur-sized sensory related feelings that impact emotional regulation, coping abilities, worries, anxieties. This post on Zones of Regulation activities explains a little more on self-regulation and specific ways to address these needs.

What is Sensory Integration?

Let's cover some of the background info about what's going on behind self-regulation. Typically, our Central Nervous System integrates sensory input from the environment in a balanced process that screens out certain information and acts on important information, at an automatic level...one that we are not cognitively aware of. For kiddos with atypical sensory integration, the central nervous system has difficulty screening out unimportant information from our environment. For those children, interaction with their surroundings can be stressful as they are either over responsive or under-responsive to normal stimulus. This results in dysfunctional behavior and social difficulties.

For a thorough explanation of sensory integration, sensory processing, and what specific actions look like as a part of our sensory systems, grab this free sensory processing booklet. You'll access the free booklet and join a short email course that explains sensory processing in great detail. It's a free informative course via email that you don't want to miss.

Proprioception Activities for kids

I shared a post in the past about proprioception and handwriting with too much pressure. In that post, I told you how the proprioceptive system receives input from the muscles and joints about body position, weight, pressure, stretch, movement and changes in position in space. Our bodies are able to grade and coordinate movements based on the way muscles move, stretch, and contract. Proprioception allows us to apply more or less pressure and force in a task. Instinctively, we know that lifting a feather requires very little pressure and effort, while moving a large backpack requires more work. We are able to coordinate our movements effectively to manage our day's activities with the proprioceptive system. The brain also must coordinate input about gravity, movement, and balance involving the vestibular system. (This post does contain affiliate links.)
Kids who are showing signs of proprioceptive dysfunction might do some of these things:

Appear clumsy

Fidget when asked to sit quietly.

Show an increased activity level or arousal level.

Seek intense proprioceptive input by "crashing and bashing" into anything.

Slap their feet when walking.

Flap hands.

Use too much or too little force on pencils, scissors, objects, and people.

"No fear" when jumping or walking down stairs.

Or, are overly fearful of walking down steps/jumping.

Look at their body parts (hands/feet) when completing simple tasks.

Sit down too hard or miss chairs when sitting.

Fall out of their seat.

Fluctuates between over-reacting and under-reacting in response to stimulation.

Constantly on the move.

Slow to get moving and then fatigue easily.

Dinosaur Themed Heavy Work Activities

This activity is easy. There is not much to it really, other than being a dinosaur themed way to calm and organize those big dinosaur feelings. The heavy work activities add proprioception that can be a tool to address regulation or sensory needs. Here, I'm sharing with you a few heavy work suggestions that may help hyposensitive kiddos. I wanted to share activities that might be of interest to the child that loves a dinosaur theme. It's my hope that these work for you and your family! If you are looking for more dinosaur themed movement activities, check out this past post sharing Dinosaur movement activities, based on the book popular children's book, Dinosaurumpus.

Please note (as with any activity that you find on this website): This is meant to be a resource and not Occupational Therapy treatment. Please seek individualized evaluation and treatment strategies for your child. All kids are so different in their sensory needs and abilities and adverse reactions can occur with globalized treatments.

Big dino-sized feelings can happen in a little body!

Simply print out the free printable, cut out the cards, and pretend to play, walk, and eat like a dinosaur! We did use our Mini Dinosaurs as we practiced all of the Dino Moves in these activities. Use them in a scavenger hunt. Your child needs to find hidden dinosaurs and once they bring them back to you, do a proprioception activity from the handout.

Another idea is to do the heavy wok activities before a fine motor task like handwriting to calm and organize the body. You can get the free dinosaur proprioception activities printable by joining the thousands of others on our newsletter subscriber list. You will receive occasional newsletter emails. Once you subscribe you'll receive an email with a link to the free printable, as well as other freebies that only our subscribers receive.

Dinosaur Activities for OT sessions

Looking for more Dinosaur activities? Try adding these to your occupational therapy interventions. Some of the ideas below are great for adding to teletherapy sessions. Others make great OT home programs.

Dinosaur Activities for Occupational Therapy

Ok, you have a child on your OT caseload (on in your classroom or home) that LOVES all things dinosaur...how do you get them involved in therapy sessions? You can totally guide therapy goals along a theme like dinosaurs. The OT dinosaur activities listed below are fun ways to work on specific skills in therapy sessions, using hands-on play and activities. You'll find fine motor dinosaur activities, gross motor dinosaur ideas, dinosaur printables, sensory play with a dino theme, and even dinosaur visual perception activities. If you have a child in OT who LOVES all things dinosaur, these are great incentive activities that will build attention and focus to the session. Adding a much-loved theme to therapy sessions can empower a child as they play with more intent and attention.

Dinosaur Gross Motor Game - This dinosaur game offers kids a chance to MOVE! Use a child's love of dinosaurs to create movement breaks and indoor activity with a dinosaur theme. This is one indoor play idea that my own children loved when they were little, but the bonus is that they gain midline crossing, motor planning, sequencing, bilateral coordination, balance, endurance, proprioception, and vestibular benefits all in the same movement activity.

Dinosaur Playdough Kit can be made with play dough and a few small dinosaur figures. It's a great way to add proprioception to the hands as heavy work before a handwriting activity. This busy activity can be pulled out at any time and kids can keep those hands busy while building intrinsic hand strength and endurance needed for tasks like coloring. Read more about warming-up the hands before fine motor tasks here.

Free Dinosaur Visual Perception Sheet - This printable page can be printed off once and used with a page protector sheet for the whole therapy caseload. Or, add it to teletherapy sessions or distance learning as part of a child's specific plan. Kids can work on visual perceptual skills such as scanning, form discrimination, figure ground, form constancy, and other visual perception skills. It's perfect for dinosaur fans of all ages!

Dinosaur Counting Cards with clothes pins to clip onto the matching number of dinosaurs is a great way to build hand strength with a dinosaur theme. Print them off and add them to your therapy toolbox. Here are more ways to use clothes pins in building skills in kids.

Goldilocks and the Three Dinosaurs book and jacks game - have you read the children's book, Goldilocks and the three dinosaurs? This children's book is very cute and a fun way to add books to occupational therapy sessions. Then, add the fine motor and motor planning jacks game to build coordination and dexterity skills by playing jacks. This is such a fun way to add movement and reading to therapy sessions, making motor planning, sustained attention, bilateral coordination, crossing midline, floor play (heavy work!), all integrated into a single dinosaur activity!

Dinosaur Matching with mini-figure dinosaurs is a fun way to work on visual scanning, visual discrimination, visual memory, and other visual perceptual skills. Using a small ball of play dough, press the dinosaur's feet into the dough. They can then try to match up the feet to the footprints. All you need are mini dinosaur figures and salt dough, play dough, or similar dough. It's a fun way to work on skills that come in handy for handwriting, reading, and number identification.

Dinosaur Guessing Game is a fun way to work on discrimination skills and visual attention. For kids that have trouble attending to tasks, this dinosaur themed activity may do just the trick. Use dinosaur figurines and a box or basket to hide the dinosaurs. You can cover the dinosaurs and ask children to find the dino with specific features such as sharp teeth or a specific color. This visual memory game builds skills needed for letter discrimination and attention to detail.

Free Dinosaur Number Puzzles - Kids can cut the paper puzzles into strips to work on scissor skills and bilateral coordination. The strait lines or these puzzles make it a great beginning scissor activity for children learning to use scissors. Then, they can challenge those visual perceptual skills to build the puzzle by scanning, and attending to details as they discriminate parts of the puzzles.

Dinosaur Emergent Reader - Use a piece of colored paper to create a cone dinosaur craft like the one shown in this post. Kids can make colored dinosaurs and match them to dinosaur counters or small pieces of paper that match the colors. Don't want to make the dinosuar crafts? Use colored cups to pretend!

Free Dinosaur Subitizing Game- This dinosaur subitizing printable page has a fine motor component by that builds precision and dexterity as kids place counters on a printable play mat. They can roll a dice ans work on an the essential math skill of subitizing. What is subitizing? Essentially, this skill means kids can look at a group of objects and know how many there without having to count each object one by one. Subitizing is important in math, especially higher math skills.

Dinosaur Sensory Bottle- You know we love sensory bottles! Sensory bottles are a great tool to add to your toolbox to address sensory needs or self-regulation. Using a sensory bottle as a coping tool can help kids relax, calm down, or focus. This dinosaur themed sensory bottle is great for kids who love dinosaur anything! Here is more information on how to make a sensory bottle.

Dinosaur Letter Tracing- Kids can work on fine motor precision and dexterity while also working on letter formation, gross motor skills, bilateral coordination, crossing midline, visual tracking, and so many more skills. All you need are dinosaur mini-figures, paper, and a marker. Draw a large letter on the paper and then children can place the small dinosaurs along the lines to "build" the letters. Here is more information on teaching letter formation and using manipulatives like these small dinosaur figures in teaching letters.

DIY Dinosaur TangramsAll you need is a set of tangram shapes, paper, and markers to make your own dinosaur tangram pattern cards. Kids will love building their own pattern cards, too. This is a great activity for those who have the actual tangram puzzle pieces, but don't have access to a color printer or are able to purchase pre-made dinosaur pattern cards. Work on visual perceptual skills by copying and building the geometric dinosaurs together as a fun activity that little dinosaur fans will love. Here is a great resource on how to use tangrams to build visual perceptual skills. Check out that article, and then you can read more on the specifics of tangrams and handwriting. The fine motor activity and the functional task of writing go "hand-in-hand"!

Are you looking for thorough information on Sensory Processing and Proprioception (or any of the sensory systems and how they affect functional skills, behavior, and the body's sensory systems? This book, Sensory Lifestyle Handbook, will explain it all. Activities and Resources are included. Get it today and never struggle to understand or explain Sensory Integration again. Shop HERE.

This post is part of our 31 Days of Occupational Therapy series where you can find free or almost free treatment activities and ideas. Stop by every day! You'll find more fun ideas each day in October.

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Dinosaur Proprioception Activities - The OT Toolbox

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This dinosaur brain break activity is a set of free proprioception activities that provides heavy work with a dinosaur theme, making movement and proprioceptive input a fun way to address dinosaur -sized needs.

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Check out GriffinOT's latest calming break animation.  It's three minutes and designed to be used in the classroom (or at home).  I hope you like it! #sensorydiet #movementbreak #brainbreak #energiser #classroom #teaching
https://t.co/XNgW8h6QUz

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Sensory Brain Breaks - Moment of Calm and Meditation no. 2 (3 minutes)

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Perfect for teachers and parents, GriffinOT's sensory diet calm brain breaks will help children to re-organise and focus. Koala, monkey and frog guide child...

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Check out GriffinOT's latest calming break animation.  It's three minutes and designed to be used in the classroom (or at home).  I hope you like it! #sensorydiet #movementbreak #brainbreak #energiser #classroom #teaching
https://t.co/XNgW8h6QUz

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Check out GriffinOT's latest calming break animation. It's three minutes and designed to be used in the classroom (or at home). I hope you like it! #sensorydiet #movementbreak #brainbreak #energiser #classroom #teaching https://t.co/XNgW8h6QUz
— Kim Griffin (@Griffin_OT) January 25, 2022

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Sensory Brain Breaks - Moment of Calm and Meditation no. 2 (3 minutes)

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Perfect for teachers and parents, GriffinOT's sensory diet calm brain breaks will help children to re-organise and focus. Koala, monkey and frog guide child...

# data[].attributes.attachment_link.metadata.attachment_props_source.data.text
Check out GriffinOT's latest calming break animation.  It's three minutes and designed to be used in the classroom (or at home).  I hope you like it! #sensorydiet #movementbreak #brainbreak #energiser #classroom #teaching
https://t.co/XNgW8h6QUz

# data[].attributes.attachment_link.metadata.attachment_props.original_text
Check out GriffinOT's latest calming break animation.  It's three minutes and designed to be used in the classroom (or at home).  I hope you like it! #sensorydiet #movementbreak #brainbreak #energiser #classroom #teaching
https://t.co/XNgW8h6QUz

# data[].attributes.attachment_link.metadata.attachment_props.text
Check out GriffinOT's latest calming break animation.  It's three minutes and designed to be used in the classroom (or at home).  I hope you like it! #sensorydiet #movementbreak #brainbreak #energiser #classroom #teaching
https://t.co/XNgW8h6QUz

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Sensory Brain Breaks - Moment of Calm and Meditation no. 2 (3 minutes)

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Perfect for teachers and parents, GriffinOT's sensory diet calm brain breaks will help children to re-organise and focus. Koala, monkey and frog guide child...

