Sensory Integration and Improving Developmental Skills: Beyond Vests and Chewy Tubes

Tara Carroll, Krista Honig Author

04/06/2020 Added

29 Plays

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2020 ASD Conference Breakout Session

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[00:00:00.060]Guessing you didn't feel those sensations
[00:00:01.820]prior to me bringing it to your attention.
[00:00:04.090]Your brain, again, filtered out that information
[00:00:06.410]is not important until you thought about it.
[00:00:09.130]And then your brain switched
[00:00:10.230]and oriented you to that information.
[00:00:12.832]That is sensory integration and it's just taking
[00:00:16.090]everything into our environment, from our environment
[00:00:18.910]and your brain processing it.
[00:00:20.556]So, here is another visual to help
[00:00:22.530]explain sensory processing.
[00:00:24.810]Again, at the top is that registration.
[00:00:27.240]This is directly related to thresholds
[00:00:29.440]which we're going to talk about more in a minute.
[00:00:31.800]The brain has to register that input first.
[00:00:35.000]And then orientation, attention and interpret.
[00:00:38.212]Children with autism demonstrate difficulties with attending
[00:00:41.630]and interpreting that sensory information.
[00:00:44.240]Therefore, they often struggle to develop
[00:00:46.090]appropriate adaptive responses.
[00:00:50.740]Now, sensory processing.
[00:00:52.040]Again, when we first learn something it's very slow going.
[00:00:55.520]It's like beating a path through untraveled terrain.
[00:00:58.754]As the neurons are activated repeatedly
[00:01:01.280]myelin is laid down and the faster the transmission.
[00:01:04.720]So, an example I often use is hiking.
[00:01:07.230]The first time a person walks on a path
[00:01:09.450]it's rough, difficult and slow.
[00:01:11.140]I'm always amazed when I go on these beautiful hikes
[00:01:14.350]in the mountains and I'm like who did this?
[00:01:17.420]Who was the first person to figure out a path, you know?
[00:01:21.197]And how much work that had to be to create that path
[00:01:24.960]for us to be able to hike on?
[00:01:26.730]The more times a person walks on that particular path though
[00:01:30.450]the path becomes flatter, it becomes smoother
[00:01:32.780]and it becomes faster to navigate.
[00:01:34.551]Now, our brain works the same way.
[00:01:37.490]The processing speed continues to increase
[00:01:40.070]as more myelin is laid down.
[00:01:42.051]Myelin is laid down when neurons are activated.
[00:01:44.871]And neurons are activated by sensory experiences.
[00:01:48.323]The more sensory experiences, the faster
[00:01:51.010]these connections become.
[00:01:53.420]Now, sensory processing dysfunction.
[00:01:55.540]Imagine driving a car that's not working well.
[00:01:58.070]Or think of your own experience of driving a car
[00:02:00.390]in a heavy rain storm.
[00:02:02.020]I know when I drive in heavy rain I put
[00:02:04.530]both hands on the wheel.
[00:02:05.920]I lean forward and of course I turn that radio
[00:02:09.560]to decrease any other distractions.
[00:02:11.555]Now, a lot of our students that have
[00:02:13.500]sensory processing dysfunction.
[00:02:15.560]That is the constant of arousal they're in.
[00:02:18.630]They're always struggling to organize
[00:02:20.820]their neurological systems.
[00:02:25.850]Now, the hardest part about sensory integration
[00:02:29.660]is explaining it to parents.
[00:02:31.450]I have a lot of team members that come to me
[00:02:33.070]and say I know it, I understand it.
[00:02:34.820]But as soon as I go to explain it to a parent,
[00:02:37.913]it just comes out wrong.
[00:02:39.640]And so, the way that I found that works easiest
[00:02:42.660]to explain it to the parents we work with is
[00:02:45.394]talking about the calm-alert state
[00:02:47.810]using the phrase on the line.
[00:02:51.020]A very large part of this is when we first start
[00:02:53.770]working with the child and family is teaching
[00:02:56.430]the parents to recognize when their child is on the line.
[00:02:59.966]This is critical.
[00:03:01.640]Until parents understand this concept