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Motor Planning: Poor Motor Planning Leads to Lack of Confidence in the Classroom

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Motor Planning: Poor Motor Planning Leads to Lack of Confidence in the Classroom

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Motor Planning: Poor Motor Planning Leads to Lack of Confidence in the Classroom - Integrated Learning Strategies

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Lack of motor planning can hinder learning development in the classroom and can cause behavior issues.

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Early motor skills may affect language development

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Early motor skills may affect language development

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Can you say 'elephant'? Shutterstock babies

Learning to sit up, crawl and walk are all major milestones in a child's early development - and parents often record these actions in baby diaries, photographs and videos. Developing motor skills allows the child to become more independent. But our research, backing a number of other studies, has shown that it may also say something about the rate of a child's cognitive development, such as talking.

It makes sense that the ability to move affects how children see, think about and talk about their physical and social environments. Indeed, over recent years, it has become increasingly clear that cognitive development is more closely related to the development of gross motor skills, such as crawling or walking, and fine motor skills, such as grasping and manipulating objects, than many have previously considered.

In fact, it has been suggested that rather than assessing motor and cognitive development separately, they should be viewed as two connected cogs within a large, complex system, each dependent on the other and working together to make small steps forward in development.

It is therefore vital that more research investigates the relationship between motor and cognitive development, rather than focusing on these as separate parts. This will not only be important for understanding typical development, but could also help to explain the difficulties that some children face when the connections in the system are disrupted.

Early links

Learning language is a very long process for infants. They have to go through a period of working out how to use their mouths to make sounds, such as blowing raspberries. Then there's babbling. Then comes the first word. Finally, children are able to build sentences and, later, to hold conversations.

Research has shown that before each of these language milestones, there is usually a change in motor actions. An example is babbling, where an infant repeats the same sound over and over again ("bababa"). In the few weeks before babbling starts, infants show a lot of arm movements, such as banging, shaking or waving. What is interesting is that after they start babbling, infants stop doing these movements as much.

Why would these two activities be related? It might be that they are both letting infants see what happens when an action is repeated, so they get used to the sounds and feelings of their bodies. Infants are learning that something they do causes something else to happen. It is like learning that when you press a button, a light comes on.

There are lots of other examples of new motor and language skills appearing around the same time. The fact that the motor action and the language milestone are so close in time suggests that the two parts of the system are developing together.

Motor difficulties

Our own research has focused on what happens when infants have difficulties in developing motor skills in a typical way. One way that we have done this is by looking at the relationship between motor and cognitive skills in autism spectrum disorder (ASD).

Language and communication problems are key to a diagnosis of ASD, but children with ASD also often show some difficulties in motor skills. We carried out a study with 53 infants who had an older sibling with ASD. This increases the risk that they will develop ASD themselves.

Working with the British Autism Study of Infant Siblings (BASIS) at Birkbeck, we found that these infants had generally poorer motor skills at the age of seven months compared to infants who had an older sibling without ASD. Importantly, we showed that motor skills at seven months predicted the rate of language development in the group of infants who went on to develop ASD themselves. This suggests that poor early motor skills could be one factor affecting the development of language difficulties, and that this might be particularly relevant for those at risk of developing ASD.

We are also investigating cognitive skills in children with developmental coordination disorder (DCD), which is diagnosed on the basis of motor difficulties which have an impact on daily living. We hope that these studies will help us to better understand the relationships between motor and cognitive development.

An important point to remember in this discussion is that children naturally develop at different rates. An infant may start crawling at any point between five and 13 months and still be within the age range expected for crawling. Some infants do not crawl on hands and knees at all, but shuffle, creep or just start walking so that they can move around the room.

This means that parents should not be worried that their child is not going to be "clever" or is not developing well if he or she is not crawling early. Crawling is one way of solving a problem, such as reaching a toy on the other side of the room, but it is not the only way. As a child's body grows and muscles get stronger, better ways of solving these problems develop.

One future question to investigate will be whether there are critical time periods in the development of these skills which cause some children to develop atypically. It will also be important to work out the different paths that motor and language skills can follow. To answer these questions, future research will need to study children over time, and study the two sets of skills together.

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Early motor skills may affect language development

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Learning to sit up, crawl and walk are all major milestones in a child's early development - and parents often record these actions in baby diaries, photographs and videos. Developing motor skills allows the child to become more independent.

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Your sensory health matters. Here's why | Virginia Spielmann | TEDxMileHigh

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Over the past year, we've been writing about all of the different sensory systems.We've written about sensory processing, what it means, why it's such an important part of child development, and how you can promote healthy development of the sensory systems in your child.

Up next is the sense of smell - or the olfactory system! Today, we've rounded up 20 great activities for kids that will put those little sniffers right to work!

Scented Doughs

1 - Rainbow Scented Cloud Dough from Lemon Lime Adventures

2 - Scented Cloud Dough from Learn Play Imagine

3 - Natural Lavender Playdough from An Everyday Story

4 - Homemade Herb and Spice Play Dough from Craftulate

5 - No Cook Apple Play Dough from The Imagination Tree

Scented Sensory Bins

6 - Sensory Play with Whole Spices and Beans from My Nearest and Dearest

7 - Pumpkin Scented Rice Sensory Bin from The Connection We Share for Hands on : as we grow

8 - Cinnamon Maple Salt Tray from My Nearest and Dearest

9 - Summer Lemon Scented Rice Sensory Bin from Little Bins for Little Hands

10 - Scented Water Sensory Bin for Spring from Fun-A-Day

Smelling Bottles

11 - DIY Sensory Smelling Bottles from Carrots are Orange

12 - Smelling Sensory Bottles from Things to Share & Remember

13 - Sense of smell: Fun with smelling bottles from Gift of Curiosity

14 - DIY Smelling Bottles from Counting Coconuts

15 - Educating the Senses: Smelling Bottles from Playful Learning

Other Olfactory Fun

16 - Scratch-N-Sniff Watercolor Paint from Learn Create Love

17 - Sensory Cooking from Meaningful Mama

18 - Scented Ice Lab from Lemon Lime Adventures

19 - Scented Chalk Paint from Munchkin and Bean

20 - Sense of smell Mr. Sketch marker work! from Montessori Design

So what are you waiting for? Round up the kids and start exploring the sense of smell! Be sure to sign up to receive our newsletter, a weekly roundup of our favorite posts delivered right to your inbox! Simply enter your email address in the box in the sidebar and click "Subscribe"!

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ACTIVITIES FOR KIDS: 20 FUN WAYS TO EXPLORE THE SENSE OF SMELL - The Inspired Treehouse

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Over the past year, we've been writing about all of the different sensory systems. We've written about sensory processing, what it means, why it's such an important part of child development, and how you can promote healthy development of the sensory systems in your child.

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Special Education and Inclusive Learning

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Sensory Learning Activities: An A-Z. Beyond Sensory play

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The ultimate A-Z list for teachers of sensory learning activities to use with your child or classroom. Taking learning beyond play.

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In sensory integration we are interested in all 8 senses. You can probably immediately think of 5 - seeing, hearing, tasting, smelling and the sense of touch.

The other 3 are proprioception, vestibular and interoception, these are defined below.

Proprioception

Our muscles and joints have tiny sensory receptors that tell our brain where our body parts are. When you put a spoon to your mouth, you don't need to look at the spoon to see where it is or feel for your mouth to know where to place the spoon; you know where your hand is in relation to your mouth. It is largely your proprioceptive receptors giving you this information.

Your brain then uses this information to plan movements so that you can coordinate your body. See this short video.

Vestibular

In our inner ear we have small, fluid filled canals, the fluid in these canals moves every time we move our head. Receptors in these canals pick up the direction of movement and send this information on to our brain. So we know if we are moving forwards, backwards, side to side, tilting our head, turning round or moving up and down.

Once again, our brain uses this information to plan for movements and help us maintain our balance.

Interoception

Interoception: this is a fairly new area for discussion in sensory integration; interoception is how our body tells our brain what is going on inside our body, when we are hungry or feel full, when our heart is beating fast or when we have that sensation of butterflies in the stomach.

Jean Ayres was particularly interested in the interaction between and development of the vestibular, proprioception, touch, vision, and hearing. She saw these as important in supporting our ability to use our body, concentrate, develop self-esteem and confidence as well as having self-control and academic skills.

We continue to see the link between poorly developed senses and these abilities both in research and in practice.

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Sensory integration is about how our brain receives and processes sensory information so that we can do the things we need to do in our everyday life. There is a theory of sensory integration and a therapeutic approach based on the theory.

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Sensory differences - National Autistic Society

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Sensory sensitivity may be experienced by autistic people. Find out more about sensory differences and the strategies that can help from The National Autistic Society.

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Sensory Integration Education - Web site search result

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Sensory Integration for Mental Health and Well-being

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In many Canadian schools, recess and phys-ed class may be the only activity students get in their day, but a school in rural Manitoba is trying to change that.

"This is our Sensory Path," says Roland School principal Brandy Chevalier, as she points to a colourful activity map on the floor of the school's main corridor.

"We are very focused on making sure our kids are learning both numeracy and literacy but also being mindful of their whole bodies and wellness, and wellness as a whole being."

The path instructs them to hop, squat, do pushups and crawl.

They follow the path every morning and after lunch, on their way to class in this community about 100 kilometres southwest of Winnipeg.

Kindergarten student Elizah Wall likes stomping on the bugs. Classmate Everly Semograd likes crawling on the flowers.

"Some parts are challenging, some parts are easy," says 11-year-old Addison Elias.

If teachers notice students fidgeting, they will send them to the path for a couple of rounds.

Students Ethan Dyck and Caleb Mitchell say it's making a difference.

"Really helps me calm down when I'm in a very active position ... It's just helps me burn some energy," Caleb says, adding his favourite activity is the frog jump.

"Helps me focus," Ethan ​adds.
See the Sensory Path in action:
Roland School's Sensory Path is the first of its kind in Manitoba, Chevalier says. It was inspired by an Alberta initiative called Don't Walk in the Hallway, launched in 2015.

Chevalier says she's been approached by schools across Canada since her school installed the path in November.

Her students' comments are music to her ears.

She explains how this helps the students. "They feel like they burned some energy. They feel ready to sit down and to get down to work. They can focus a little bit better."

She hopes such exercise can become "a preventative measure for some behaviour issues that might happen by a child who cannot regulate themselves to sit in class."

The benefits aren't just academic. Doing exercises like this every day increases physical competence, which boosts confidence, making people more likely to move and be active.

That has health, social, environmental, and economic benefits.

But Canadians are just not moving enough. We got a C- in a recent study of activity levels in 49 countries.

It's not how much you move. It's not whether you're fit or not. It's do you have the ability to move on land, air, ice, snow, water? - Dean Kriellaars , University of Manitoba

According to Health Canada:

Just 13 per cent of preschool children and 9.5 per cent of children and teens are meeting Canada's 24-hour Movement Guidelines.

Only 18 per cent of Canadian adults are doing 150 minutes of moderate-to-vigorous physical activity per week.

Adults age 65 to 79 aren't doing any better - 14 per cent of them are meeting the guideline of 150 minutes of moderate-to-vigorous physical activity in bouts of 10 minutes or more.

"There's two returns on investment here," says Dean Kriellaars, with the department of physical therapy at the University of Manitoba. He has practised, researched and taught physical literacy for more than a decade.

"First is the health-related equity that happens if you increase they physical literacy of the population. And then safety and activity levels, you then get dramatic reductions in costs."

In 2013, the World Health Organization estimated the global cost of physical inactivity was approximately $54 billion US in direct health care, plus another $14 billion in lost productivity.

It accounts for up to three per cent of national health-care costs, and that doesn't include mental health and disorders such as repetitive strain injury, carpal tunnel syndrome and tendinitis.

More than 40 non-communicable diseases including breast cancer, Type 2 diabetes and strokes can be related to what Kriellaars describes as a global physical inactivity epidemic.

"Our society has to change. Our valuing of movement has to change, in our workplace, in our schools, where movement will be as important as reading and writing," he says.

"Physical literacy has a physical component, a social component and a psychological component. It's really about creating that holistic picture of a child and saying we need all three of those working together."

Chevalier sees a strong future for movement programs in schools. "I think a lot of schools are embracing opportunity for choice in seating in the classrooms, and this just directly complements that concept."

Her advice for education professionals?

"You need to do your homework. You need to sit down with your occupational therapist. You need to sit down with your experts in the building from phys-ed background and really chat about what your students need," she says.

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Feeling fidgety in class? Go stomp, jump or hop down this school's sensory hallway | CBC News

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In many Canadian schools, recess and phys-ed class may be the only activity students get in their day, but a school in rural Manitoba is trying to change that. "This is our Sensory Path," says Roland School principal Brandy Chevalier, as she points to a colourful activity map on the floor of the school's main corridor.

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What is a sensory diet?

Just as your child needs food throughout the course of the day, the need for sensory input must also be met. A "sensory diet" (coined by OT Patricia Wilbarger) is a carefully designed, personalized activity plan that provides the sensory input a person needs to stay focused and organized throughout the day. Just as you may jiggle your knee or chew gum to stay awake or soak in a hot tub to unwind, children need to engage in stabilizing, focusing activities too. Infants, young children, teens, and adults with mild to severe sensory issues can all benefit from a personalized sensory diet.

Each child has a unique set of sensory needs. Generally, a child whose nervous system is overaroused and too wired needs more calming input, while the child who is more underaroused and too tired needs more alerting input. A qualified occupational therapist can use her or his advanced training and evaluation skills to develop a strong sensory diet for your child-or you-but it's up to you and your child to implement it throughout the day.

The great news is that the effects of a sensory diet, combined with professional intervention, are usually immediate AND cumulative. Activities that perk up your child or calm him down are not only effective in the moment; they actually help to change your child's nervous system over time so that he or she is better able to:

tolerate sensations and situations that are challenging

regulate emotions, alertness and increase attention span

reduce unwanted sensory seeking and sensory avoiding behaviors

handle transitions with less stress

Creating a Sensory Diet: The Ingredients

It is strongly recommended that you work with an occupational therapist who has a solid understanding of sensory processing issues. One of the trickiest aspects of sensory difficulty is recognizing when a child is overreactive or underreactive in any given moment, and then calibrating sensory input to meet him where he is and provide a "just right challenge" to help him move forward into a "just right" state of being. That's why it's so important to partner up with knowledgeable help. Our comprehensive book, Raising a Sensory Smart Child, which includes the Sensory Checklist you can print here, is geared toward building your "sensory smarts."

Print out these sensory diet activities to get started. You'll need to modify them depending on your child's age, arousal level (does she to rev up or relax?), whether she is in school, at home, or away, and whether or not you have special equipment available. See our Toys and Equipment page for items that provide valuable sensory input. Also check our Working with Schools page regarding sensory diet at school.

Proprioception

Proprioceptive input (sensations from joints, muscles and connective tissues that underlie body awareness) can be obtained by lifting, pushing, and pulling heavy objects, including one's own weight. A child can also stimulate the proprioceptive sense by engaging in activities that push joints together like pushing something heavy or pull joints apart like hanging from monkey bars.

Toddlers and Preschoolers

Make a "burrito" or "sandwich." Firmly press on your child's arms legs and back with pillows or make a "burrito" by rolling her up in a blanket.

Push and pull. She can push her own stroller, and a stronger child can push a stroller or cart filled with weighted objects such as groceries.

Carry that weight. Your child can wear a backpack or fanny pack filled with toys (not too heavy!).

School-age Kids

Jump! Have your child jump on a mini-trampoline or rebounder or play hopscotch.

Push and pull. Have him vacuum, carry books from one room to another, help wash windows or a tabletop, and transfer wet laundry from the washing machine to the dryer.

Teenagers and Adults

Heavy lifting. Without straining, teens and adults can shovel snow or lift free weights.

Push, pull, and carry. Rake leaves, push heavy objects like firewood in a wheelbarrow, do push-ups against the wall, wear a heavy knapsack (not too heavy!) or pull a luggage cart-style backpack, or mow the lawn with a push mower.

Reassuring pressure. Get a firm massage, use a weighted vest or lap pad from a therapy catalog, or place light weights in the pockets of a fishing, athletic or regular type of vest. (Please see Raising a Sensory Smart Child for weighted wearable recommendations and precautions).

Vestibular

Vestibular input (the sense of movement, centered in the inner ear). Any type of movement will stimulate the vestibular receptors, but spinning, swinging, and hanging upside down provide the most intense, longest lasting input. If your child has vestibular (movement) sensitivities, please work closely with a sensory smart OT who can help you recognize and prevent signs of nervous system overload.

Toddlers and Preschoolers

Swing. Encourage her to swing on playground swings, trying various types of swings and movements, such as front to back and side to side.

Spin. Have him spin using a Sit n' Spin, Dizzy Disc Jr., or office chair. Let her run in circles, and ride a carousel. Hold your child's arm and spin in a circle as he lifts off the ground, or play airplane by holding one of his arms and the leg on the same side of his body as you spin in place (only if he does not have low muscle tone).

School-age kids

Get upside down. Have him hang upside down from playground equipment, do somersaults, or ride a loop-de-loop rollercoaster.

Swing and roll. Encourage her to use playground swings and roll down a grassy or snowy hill (which good proprioceptive input as well).

Spin. Encourage her to go on amusement park rides that spin, have a Dizzy Disc Jr..

Teenagers and Adults

Swing and spin. Swing on a hammock, use playground swings or merry-go-round (you're never too old!).

Move that body! Do cartwheels, swim (doing flip turns and somersaults in the water), do jumping jacks, and dance.

Tactile

The tactile sense detects light touch, deep pressure, texture, temperature, vibration, and pain. This includes both the skin covering your body and the skin lining the inside of your mouth. Oral tactile issues can contribute to picky eating and feeding difficulties.

Toddlers and Preschoolers

Food and drink. Let your child drink plain seltzer or carbonated mineral water to experience bubbles in her mouth (you can flavor it with a little juice or with lemon, lime, etc.).

Messy play with textures. Have her play with foamy soap or shaving cream, and add sand for extra texture. Have her fingerpaint, play with glitter glue, mix cookie dough and cake batter, and so on. Let your child use the playground sandbox or create your own at home, filling a bin with dry beans and rice or other materials and small toys. Cover and store the bin for future use.

Use child-friendly modeling material such as Play-Doh, Model Magic, and Sculpey (the classic Play-Doh Fun Factory provides excellent proprioceptive input as well). Never force a child who is unwilling to touch "yucky" substances. Let him use a paintbrush, stick, or even a toy for cautious exploration.

Dress up. Dress up in fun costumes to get used to the feel of unfamiliar clothing,

School-age kids

Food and drink. Provide your child with frozen foods (popsicles, frozen fruit or vegetables) and mixed temperature foods (hot fudge sundae, hot taco with cold toppings, etc.).

Get in touch with nature. Encourage him to walk barefoot in the grass (avoiding pesticide applications), sand, or dirt. Have him garden and repot indoor plants.

Play dress-ups. Encourage play with make-up, face painting, and costumes, putting on a play or making a mini movie with a video camera.

Teenagers and Adults

Tactile hobbies. Sculpt, sew, weave, crochet or knit. Create a scrapbook (which involves lots of pasting and working with different textures). Use sandpaper to smooth a woodworking project. Make things out of clay, and try using a potter's wheel.

Auditory

Auditory input refers to both what we hear and how we listen, and is physiologically connected with the vestibular sense. In addition to various types of recorded and live music, here are some ways kids and adults can get calming and organizing auditory input.

Get outside and listen. Go to the beach or sit still and listen to the rain, thunder, and so on. If you hear birds singing, try to identify what direction a given bird is calling from.

Listen to natural sound recordings. There are many recordings of rain falling, ocean waves, bird songs, and so on. Sometimes natural sound recordings also feature light instrumentation with flutes, keyboards, etc. Some children and adults find they sleep better if they play such music.

Play a listening game. You and your child sit very quietly and try to identify the sounds you hear (traffic, the hum of the refrigerator, a door shutting, etc.) and where it's coming from.

Find calming, focusing music. Listen to music specially engineered to promote calm, focus, energy, or creativity. Keep in mind, of course, that musical preference is highly idiosyncratic, so this will take some experimentation. The music you love may distress your child, while the music he finds so soothing may drive you up the wall.

Encourage musicianship. Provide your child with a musical instrument and encourage him to play and even take lessons.

Give him some control. For a child with auditory sensitivity, predicting and controlling sounds can be very helpful. Encourage him to turn on the vacuum cleaner, help him pop the balloons after a birthday party, anticipating the noise. Try Sound Eaze and School Eaze CDs that desensitize children to everyday sounds such as flushing toilets, thunder, barking dogs, alarms, and other sounds many kids find distressing.

Create pleasant sounds. Get a white noise machine, tabletop rocks-and-water fountain, or aquarium.

Visual

Visual input can often be overstimulating for a child with sensory issues. Think about ways you can simplify the visual field at home or school for a calming, organizing effect. Alternately, if the child seems "tuned out" and doesn't respond easily to visual stimulation, add brightly colored objects to encourage visual attention. For example, a child who has trouble getting aroused for play may be attracted by a brightly painted toy chest filled with toys in appealing colors. A child who seem unable to watch a ball as it rolls may be able to watch it if the ball lights up or makes noise as it moves.

Avoid excess visuals. Hide clutter in bins or boxes or behind curtains or doors-a simple, solid-color curtain hung over a bookshelf instantly reduces visual clutter. In rooms where the child spends a lot of time, try to use solid colored rugs instead of patterned ones. Solid-colored walls in neutral or soft colors are less stimulating than patterned wallpaper in bold colors.

Seat him elsewhere. Have your child sit at the front of a classroom where there is less distraction. He may also need to sit away from the window to avoid the allure of the outdoors. Some children do best sitting in the back of the room so they can monitor what other kids are doing without constantly turning around. Work with the teacher and an OT to see which seat placement works best.

Be color-sensitive. Avoid toys, clothes, towels, etc., in colors that your child find distressing.

Smell

Olfactory input (sense of smell) comes through the nose and goes straight to the most primitive, emotional part of the brain. So if your child is upset by something being stinky, it's no wonder. Certain odors can stimulate, calm, or send him into sensory overload.

Smell stuff! Explore scents with your child to find ones that work best to meet your goal (to soothe him or to wake him up). Everyone has different preferences, but vanilla and rose scents are generally calming. Peppermint and citrus are usually alerting. Let's say your child needs help staying calm and loves vanilla. You can use high-quality vanilla soap and bath oils at bath time, vanilla candles or essential oils in an aromatherapy machine at bedtime, and vanilla body lotion. Avoid synthetic scents.

Caution: Some kids, teens, and adults do not tolerate strong scents well. For them, use unscented laundry detergent and shampoos, and other unscented roducts.

Scent play. Play a smelling game with your child. Have her close her eyes or wear a blindfold and try to identify smells such as citrus fruit, flowers, spices such as cinnamon, and so on.

Taste

Taste input is perceived by our tongue but how we interpret or experience it is strongly influenced by our sense of smell. As an experiment, chew some gum until the flavor is gone, then hold a lemon under your nose; the gum will taste like lemon. Help your child with to broaden the tastes he tolerates or likes, and use strong tastes he enjoys to help arouse his sluggish system.

Give strong-tasting foods before introducing new ones. Strong tastes can stimulate the mouth of an undersensitive child and make him more willing to try new foods. Before presenting new foods, let the child have one peppermint, sour gummy bear, or other strong-flavored food.

Play a taste game. If your child does not have a strong negative reaction to refined sugar (becomes very "hyper" or sleepy), get an assortment of flavored jellybeans. Eat one at a time, and have her guess which flavor it is. If you wish to avoid sugar (and artificial color and flavor in most candies), you can play this game with slices of fruit, or another healthier snack.

Involve him in food preparation. Children are more likely to taste something if they help make it. Let your child help you grow fruit, vegetables, and herbs, and plan dinner and shop. Give him a sense of control: let him choose between chicken or fish, string beans or sugar snaps, potato or rice. Then let your child put the meat in the baking pan, break off vegetable tips and dump in water, and so on. Let him help you arrange food on each plate so it looks nice.

Play with your food. A so-called picky eater may be more willing to eat "rocks and trees" than meatballs and broccoli. Fun arrangements such as some vegetable sticks and grape tomatoes placed in a smiley face pattern on a plate encourage kids to taste something new.

Sample Sensory Diet

Here is a sample sensory diet, created for a second grade child with sensory processing disorder. We've used the annoying term "as directed" to avoid providing a cookbook recipe. Activities must be individualized for each child and modified frequently to meet changing needs. A separate program was worked out for this child with the school, including frequent movement breaks, an inflatable seat cushion for wiggling while remaining seated, and providing crunchy/chewy oral comfort snacks at handwriting time.

In the Morning

Massage feet and back to help wake up

Listen to recommended therapeutic listening CD

Use vibrating toothbrush and/or vibrating hairbrush

Eat crunchy cereal with fruit and some protein

Spin on Dizzy Disc Jr. as directed by your OT or PT

Jump on mini-trampoline as directed

After school

Go to playground for at least 30 minutes

Push grocery cart or stroller

Spinning as directed

Mini-trampoline. Add variety: have him play catch or toss toys into a basket while jumping.

Massage feet to "reorganize," use therapy putty, make "body sandwiches," wheelbarrow walk

Do ball exercises as directed

Listen to therapeutic listening CD

Oral work - suck thick liquids through a straw, eat crunchy and chewy snacks, or chew gum before and/or during tabletop activities

At dinnertime

Help with cooking, mixing, chopping, etc.

Help set table, using two hands to carry and balance a tray

Provide crunchy and chewy foods

At night

Family time: clay projects, painting projects, etc.

Warm bath with bubbles and calming essential oil

Massage during reading time

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A "sensory diet" is a personalized activity schedule that provides the sensory input a person's nervous system needs to stay focused and organized throughout the day.

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We all have sensory needs and, in the main, most adults find subtle and appropriate ways to accommodate them. This could be our favourite winter comfort food to the ways we fidget (eg, curling our hair or doodling).

But there are some people who find managing sensory needs incredibly difficult, if not impossible - and many of them will be in your classrooms.

Research suggests between one in six and one in 20 children ( bit.ly/SPDFindings) have symptoms of Sensory Processing Disorder (SPD), a condition where the brain cannot properly process information from the senses and therefore has trouble with responding appropriately.

Until about 10 years ago, it was understood that sensory processing often occurred in conjunction to other special educational needs and disabilities, such as ADHD, autism, Asperger's syndrome, developmental delays, prematurity, Tourette's and anxiety. Now it is recognised as a standalone condition ( bit.ly/SORAbstract).

And yet SPD appears to be a "new" thing in mainstream schools. We aren't even sure what to call it. SPD or Sensory Integration Dysfunction students in one school are called, "sensory awareness" or "sensory smart" students in another - and these are the schools that recognise it.

Why is there such confusion and lack of knowledge?

Partly it is because of the condition being defined and dealt with differently across different NHS services both regionally and nationally. Also, schools often don't "see" the problem. This can be through a lack of training, but also many sensory kids - mine included - often work hard to restrain their needs in front of others.

Emotional outbursts

Students can present a full range of hidden and expressed needs. They vary from mild to severe, with a hypo-reactive nervous system (under-reactive) or a hyper-reactive nervous system (over-reactive). In more complex cases, a child may have a mixture of the two.

An SPD diagnosis may be reached only as part of a neuro-developmental assessment by child and adolescent mental health services (CAMHS). To get a sense of extremities of SPD needs, here are some common examples:

Touch - The child may complain if socks are not on correctly and seem overly sensitive to pain such as small cuts, or have difficulty judging how much strength to use, or wants to touch rather than be touched.

Sight - Becomes easily distracted by visual stimuli or dislikes having their vision restricted.

Hearing - Becomes upset when surrounded by a lot of noise, such as large crowds or school bells, or likes to make a loud noise.

Smell - Seems bothered by smells that most people do not notice or explores objects by smell.

Taste - Prefers dry, cold food, or prefers hot, sauced-based foods.

There are extra senses when it comes to SPD. They are: "vestibular" (balance), "proprioceptive" (body awareness), "thermoception" (heat and cold), "nociception" (pain) and "interoceptive" (internal body needs, such as hunger).

Each sensory child will have differing needs with different combinations of sensory inputs.

Lucy Short, a mother of a child with SPD, explains this further.

"When he's with other children he wants to fit in and be like them, so tries to cope with his sensory feelings," she says.

Those with SPD will also copy the actions of their peers to "fit in". This often makes it worse for the child in the long run.

"Because he is trying to be so good all day and seem 'normal' like the other children", says Lucy, "when he is home, he is exhausted and angry - and has horrendous emotional outbursts - as his sensory needs are 100 times worse.

Grace Berry, a learning mentor at Milton Park Primary School, adds that unmet sensory needs can be wrongly identified as behaviour needs by schools.

"It's likely to occur when staff are not aware of the sensory system - and how a child who has a sensory need that is not met can have outbursts.

"This means children are labelled as 'naughty' if they are extroverted in their outbursts or 'fussy' when they are experiencing a sensory need that is not being met in a healthy way."

Another factor that can be upsetting for parents is that schools can insinuate parents are looking for "a reason, framework or spectrum that explain their child's personality, quirks and behaviours", says Rebecca Huseyin, another parent of a child with SPD.

"Very few adults, myself included, truly understand anything about what's going on in the child's brain at the various developmental milestones," she says.

Immediate results

Once a school recognises "sensory kids", the results can be immediate. By understanding how SPD affects students, and then putting in place interventions in and around the school, the impact on the students is incredible.

One example of best practice is allowing your "sensory kids" to go into lunch first. Sensory students often struggle with meal times' temperature, sounds and smells, so this enables them time to start eating when the environment is calmer and they can have more time to manage their food. It costs nothing, but is a huge benefit for that child - and their parents.

Here are five sensory tips to get you started from Claire Nicholls, a Sendco at an all-through school in Bristol:

Train all staff - All teachers need to be aware of potential issues that may become barriers to learning. Try your LEA, a local SEND school or a charity such as BIBIC. Websites such as the STAR Institute (spdstar.org), the Sensory Processing Disorder Resource Center (bit.ly/SPDResource) and SensorySmarts (sensorysmarts.com) offer checklists as a starting point. The Sensory Spectacle (sensoryspectacle.co.uk) and Sensory Spectrum (thesensoryspectrum.com) also offer a wealth of CPD opportunities.

Identify pupils - Instead of assuming it is a behaviour issue, consider if it is a sensory need instead.

Use resources - These can include ear defenders, weighed jackets, a sensory tent or den, fiddle toys, wobble cushions or seats. Consider what will work for your learners. Try Sensory Direct - they offer good value multipacks (sensorydirect.com).

Flexible systems - Be clear about which pupils are allowed something different and why, then communicate this to all staff, including those on supply.

Think about environment - Overwhelming classroom displays, hot classrooms, general noise, school smells and tactile peers can all be triggers. Watch Jennifer Allison's TED talk (bit.ly/AllisonTED) for more help. Playtimes and lunchtimes can often be very difficult times. Consider allowing children in early for lunch, alternative eating areas and review your lunchtime activities.

My hope is that the sensory world is a little more visible now - and being a sensory school is within touching distance for both your students and their families.
Nicole Ponsford is the founder of TechnoTeachers, digital leader for WomenEd and leader of @WomenEd_Tech

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How to support children with additional sensory needs

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We all have sensory needs and, in the main, most adults find subtle and appropriate ways to accommodate them. This could be our favourite winter comfort food to the ways we fidget (eg, curling our hair or doodling).

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Sensational Kids OT - Sensory Specialists

What is Sensory Processing?

'Sensory Processing' is the way in which the nervous system receives sensory messages and generates them into responses. Majority of us are born with the capacity to receive sensory information and organise it effortlessly into appropriate behavioural and physiological responses. For example if we are cooking toast and smell it burning we don't have to stop and think what to do. We unconsciously interpret the information into a behavioural response of rushing to the kitchen and turning off the toaster. Simultaneously our body produces a physiological response; increased heart rate, rise in blood pressure, fine sweat. (Adapted from Miller, 2006)

What is Sensory Processing Disorder?

Sensory Processing Disorder (SPD) is an inability to process information received through our senses for generating appropriate responses. The result of this is a decreased ability to respond to sensory information in order to behave in a meaningful & consistent way. It can also lead to difficulty in using sensory information to plan and organise our own body & make sense of the environment in which we function thus impacting on our ability to learn. (Adapted from Miller, 2006).

Types of Sensory Processing Disorders:

(Taken from Miller, 2006 'Sensational Kids')

There are 3 main types of sensory processing disorders:

1. Sensory Modulation Disorder (SMD)

2. Sensory-Based Motor Disorder (SBMD)

3. Sensory Discrimination Disorder

1. Sensory Modulation Disorder:

The child experiences difficulty processing sensory information into appropriate behaviours/responses which match the intensity of the sensory information (Miller, 2006)

There are 3 types of SMD:

I. Sensory Over-Responsivity (sensory defensiveness) This is where children respond more intensely & faster for longer durations e.g. becoming really upset when touched by another child standing in line (Miller, 2006)

II. Sensory Under-Responsivity - These children show less of a response to sensory input than would be expected for the situation, they take longer to respond and require more intense input before they even respond e.g. having a high pain threshold (Miller, 2006)

III. Sensory Seeking - These children have a intense craving for sensory experiences and will actively seek this out, often in ways that aren't matched or appropriate to the environment e.g. running around during group time (Miller, 2006)

2. Sensory-Based Motor Disorder:

This is where the child has trouble controlling, planning and supporting their movements into a smooth, coordinated and sequence way.

There are 2 types of SBMD:

I. Dyspraxia - These children have difficult processing sensory information to create physical, unfamiliar or sequenced movements e.g. difficulty riding a bike (Miller, 2006)

II. Postural Disorder - These children have difficulty maintaining enough control of their bodies to meet the demands of a given motor task e.g. difficulty remaining in an upright sitting position for writing tasks (Miller, 2006)

3. Sensory Discrimination Disorder:

This is where the child experiences difficulty distinguishing between similar sensations. They need additional time to process sensory information and their capacity to perceive the information as quickly and naturally as other children do is reduced. For example they may unable to up their buttons or find their pencil in their pencil case without looking (Miller, 2006)

Children can present with a combination of sensory processing patterns or may only have one of the above discussed difficulties.

What role do the senses play in development?

The senses provide us with essential information about our own body and the environment in which we function. They provide us with information about where our body is in space, how our body is moving, what impact the environment is having on our body, what is happening in the environment and help us in knowing how to effectively respond to task and environmental demands.

Let's think about just the simple action of walking down a step something which we are able to do without looking or even thinking about. How do we know where our body is, how do we know to shift our balance between our feet, shift the balance of our body, know when our foot has touched the step without even looking? We know because each of our sensory system is telling us what is happening and helping us to generate appropriate responses.

Our sensory system is the foundation of our skill development and is like laying the foundations for a house. Whilst some structures may be able to be developed without the support of the foundations it does not become a structurally sound 'house' without good foundations. Just as we need a foundation to build a house we need effective sensory processing for the development of our skills. If we are unable to process information on this foundation level we are required to pull in higher cognitive functions to help make sense of our world. This increased cognitive effort is difficult to sustain and can take away the free cognitive space left for working on more complex tasks e.g. handwriting, riding a bike etc.

What some of the indicators of a Sensory Processing Disorder (SPD)?

It is important to note that we all have sensory problems it only becomes a disorder when the impact is chronic and/or disrupts our everyday life (Miller, 2006). There are many ways in which a SPD can present below are just some of the difficulties:

Heightened reactivity to sound, touch or movement

Under-reactivity to certain sensations e.g. not noticing name being called, being touched, high pain threshold

Seeking increased amounts of auditory, tactile or movement input e.g. making noises to self, constantly touching objects/people, being "on the go"

Appears lethargic/disinterested; appearing to mostly be in own world

Difficulty regulating own behavioural and emotional responses; increased tantrums, emotional reactive, need for control, impulsive behaviours, easily frustrated or overly compliant

Easily distracted, poor attention and concentration

Poor motor skills; appears clumsy, reduced coordination, balance and motor planning skills, poor handwriting skills

Difficulty mastering activities of daily living e.g. dressing, tying shoe laces, self-feeding

Restricted eating habits or picky eater

Difficulty engaging in grooming tasks e.g. hair-brushing, hair-washing, nail cutting etc

Loves movement and appears to have a need for intense pressure, continually seeking this out e.g. constant spinning, running around, jumping, crashing in objects/people

Avoids movement based equipment e.g. swings, slides etc

Appears floppy or has 'low muscle tone', tires easily and is often slumped in postures

Does things with too much force, has big movements, moves fast, writes too light or too hard

Delayed communication and social skills, hard to engage in two-way interactions

Prefers to play on their own or difficulty in knowing how to play with other children

Difficulty accepting changes in routine or transitioning between tasks

Difficulty engaging with peers and sustaining friendships

Diagnosis of a Sensory Processing Disorder (SPD):

Parents of children with SPD often find it hard to get a diagnosis. They intuitively know that there is something wrong for their child however unless they encounter a trained professional their concerns may be overlooked, misinterpreted or dismissed. When parents do get a diagnosis they report that this is the first time that someone has truly understood their child and given meaning to the difficulties which their child is experiencing and which they encounter as a family.

Finding an Occupational Therapist who is trained in Sensory Integration is an essential step in gaining a diagnosis of Sensory Processing Disorder. Not all Occupational Therapists are trained in this area and therefore may not address the underlying causes of some of the mre evident difficulties e.g. handwriting, attention, social, play and motor difficulties. Persevere in finding an Occupational Therapist and a team of professionals who are trained in assessing your child to determine if they do have a sensory processing disorder. 'Sensational Kids OT' is able to provide a comprehensive assessment to look at sensory processing and if appropriate a diagnosis of SPD.

Treatment for SPD:

OT is fun and most children will enjoy participating in OT sessions despite how hard they are working! The aim of therapy is to impact the development of how the body responds to the sensory messages it receives and how to produce meaningful responses. Therapy also aims to educate parents, caregivers, families, childcare workers and teachers to provide a context which is conducive to the child's sensory processing style.

Under the guidance of a therapist, the child actively takes in sensation through a playful context. The therapist will help to activate the neural pathways and provide organization within the central nervous to produce more regulated responses. It aims to provide a neural platform which promotes the development of more complex skills by freeing up the higher cortical levels which are currently being used to process sensory information. The child responds favourably to SI treatment, because the nervous system is pliable and changeable. Rather then addressing the symptoms we are addressing the underlying causes which are essential in sustaining change. Therapy teaches the child to succeed-and they love it!

The specific goals of occupational therapy using a sensory integration framework are to improve the person's social participation, self-esteem, self-regulation and sensory-motor abilities.

What techniques may be used during the treatment process?

The therapist will provide a variety of therapy techniques and these will be individualised to your child's specific sensory needs, the context in which they need to function and the dynamics of their social environment. Some of the techniques used may include:

Therapressure Brushing Protocol

Therapeutic Listening®

Implementation of a sensory diet through a home program

Implementation of the Alert program to promote to self-regulation

Intense and direct sensory integrative therapy

Oral-motor programs

Environmental modifications to support a child's sensory processing patterns

What are the expected outcomes of the treatment?

There is no known cure for SPD however there is the capacity to evoke change. Some of the changes which parents, teachers, childcare workers and families can expect to improvements in the following areas:

Attention & focus

Self-regulation with responses being better matched to their environment

Postural Control

Praxis (motor planning), balance & coordination

Fine motor skills

"Evenness" or more regulated emotional & behavioural responses

Oral motor control and improved eating habits

Communication, articulation and social skills

Increased engagement, interaction and development of play skills

Visual motor integration

Improved sleep patterns

Increased learning opportunities

Becoming less or more responsive to sensation received

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Sensational Kids OT - Sensory Specialists 'Sensory Processing' is the way in which the nervous system receives sensory messages and generates them into responses. Majority of us are born with the capacity to receive sensory information and organise it effortlessly into appropriate behavioural and physiological responses.

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Our senses are our primary source of information about the world, nothing trumps the authority of the information we get from them. Even if our thinking brain tells us that something is not real, our senses take the upper hand.

This is the second in a series of three sensory articles. In article one I evaluated the reality of sensory processing difficulties for our pupils. Suffice to say that for a variety of reasons we now have within our classrooms children who process sensory information in a way different to the norm.

You cannot escape the dinosaurs

Recently I experienced a perfect example of the trumping of sensory experiences over cognition for myself. I am a sensory engagement specialist, everything I do is focused on better understanding and engaging the senses. I was at a party and had the opportunity to try a virtual reality headset. Inside the virtual world dinosaurs were grazing in a wilderness.

I could see them and hear them. I knew they were not real. I also knew that I regularly tell people that the information you get from your senses can't be trumped, but I thought that I would be able to do it. I figured, rather arrogantly, that I could pit my knowledge about engaging the senses against the experience I was having.

So I focused on the food in my mouth, the feel of my bare feet against the carpet, I listened not to the dinosaurs but to the sounds of my friends around me. I knew and I sensed, that I was not in that world.

And then a dinosaur walked straight towards me and I instantly threw myself to the floor! You cannot beat the information you get from your senses - even if you are a sensory engagement specialist...

For most of us our sensory systems are configured within normal ranges. They make it possible for us to accurately sense and discern the world around us. But as discussed in article one, people with sensory processing difficulties may have some of their senses configured in such a way that they do not accurately match up with reality.

In some individuals this configuration is permanent and constant and for others it fluctuates. We all experience some variation with our perception, e.g. when we've first woken up, or when we're tired or ill, we would not expect to sense as accurately as after our first cup of coffee. Some people have their sensory abilities affected in a more pronounced way - by their sleep, their food intake, their current stress levels and so on. Many factors come into play.

You cannot reason with senses

The important thing to remember is that you cannot reason with the senses, even within your own self. If you are supporting a child who produces explosive behaviours in response to sensory triggers you cannot tell them that they "sensed it wrong".

Have you ever heard yourself say that a noise "wasn't that loud" or that a push "wasn't that hard"? If you find you are consistently accusing a pupil of over-reacting to sensations, question whether or not something may be at play with their processing.

Reaction to sensation tends to be perfectly accurate to what was experienced by the individual. Two people do not necessarily experience the same sensation in the same way. We each live through the lens of our own physiology, our own brains. If a pupil receives a sensory message that tells them they are in danger they will respond as such. Those sensory messages enter the brain at its most basic level and trigger the fight or flight response. There is no filtering of these experiences through the rational mind first.

Fight or flight - in that order

Fight or flight is the organism's way of protecting itself and ensuring its survival. Survival is our absolute top priority and our animal selves are willing to do anything, including hurt others, in the name of self-preservation. This does not just apply to children from troubled backgrounds, or to children who have sensory difficulties, it applies to all humans. The difference for children from chaotic backgrounds or children with sensory processing difficulties is simply that their brains are likely to be triggered more easily.

When our senses tell us we are in danger it is fight first. The phrase fight or flight is in that order for a reason. At a most basic level if we can kill whatever threatens us, our animal-level understanding believes the threat to have been removed; it is a better way of ensuring our long-term survival than running away. If we flee then we will likely have to face that same threat again another day. It makes survival sense to fight first.

Inside a split second

The decision to fight is taken in a split second and in that split second the following things happen, extraordinarily quickly and without rational thought:

1. We receive a signal from our senses saying we are in danger.

2. We associate that signal with something (often with the person nearest to us or the person who is producing the most sensory output - e.g. the one that is loudest or moving fastest). We do not necessarily associate the signal with what produced it.

3. At an animal level we judge which of us would win in a fight.

4. If we think we would win, we attack.

5. If we think we would not win, we look for an escape route.

6. If there is an escape route we flee.

7. If there is not an escape route we muster ourselves to attack with everything we have: our animal self is willing to fight to the death.

Animals without emotion

I was supporting a teacher who has a pupil who from time to time bites their peers. Not the sort of little nip to get a reaction: a full-on bite. The teacher observed that afterwards they did not seem remorseful or even particularly emotional. This unemotional response is exactly what I would expect from a sensorially triggered behaviour. To understand the reasons, we need to go back to the primitiveness of the response. We are all animals at a base level. When that message hits our brains that we are in danger and fight or flight is triggered the brain does something extraordinary in order to ensure our chances of survival: it shuts down processing in other areas of the brain in order to maximise our capacity to fight or flee. In so doing it shuts down:

Our ability to process language.

Our ability to access memories.

Our ability to think rationally.

Our ability to lay down new memory.

Our ability to feel and process emotions.

Let that sink in for a while. It is an extraordinary list. A child who has had their fight or flight response triggered loses the ability to do all of the above. Now look at that list alongside the decisions made in that split section of reaction time and you will begin to see how ineffective standard responses to behaviour are going to be.

Avoid standard responses to behaviour

Standard responses can make sensory triggered behaviour worse. We might shout "Stop!" at a child about to pick up a chair or punch a peer. But what use is this instruction if their language processing has already shut down.

A sound we believe carries instructional information becomes simply a sound and is judged on its auditory merits. "Stop!" is a loud abrupt sound. Loud abrupt sounds in nature indicate aggression. Producing such a sound as a child rattles through those decisions in that split second of reaction time is likely to jump them from step three directly to step seven, because if their senses tell them their potential opponent is about to attack then it no longer matters whether they can escape or not, they have to fight. Shouting stop could well result in the chair be thrown further or the punch being delivered with greater force.

Imagine that a child goes to storm out of the class and we stand across the door to prevent them from leaving. Some children will try to escape a situation before the sensations become too much for them. When we prevent them from getting away we force them to step seven in the split-second decision-making process. We prompt an aggressive response that could have been avoided.

Imagine that we rush towards a child about to enter a fight intending to use ourselves as a shield to protect the recipient of their aggression. That child does not have access to rational thought so they cannot understand our sudden movement as a protective action; someone rushing straight towards you in the animal world is a sign of attack so once again our standard response to behaviour leads to an amplification of the behaviour.

We threaten children with the consequences of their actions, at a time when they have no access to rational thought. We appeal to a child's emotional literacy pointing out the emotional effect of their behaviour on others, at a time when they cannot feel emotion.

We remind a child that the last time they did this the consequences were bad, at a time when they cannot access memories. We get frustrated that the child does not learn from past events, when their experience of them happened at a time when they were physically incapable of laying down new memories. You can appreciate the problem!

Supporting children with sensory difficulties

Prevent: The best way to support a child whose behaviour is triggered by sensory causes is to work out what those causes are and remove them, remembering as you do so that you cannot reason that a cause is insufficient - what their senses tell them is the reality they live in.

Flight: If you cannot remove the trigger then you need to think about how you respond. They have only two options: fight or flight. We definitely don't want the first so we need to work out how to safely facilitate the second. Look at creating sensory flight paths - these are essentially practised routes which children are used to employing to remove themselves from situations of conflict that are clearly perceived by the senses of that child when in a heightened state. Think visually clear pathways that lead to low stimulating environments.

Sound: Do not shout or raise your voice. Give instructions calmly and in soothing tones, being aware that the only aspect of your communication that may reach them is the sound you are making. Aim to put into the situation the feeling you want to be there. Don't meet their anger with anger of your own, instead try to compensate: meet their stress with your uber calm and attempt to level the playing field.

Approach: Do not approach them at speed or directly, tricky to do I appreciate but you are aiming for a swift sideways approach keeping your body language as uncombative as possible. Think of those animals on nature programmes that puff themselves out to look more threatening: don't do that!

Touch: Don't grab or restrain or pull. But do touch - firm reassuring pressure delivered with caring intent has almost magical properties when it comes to dissolving tensions.

Prevention is always better than a cure...

...Especially where the sensory world and behaviours are concerned. In my final article on May 9 I will be looking at low-level niggly sensory behaviours and at how we can deploy sensory stimulation to actively provide for sensory needs and enhance the curriculum.

Joanna Grace is a sensory engagement and inclusion specialist, author, trainer, TEDx speaker and is founder of The Sensory Projects. Visit www.thesensoryprojects.co.uk

Further information

The rising tide of sensory troubles: An overview (part 1), Joanna Grace, Headteacher Update, January 2019: http://bit.ly/2CXmrkk

Two CPD events - Develop Your Sensory Lexiconary (a course that teaches the development of seven sensory systems) and Exploring the Impact the Senses have on Behaviour - are due to take place in 2019 at venues around the UK. For details, visit http://bit.ly/2SVsQBm

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The rising tide of sensory troubles: Explosive behaviours

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Our senses are our primary source of information about the world, nothing trumps the authority of the information we get from them. Even if our thinking brain tells us that something is not real, our senses take the upper hand. This is the second in a series of three sensory articles.

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What does the evidence say?

Sensory Strategies

Whilst there is a lot of research on the use of sensory strategies, the design of much of it is poor. A recent review considering the use of sensory strategies with pre-schoolers (Bodison & Parnham, 2018) found 11426 potential articles. However, only 24 were suitable to review, and only eight were used in the report. These numbers show that, although there is a huge amount of information written about sensory strategies, there are very few studies with a good research design.

The authors found that "insufficient evidence supports the effectiveness of regularly incorporating specific sensory techniques into classroom routines for pre-schoolers with ASD" (p.9). Their recommendation was to use the interventions cautiously. They found insufficient evidence for using weighted vests with children on the autism spectrum. It is felt that this study supports the AJOT recommendation for documentation and review when using sensory strategies.

There are two small case studies looking at sensory movement breaks. One case study (Mills & Chapparo, 2016) showed a drop in the number of daily behaviour incidents of a child with ASD after participating in sensory activity programme. The incidents dropped from 83 incidents prior to 14 incidents per day after the programme was used. Perez, Wong and Perryman (2019) were able to demonstrate that off task behaviour decreased in the three children that participated in their sensory activity schedule. It is important to note that in both of these studies the sensory programmes were created by an OT to support the children's specific needs.

Sensory Integration

Ayres ® Sensory Integration (ASI) treatment is very different to the use of sensory strategies, such as wobble cushions, fidget toys or weighted vests, commonly used in schools. One essential criteria of ASI treatment is that it is child led. A second essential criterion is that the child must be actively engaging in sensory experiences. There is a fidelity measure which aims to ensure that there is consistency with therapists using the ASI treatment approach (Parnham et al 2007).

Schaff et al completed a review of research looking at using ASI with children with autism in 2018. The authors only included studies where the sensory integration treatment met this fidelity measure. They reviewed five studies. Their results indicated strong evidence that ASI treatment provides positive outcomes for improving function and participation goals in children with autism. These goals were individualised for each child's needs. They also found a moderate degree of evidence to support the use of ASI to help to improve behaviours, and increase independence with self-care activities. There was only emerging but insufficient evidence to support the use of ASI to improve play, sensory motor and language skills.

An exciting piece of new sensory integration research in the UK

Whilst results are not yet available, an exciting piece of research is currently being completed at Cardiff University. Radell et al (2019) are running a trial comparing ASI to usual care in children with autism. They aim to recruit 216 children within the UK to participate in the trial. Half of the children will receive two sessions of ASI therapy a week for ten weeks. The other half, a control group, will receive the usual care provided. All sensory integration therapy will be scored against the fidelity measure. The study aims to provide high quality evidence on the clinical and cost effectiveness of ASI. The results should give clear data on the true effectiveness of ASI for children with autism.

Where to Next?

Next you might want to ready about more common sensory differences which present in autism. We recommend these articles

To learn even more about the senses we recommend our Free Introduction to Sensory Processing.
Page references
* Atwood, T., Evans, C., & Lesko, A. (2014). Been There. Done That. Try This! Philadelphia: Jessica Kingsley Publishers

Bodison, S. C., & Parham, L. D. (2018). Specific sensory techniques and sensory environmental modifications for children and youth with sensory integration difficulties: A systematic review. American Journal of Occupational Therapy, 72, 7201190040. https://doi.org/10.5014/ajot.2018.029413

** Hazen, E. et al (2014) Sensory Symptoms in Autism Spectrum Disorders Harvard Review of Psychiatry Volume 22 Number 2 March/April 2014

Parham, L. D., Cohn, E. S., Spitzer, S., Koomar, J. A., Miller, L. J., Burke, J. P., et al. (2007). Fidelity in sensory integration practice intervention research. American Journal of Occupational Therapy, 61, 216-227

Pfeiffer, B. A. (2012, June). Sensory hypersensitivity and anxiety: The chicken or the egg? Sensory Integration Special Interest Section Quarterly, 35(2), 1-4

Randell, R. et al (2019) Sensory integration therapy vs usual care for sensory processing difficulties in autism spectrum disorder in children: study protocol for a pragmatic randomised control trial. BMC Trials. https://doi.org/10.1186/s13063-019-3205-y

Schaaf, R. C., Dumont, R. L., Arbesman, M., & May-Benson, T. A. (2018). Efficacy of occupational therapy using ASI: A systematic review. American Journal of Occupational Therapy, 72, https://doi.org/10.5014/ajot.2018.028431

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ASD and Sensory Processing Disorder - A Brief Introduction

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Whilst there is a lot of research on the use of sensory strategies, the design of much of it is poor. A recent review considering the use of sensory strategies with pre-schoolers (Bodison & Parnham, 2018) found 11426 potential articles. However, only 24 were suitable to review, and only eight were used in the report.

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People often use the terms 'Sensory Integration' (SI) and 'Sensory Processing' to refer to the same theory. Dr A. Jean Ayres first published her first book on sensory integration theory in 1972. She was the first author to use the term 'Sensory Integration' to describe sensory issues in children. Her book outlined both the sensory integration theory and her recommendations for sensory integration therapy.

More recently, the term 'Sensory Processing Disorder' (SPD) is being used. This term was first published by Dr Lucy Miller in 2006. Dr Miller's model of sensory processing is based on Ayres' original sensory integration theory.

Nowadays, authors typically use either one term or the other, depending on their training and/or work experience. Therapists will usually use the term that they were taught when they trained. This is influenced by who they trained with, and where and when they completed their training.

To clarify 'Sensory Integration' and 'Sensory Processing' refer to the same initial idea of how the brain processes sensory messages. The differences between SI and SPD are subtle. In order to explain them, this post gives a short history of Ayres' and Miller's work.

Sensory Integration Theory

Dr A. Jeans Ayres in 1972 (p.1) first described Sensory Integration (SI) as 'the organisation of the senses for use.' Dr Ayres was an occupational therapist working with children with learning disabilities in California. Noticing that many of these children interpreted sensory messages differently to their peers, she began to focus her attention on the , vestibular, proprioceptive and vision senses. Her research indicated that the children she was working with did not integrate, or combine, the messages from these senses very well. This is how she started to develop her sensory integration theory.

As a result of poor integration of the sensory messages, Dr Ayres theorised children could have challenges with:

Postural control

Coordination of both sides of the body (bilateral integration)

Sensory sensitivity

Discrimination and/or

SI and learning

Dr Ayres felt that these SI challenges were contributing to the children's difficulties with learning. This thinking can be seen in her sensory integration theory and is shown in the picture below. On the left, the sensory integration model shows the senses Dr Ayres felt were most likely to contribute to SI dysfunction. As you follow the model to the right, it shows the skills that each sense influences. Dr Ayres hypothesised that each skill formed the foundation for the next skill. Finally, resulting in the end products of concentration, attention, learning, etc.

Through her work, Dr Ayres created sensory integration therapy. She found that if she treated the children using a SI approach they made improvements in their learning. The is called a 'bottom up' approach because it works on improving foundation abilities with the expectation that this will have a knock on effect to function skills. So, for example, Dr Ayres felt that working on postural control and discrimination would improve a child's handwriting without working specifically on handwriting. Many therapists still use this treatment approach today (Ayres® SI).

Image: Western Psychological Services SI and the Child 1979

Sensory Processing Disorder

Dr Lucy Miller first used the term Sensory Processing Disorder (SPD) in 2006 to describe sensory issues in her book, Sensational Kids. Dr Miller had initially studied under Dr Ayres. After this she has continued to research SI along with her colleagues. The primary aim of this research was to have SPD identified as a stand-alone diagnosis by the American Psychology Association in their updated manual the DSM-5. Dr Miller defined three parts to SPD: sensory modulation; sensory discrimination and sensory-based motor disorders.

Dr Miller's model draws heavily on Ayres' initial work and sensory integration theory. In my opinion, however, Dr Miller's format is easier for parents and teachers to follow.

Dr Miller also published her treatment approach in 2012 (A SECRET, Bialer & Miller).

Image: Lucy Miller, Sensational Kids; Hope and Help for Children with Sensory Processing Disorder (2006)

Overall, what is the main difference between Sensory Integration and Sensory Processing Disorder?

At their core, both models refer to the same primary idea, they just use different terminology. Where Dr Ayres refers to 'Sensory Integration Dysfunction', Dr Miller and colleagues use 'Sensory Processing Disorder'. Dr Ayres used the term 'tactile defensiveness ' to describe what Dr Miller calls 'sensory modulation, tactile over-responsivity'. Dr Ayres described 'postural ocular and vestibular ocular disorders', but Dr Miller uses the term 'sensory based movement - postural disorders'. Both authors use the terms '' and 'sensory discrimination'. Ayres included 'bilateral integration and sequencing' and Miller has not.

Is there a difference in how therapists from each tradition (SI or SPD) approach treatment?

In short, yes.

A pure Ayres® Sensory Integration therapy approach will be led by a trained therapist in a specialised clinic space. It must be child-led. The therapist continually creates opportunities at a 'just right' level to help improve the child's sensory integration. Therapists using Ayres® SI should use the fidelity guidelines outlined by Parham and colleagues in 2011. These guidelines describe the core components of the Ayres® SI treatment.

Miller's model uses elements of this approach, however, it includes additional therapies such as listening therapy. It also includes greater parent involvement in therapy and extra strategies for home and school. Most other authors will outline sensory strategies that can help to support the senses at home and school. These strategies can be used to complement direct sensory integration treatment.

Sensory Integration vs Sensory Processing Disorder

In summary, the terms 'sensory integration' and 'sensory processing' refer to the same theory and idea. As with many ideas, once the founder has passed on their knowledge, different roads are taken by their students. This has been the case for SI theory, resulting in the term 'sensory processing'. My hope is that these different roads will ultimately lead to stronger evidence, and the best outcomes for children and adults that need help to organise their senses.

A History of Sensory Integration vs Sensory Processing Disorder

1950-60s

Jean Ayres begins working on her theory of SI.

1972

Jean Ayres publishes Sensory Integration and Learning Disorders. In this book she outlines her SI theory and discusses how children can be assessed for SI dysfunction. The book also includes recommendations on how to treat and support children who have sensory challenges.

1979

Sensory Integration and the Child is published. Jean Ayres wrote this book for parents in order to break her SI theory into a more easily read format. Publishers released an updated 25th anniversary edition of this book in 2004. The newer edition includes comments from occupational therapists currently researching SI.

1980-90s

Some authors, especially in education, discredit the effectiveness of SI for children. All readers must, however, note that a huge flaw with many of studies at this time is that they do not quantify what classes as 'sensory integration.' Many studies call sensory strategies such as weighted blankets and ball chairs 'SI treatment,' even though they are not. This is like calling an Ace of Spades the King of Diamonds, although the two may be cards, they are not the same.

1999

Winnie Dunn publishes the 'Sensory Profile.' This is the first standardised assessment to look at sensory modulation difficulties. You can read more about sensory modulation on our 'What is SPD?' page. Dunn published an updated version of the tool in 2014 (SP2).

2000s

Above all there is a huge push for all research on SI theory and treatment to be of high quality. In order to do this, researchers must describe exactly what their treatment process involved.

2006-7

Lucy Miller and colleagues formally publish the term Sensory Processing Disorder (SPD) in their books. Parnham and colleagues also publish a fidelity measure, this clearly describes the components of SI treatment. They, therefore, recommend this is used in all research on SI effectiveness.

2010s

The term Sensory Processing Disorder is used more widely in media and publications, especially books on the topic for parents and teachers. However, many books written for therapists typically continue to use the term SI. Schaff and Davies (2010) discuss the evolution of SI in an editorial for the American Journal of Occupational Therapists. Overall, they conclude there is no consensus on term use and advocate continued research.

Authors continue to use the terms SI and SPD interchangeably. A huge amount of research is currently being done to support the use of SI treatment, including using SI for children with autism. This also includes randomised control trials, the most rigorous type of evidence. For more information on publications, you can follow the links at the end of this timeline.

Therapists continue to train in Ayres® SI through organisations including the SI Education and CLASI. In addition, Lucy Miller offers training in her A SECRET model, this now includes university certification.

There is more research being published and conducted on SI. Some of the research (e.g. Ayres® SI has been used (e.g. Schaaf, 2018) indicates that it is an effective treatment for children, including those with autism. Other reviews (e.g. Novak, 2019) come to the opposite conclusion. Unfortunately, a lot of research uses the term sensory integration therapy, however, they do not stick to the fidelity treatment measure. This means it is not always clear if Karim, 2015). In some cases, the treatment has been described as SI, when it clearly is not. For example, this study which uses Brain Gym as their 'sensory integration approach.' It is important when you are reading research and information that you check what model the authors are using.

There is a large research study ( Randell, 2019) underway at the University of Cardiff comparing sensory integration therapy with usual care for children with autism. The results of this study should be available in 2021. This study has the potential to provide more clarity on the effectiveness of Ayres® SI.

Excitingly, the Third Edition of Sensory Integration Theory and Practice was published in 2019. Well, maybe less exciting for those outside of the field. However, it is quite a big milestone for those who have been following SI over the last seven decades.

2020 and beyond

The Ayres 2020 vision team are working on a new assessment tool, the EASI, to help therapists assess for sensory integration dysfunction. They aim to publish this in 2020. Currently the assessment tool is being standardised. This means that it is being tested with typically developing children to identify age cut offs and scores.

The results from the Cardiff study will be published. In addition, the impact of SI is being researched by many individuals and teams. This research will be used to inform and shape the future of sensory integration theory and practice.

What if I want to read more research/evidence on SI and SPD?

These websites often update their publication list:

Where can I study more about Sensory Integration?

SI for parents & teachers & health professionals

For parents, teachers and professionals new to the sensory world, GriffinOT has a variety of online training courses available.

Sensory integration for allied health therapists

These organisations provide training for occupational therapists wanting to qualify as SI practitioners:

CLASI (Global)

SI Network (UK & Ireland) - offer a lot of online options

Pediatric Therapy Network (California USA)

STAR Institute (Denver USA)

Books & page references

Asterisks * indicate references that are parent and teacher friendly

Ayres, A.J. (1972). SI and Learning Disorders.

Ayres, J.A. (1979). SI and the Child.*

Bialer D., Miller. L.J. (2012). No Longer A Secret: Unique Common Sense Strategies for Children with Sensory or Motor Challenges.

Dunn, W. (1999). Sensory Profile. User's Manual. Texas: The Psychological Corporation.

Parham, L. D., Cohn, E. S., Spitzer, S., Koomar, J. A., Miller, L. J., Burke, J. P., et al. (2007). Fidelity in SI practice intervention research. American Journal of Occupational Therapy, 61, 216-227.

Miller, L.J. (2006). Sensational Kids Hope and Help for Children with Sensory Processing Disorder. *

Miller L.J., Anzalone, M.E., Lane, S.J., Cermak, S.A. and Osten, E.T., 2007. Concept Evolution in SI: A Proposed Nosology for Diagnosis. American Journal of Occupational Therapy 61(2), pp. 135-140.

Schaaf, R.C., Davies, P.L., (2010) Evolution of the SI Frame of Reference. American Journal of Occupational Therapy 64 (3), pp. 363-367.

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Sensory Integration Theory & Sensory Processing: What's the Difference?

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People often use the terms 'Sensory Integration' (SI) and 'Sensory Processing' to refer to the same theory. Dr A. Jean Ayres first published her first book on sensory integration theory in 1972. She was the first author to use the term 'Sensory Integration' to describe sensory issues in children.

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What is Sensory Processing Disorder and how it might affect your child?

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Learn what sensory processing disorder is and how differences with processing sensory information affect attention, behavoiur and learning.

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Improves Motor, Emotional and Cognitive abilities, through Music and Language

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The Tomatis® Method serves over 200,000 individuals a year worldwide. It offers children, adults, and seniors, one of the most innovative and advanced, neurosensory stimulation training to improve brain function. Supported by a wealth of studies, the Tomatis® Method is commonly used to improve motor skills as well as emotional and cognitive abilities. The training sessions are customized by a Certified Tomatis® Practitioner with a background in education, therapy or medicine, based on an individualized assessment of the client's needs. Children and adults can follow their daily listening sessions in the comfort of their home or in the provider's office through a unique portable device called TalksUp®.

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Tomatis® Method, auditory stimulation program for improving brain functions

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Tomatis® improves Motor, Emotional, and Cognitive abilities, through Music and Language. It offers children, adults, and seniors, one of the most innovative and advanced, neurosensory stimulation training to improve brain function. Find a certified Practitioner or get professional information and visit the official website.

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Free online sensory processing course for teachers, assistants and parents

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GriffinOT's free sensory course gives an introduction to the senses and sensory processing. It helps educators and parents to understand sensory behaviours.

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Special Education and Inclusive Learning

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Sensory Learning Activities: An A-Z. Beyond Sensory play

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The ultimate A-Z list for teachers of sensory learning activities to use with your child or classroom. Taking learning beyond play.

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Differences associated with learning difficulties are found less in specific areas of the brain and more in the connections between them, experts say.

After scanning 479 children's brains, Cambridge University researchers found they were organised in multiple "hubs".

Those with no difficulties - or very specific ones, such as poor listening skills - had well connected hubs.

But those with widespread and severe difficulties - 14-30% of all children - were found to have poor connections.

It was recently suggested schools were failing to spot ADHD and autism, which could be contributing to a rise in exclusions.

Dr Duncan Astle told BBC News: "We have spent decades searching for the brain areas for different types of developmental difficulty such as ADHD and dyslexia.

"Our findings show that something which is far more important is the way a child's brain is organised.

"In particular, the role that highly connected 'hub' regions play.

"This has not been shown before and its implications for our scientific understanding of developmental difficulties is big.

"How do these hubs emerge over developmental time?

"What environmental and genetic factors can influence this emergence?"

"Another key finding is that the diagnostic labels children had been given were not closely related to their cognitive difficulties - for example, two children with ADHD [attention deficit hyperactivity disorder] could be very different from each other.

"This has been well known in practice for a long time but poorly documented in the scientific literature."

Mental-health disorders

Treatment should be "less reliant" on naming a diagnosis, Dr Astle said.

"They should either receive broad interventions that benefit everyone or tailored interventions that support the child's areas of cognitive difficulty by harnessing their relative strengths.

"But the take-home message is that the 'label' is unlikely to be helpful in deciding how to support a child."

Earlier research has suggested poor connectivity within the brain also plays a role in the emergence of mental-health disorders in adolescents.

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Learning difficulties 'link to brain connections'

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Differences associated with learning difficulties are found less in specific areas of the brain and more in the connections between them, experts say. After scanning 479 children's brains, Cambridge University researchers found they were organised in multiple "hubs". Those with no difficulties - or very specific ones, such as poor listening skills - had well connected hubs.

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Babies are born with 'primitive' reflexes, designed to help them get used to the world

Most fade away within the first two years of life, however the brain's scrapping of the reflexes doesn't always go to plan - which is referred to as 'retained reflexes'

On Wednesday, the host, 53, discovered his son's learning difficulties were down to the condition when his wife took him Eli to the The Key Clinic last year

After practicing ten-minute exercises, Chris' young boy can now do 'joint-up writing' and 'reads book for fun'

The presenter revealed he and his older son Noah, 11, have also been diagnosed with the same condition

He shares his boys, as well as twins Walt and Boo, 14 months, with wife Natasha Shishmanian, 39

Chris Evans has revealed his son Eli, seven, underwent 'miracle' treatment after his 'retained reflexes' left him unable to read and write.

The presenter, 53, discovered his 'creative' young boy's learning difficulties were down to the condition when his wife Natasha Shishmanian took him to the The Key Clinic - a centre which specialises in child development - last year.

During Wednesday's The Chris Evans Virgin Radio Breakfast Show with Sky, the host enthused Eli can now do 'joint-up writing' and 'reads book for fun' after practising helpful exercises, and revealed he was recently diagnosed with the same condition.

Chris - who also shares Noah, 11, and twins Walt and Boo, 14 months, with golfer Natasha, 39 - expressed his past worries over his son's development as while he's a 'creative genius', Eli could only 'read a little bit'.

The radio personality explained: 'Our little boy, Eli, who's seven loves school. He loves life. He is seven, you know and at the start of this year, his new year at school, he couldn't really read and he couldn't really write.

'He could read a little bit, but not much. But he's creative, such a genius. He's a shining star in our world. So was he dyslexic? How was he with his maths? Not very good.'

Revealing his wife of 12 years took the initiative to improve their child's learning journey, the businessman - who also shares older daughter Jade, 33, with ex Alison Ward - said: 'Tash started looking around and she came across this place called The Key Clinic.

'And what The key clinic do is they focus on a link between all these learning issues and potential issues of communication or spacial awareness. And they're all linked to something called retained reflexes.'

Chris went on to give his listeners insight into the condition, which he described as a 'phenomenon'.

He explained: 'Retained reflexes means is that we're all born with these reflexes that are designed to keep us alive in the first few months and the first year and may be second year of our lives. And there are about 19 of them.

'They are sort of superpowers in our first year or couple of years of our lives. But when we no longer need them, they're supposed to leave us. But if they don't leave us, they can cause massive issues.'

In a bid to aid his education, Eli underwent a 'drug free movement method', which aims to 'improve learning and behavioural problems' by maturing the nervous system.

WHAT ARE RETAINED PRIMITIVE REFLEXES?

Babies are born with their own set of 'primitive' reflexes, designed to help them get used to the world.

Such reflexes include tightly grasping a finger placed in their hand and attempting to suckle when their cheek is stroked.

Most of the reflexes fade away within the first two years of life, after the infant has achieved milestones including crawling.

The Bird charity, a neurological body that has treated thousands of children, says the brain's system of scrapping the primitive reflexes doesn't always go to plan.

It writes: 'For many children who do not pass through developmental milestones... primitive reflexes can remain active in the central nervous system.'

'Retained reflexes act as a barrier to normal development and make it more difficult to develop neurologically and function adequately within everyday living..

'A presence of primitive reflexes makes it more difficult for an individual to function as each task and activity requires more effort and energy than is naturally required.

'Activities of daily living will not come naturally to an individual with retained reflexes and as a result they may appear awkward, uncoordinated and rigid when performing tasks.

'This will inevitably lead to increased frustration levels, reduced self-esteem and increased anxiety levels.'

Detailing the ten-minute daily exercises, The Big Breakfast star said: 'Key neuro movement therapy uses simple, precise exercises to inhibit the primitive reflexes, overcoming blockages, creating new neural pathways in the brain by maturing the nervous system and changes the neuroplasticity of our brain.

'And of course, the longer these reflexes remain locked, the more hard wired our neuroplasticity becomes and the more it is becomes an accepted a normal state when it really, really isn't. And this is revolutionary.'

And after a trip to his kid's school, Chris and Natasha were left amazed at Eli's improvement.

He enthused: 'I've been thinking about talking about this on radio for a while. But yesterday we were asked to go to school.

'My wife and I, because Eli has gone from in a year of doing this, from not being able to read to four stages above his expected reading level for his age. He can also do jointup writing.

'He reads books now for fun. His whole personality has changed. He's become less anxious. And it's all because of this. It absolutely works.

'You can't do them haphazardly because you have to change this wiring of your brain and your brain has to it has to get fed up with the onslaught that you're confronting with every day.'

Chris explained that after Eli's diagnosis, he discovered he and his eldest son Noah also have retained reflexes.

The former BBC star said: 'It works to the extent that now Noah, who's Eli's elder brother. He's eleven. We've discovered he's got retained reflexes. Guess who else has got them? This 53 year old sat here!'

Insisting Eli still has a long way to go, he added: 'Eli is not sorted, but he's getting sorted. I mean, it's like a miracle. It's like a blooming miracle. It's unbelievable.'

Babies are born with their own set of 'primitive' reflexes, designed to help them get used to the world.

Most fade away within the first two years of life, however the brain's scrapping of the reflexes doesn't always go to plan - which is referred to as 'retained reflexes'.

The Bird charity, a neurological body that has treated thousands of children, explains: 'For many children who do not pass through developmental milestones... primitive reflexes can remain active in the central nervous system.

'Retained reflexes act as a barrier to normal development and make it more difficult to develop neurologically and function adequately within everyday living..

'A presence of primitive reflexes makes it more difficult for an individual to function as each task and activity requires more effort and energy than is naturally required.

'Activities of daily living will not come naturally to an individual with retained reflexes and as a result they may appear awkward, uncoordinated and rigid when performing tasks.

'This will inevitably lead to increased frustration levels, reduced self-esteem and increased anxiety levels.'

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Chris Evans says miracle treatment helped son's learning difficulties

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Babies are born with 'primitive' reflexes, designed to help them get used to the world Most fade away within the first two years of life, however the brain's scrapping of the reflexes doesn't always go to plan - which is referred to as 'retained reflexes' On Wednesday, the host, 53,

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This week's blog is dedicated to my occupational therapist - words cannot express my gratitude for guiding me through my pain and for helping me learn to regulate my nervous system; our work has changed my life - and to a special young man I had the pleasure of meeting this week - may you begin to see your true self, work to forgive yourself and learn to love yourself; I hope you feel better very soon.

A Little History

I've been going to occupational therapy for close to one year now. I was referred to an occupational therapist (OT) by a psychiatrist because, after over 20 years of seeking help and trying everything to get better, while there were slight improvements in my well-being, something was still extremely wrong.

Every day was a struggle. I was easily overstimulated. Overwhelmed. I had frequent meltdowns. Bursts of anger. Rage. It would reach a point where the things I did felt like they weren't by choice; rather, they were things my body had to do in order to survive. When you're living in a constant fight-or-flight response, you fight or flee at almost every turn.

I was continually putting others and myself in harm's way, and I didn't know how to stop it. I would throw things and punch my hands and feet into walls - fighting. Smash my head into doors - fighting. Hurt my husband or myself - fighting. I would take my seat belt off while my husband was driving and threaten to get out of the car - fleeing. Walk out into traffic - fleeing. Say I wanted to kill myself and make faint attempts at suicide - fleeing. After, I could never explain what made me do the things I was doing. It was like I had been possessed. And I would feel so remorseful that I wouldn't want to live.

At this point, I knew about my sensory processing disorder (SPD) and obsessive compulsive disorder (OCD) diagnoses, but I didn't understand how imperative regulating my nervous system was to ending the fight-or-flight response I was living in.

And then came occupational therapy. Seeing my OT this past year not only taught me how to regulate my nervous system, it saved my life. And my marriage. I'm finally seeing who I truly am, and I am learning to reconnect my mind, body and soul.

16 Things I've Learned While Working with My OT

1. To understand my body's needs. I remember my OT asking me what I do for my body during one of our first visits, and, outside of exercising, I didn't know what to say. I was all in my head. It took a while for me to grasp the concept of my body needing things. The things my sensory diet would provide. I didn't know that what I would learn would change everything. Ending my fight-or-flight response. Ending my suicidal thoughts and attempts. Ending the violent acts against others and myself. The information I needed was always within me, but I didn't know how to tap into it until I began working with my OT.

2. To be in my body and to pay attention to where my emotions sit in my body. Through craniosacral therapy, my OT has guided me to do body scans in order to feel each part of my body. To sense where my emotions sit in my body. Once I'm able to locate them, I can identify what they're telling me and work to alleviate the physical pain they're causing.

3. To be aware of my breath and to get it to reach all parts of my body. To pull my breath from my toes all the way to the top of my head as I inhale and back down from the top of my head to my toes as I exhale.

4. To cross my legs, arms and invert and cross my hands to get both sides of my brain to communicate. My OT told me that when I have sensory overload, the left side of my brain shuts down. The side of cognition and speech and coordination and motor skills. Crossing my legs, arms and hands (or doing eagle pose) gets both sides communicating again, and I feel clearer.

5. To understand how all the parts of my nervous system affect me. I'd read Sharon Heller's, Too Loud, Too Bright, Too Fast, Too Tight , a few years before going to an OT, so I knew about my olfactory, visual, auditory, gustatory, tactile, vestibular, proprioceptive and interoceptive senses, but seeing an OT helped me understand how they operate and work together.

6. To have a sensory diet. Again, I'd read about it, but I didn't truly understand what it meant until I started seeing an OT. For my sensory diet, I have to do things every hour to regulate my nervous system. It's become a lifestyle, and, since starting it, I feel the best I've ever felt.

7. To stimulate and engage my senses. When you have sensory processing issues, it is instinctual to block out your senses: close the blinds, avoid sounds, limit interactions with others. While working with my OT, I learned I need to engage my senses multiple times a day: smell essential oils or foods, listen to music, connect to others, etc. in order to regulate my nervous system.

8. To eat protein and carbs every two to three hours. I learned at a sensory conference that this helps keep my glucose levels balanced. And if I schedule eating every two to three hours, then I can't forget to eat, which could cause a meltdown. I try to eat unprocessed foods without anything artificial added. For example, I eat eggs and potatoes or rice and beans. Good snacks are apples and peanut butter or carrots and hummus.

9. To have a routine. I need routine so my body knows what to do. My body needs the routine even if I'm not cognitively aware of it. Sometimes, I even set timers to remind myself to continue onto the next part of my routine. But since I've developed a routine I can stick to, my body remembers it.

10. To move. I used to work all day at the computer and then workout around 3 p.m., but then my OT helped me see I wasn't doing enough for my body throughout the day. Now, I do cardio before noon, and I do yoga in the afternoon and at night.

11. To practice compression and tension release techniques. I use my weighted blanket first thing in the morning, when I take breaks and right before bed. The compression on my body provides tension release and helps regulate my nervous system. Also, before I started seeing an OT and was highly unregulated, I'd feel surges of energy when I became overstimulated. Unfortunately, I'd throw things or hurt myself because I didn't know any better. But now, I know I need to move and provide tension release for my body. I'll press up against the wall, do push-ups, jump on my mini trampoline, ask for a hug, etc.

12. To take breaks and to schedule downtime. Before seeing my OT, I would push through all of the things I needed to accomplish in the day, thinking I'd take a break when I was done. My OT helped me to see that my nervous system wasn't staying regulated when I did this, and that I needed breaks throughout the day to reset and refresh. Now, I look forward to my breaks throughout the day. I also try to schedule downtime a few times a week. Downtime goes beyond simply taking a break, it's having time to let my mind wander.

13. To do the things that make me happy. Unfortunately, for those of us who live in fight-or-flight response, our love for ourselves usually suffers too. I didn't realize how much I was punishing myself. How rigid and strict I was with myself. How little I was letting myself enjoy life. When I began to forgive myself, my playful and creative nature were waiting for me to enjoy. I also find that, if I do little things throughout the day that make me happy, like letting myself watch TV for 15 minutes while I eat lunch, that I feel much better overall.

14. To take Epsom salt (magnesium) baths. In my opinion, magnesium is essential for anyone with a neurological difference. I've read that it's because we have a magnesium deficiency, but it could also be because, if our bodies are in a constant fight-or-flight response, every muscle is tense. Since my OT suggested I take an Epsom salt bath, I can only go a few days without one. It releases tension like nothing else.

15. To forgive myself. For having episodes and getting out of control. For having meltdowns. For hurting others. For hurting myself. For only being able to do so much in a day. For sometimes having to limit my interactions. For needing to put my needs first.

16. To practice acts of self-care each day. To respect and nurture my sensitive nervous system. To love myself.

If you or someone you know has been diagnosed with a disorder, are neurodivergent or are living in fight-or-flight response, I strongly encourage you to see an OT. Someone who will listen to you. Understand your needs. Help you regulate your nervous system. Guide you toward a better life. A calm, regulated life. A life inside your body where your mind and soul feel safe to dwell.

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Neurodiversity and Fight-or-flight Response: How Occupational Therapy Saved My Life by Teaching Me to Regulate My Nervous System and the 16 Things I've Learned

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Dedication This week's blog is dedicated to my occupational therapist - words cannot express my gratitude for guiding me through my pain and for helping me learn to regulate my nervous system; our work has changed my life - and to a special young...

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Sensory disorders are not just about itchy tags. Here are 3 complex and multi-faceted conditions that are often mistaken for ADHD, anxiety, and other comorbidities. A must-read for parents.

1 of 16

Mistaking Sensory Disorders for ADHD

A child with SPD might have trouble with senses and be prone to accidents like falling down the stairs.

2 of 16

8 Senses in Disorder

A mother plays frisbee with her son with ADHD and SPD

3 of 16

Typical Sensory Processing

Little boy standing behind the window in sad mood. Sad Teenager looking in the Window and closing his ears with hands. Unhappy child in a plaid shirt. Alone at home. Upset.

4 of 16

How Sensory Disorders Scramble Messages

A child with SPD examines the ground with a magnifying glass.

5 of 16

3 Types of Sensory Disorders

6 of 16

1. Sensory Modulation Disorder

7 of 16

2. Sensory Discrimination Difficulties

Boy exercising on half balance massage ball with instructor

8 of 16

3. Sensory-Based Motor Disorder

9 of 16

Dyspraxia

A girl with SPD on a swing.

10 of 16

Does My Child Have a Sensory Disorder?

An ADHD girl with SPD examines her teddy bear.

11 of 16

Symptom Overlap Between SPD and ADHD

A girl with SPD climbs a chute at the playground.

12 of 16

Hyperactivity with Sensory Disorders

A family with SPD plays in the park.

13 of 16

How Parents Can Approach Sensory Disorders

A parent with attention deficit disorder hugs their child with ADHD, after sharing some of the tricks they use to navigate ADD symptoms

14 of 16

The Power of Touch

A girl has OT to treat her SPD.

15 of 16

Treatment with OTSI

A girl with SPD plays with a sensory table.

16 of 16

Think Your Child Has a Sensory Disorder?

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