[00:03:03.980]it's really challenging to make progress with IFS people.
[00:03:07.670]So again, you're gonna hear us use
[00:03:08.830]that word a lot, on the line.
[00:03:10.870]On the line means the calm and alert
[00:03:13.280]state of the optimum functioning of where
[00:03:15.480]that child is ready to learn.
[00:03:19.320]Sensory modulation, again.
[00:03:20.740]You see that kid walking on the line.
[00:03:23.280]It is the ability of the nervous system
[00:03:25.150]to have a middle ground or comfort zone of regulation.
[00:03:28.480]As a child interacts with the challenges of daily life.
[00:03:31.990]So, it is the ability to regulate and organize
[00:03:34.960]the degree, intensity and nature of
[00:03:37.360]responses to sensory input.
[00:03:39.200]To maintain that, again, calm and alert state.
[00:03:41.870]We all do things to keep ourselves regulated.
[00:03:44.826]I had a boss once that constantly moved
[00:03:47.340]his leg during meetings.
[00:03:48.780]It was his way of self regulating so
[00:03:50.480]he could attend and focus.
[00:03:52.520]Now, a child with poor modulation has a
[00:03:54.520]very narrow comfort zone or line.
[00:03:57.410]And struggles to make these adjustments to stay on the line.
[00:04:01.470]So, the goals for the child is to be organized.
[00:04:03.770]To be on the line, to be calm and alert
[00:04:05.910]for as much of the day as possible.
[00:04:08.460]It shouldn't just be turned on when needed because
[00:04:11.470]that doesn't help the brain make neurological changes
[00:04:14.320]and become the child's new normal.
[00:04:16.520]So, that's my biggest frustration is when we say okay.
[00:04:19.920]We're gonna get the child organized
[00:04:21.530]so we can work on speech.
[00:04:23.170]And then they can go right back to being dysregulated.
[00:04:25.740]If a child spends 75% of his time below the line
[00:04:29.756]then those current pathways are not being reinforced.
[00:04:34.700]We also spent a lot of time talking to parents
[00:04:37.150]and getting them to recognize when
[00:04:39.300]their child is on the line.
[00:04:41.040]And figuring out strategies to keep them there
[00:04:43.370]as much as possible.
[00:04:45.550]It also helps to understand that every single
[00:04:47.900]child's line is different.
[00:04:49.660]So, children with low registration to auditory input
[00:04:52.480]have very high lines.
[00:04:54.250]Most auditory input does not reach their threshold.
[00:04:57.120]So again, that's very very common with kids with autism,
[00:04:59.955]that low registration.
[00:05:02.010]So again, their line is way up here.
[00:05:04.670]And we keep giving them input.
[00:05:06.070]We keep talking to them but it's never
[00:05:08.338]reaching that threshold.
[00:05:09.970]So, they're never getting to that register part
[00:05:12.360]that starts that whole process of sensory processing.
[00:05:16.170]Children with sensory sensitivity have low lines.
[00:05:19.070]It takes very little sensory input to reach that line.
[00:05:22.720]So again, if you have a child that's sensitive to input
[00:05:26.290]a lot of times we give them way too much input
[00:05:28.060]and then they're over stimulated.
[00:05:29.840]And so again, they have a hard time getting
[00:05:31.670]to that line and staying on that line.
[00:05:34.580]The key to understanding sensory modulation
[00:05:36.988]is what does it look like when the child is on the line?
[00:05:40.490]And where are his or her thresholds for each main sense?
[00:05:43.770]So, a parent might tell me, oh.
[00:05:45.150]My child loves the rocking horse.
[00:05:46.830]He rocks and rocks and rocks.
[00:05:47.970]Okay, well what does he look like when he's rocking?
[00:05:51.270]Is he giving you better eye contact?
[00:05:53.140]Is he focused on you more?
[00:05:54.970]That gives you those keys to knowing
[00:05:56.810]if that input is actually organizing your child.
[00:05:59.200]And if it helps that child get on the line.
[00:06:01.650]Some kids are only on the line or often
[00:06:04.560]the first time we see them on the line
[00:06:05.690]is when they're in the swimming pool.
[00:06:07.210]So again, trying to figure out when they're most organized
[00:06:10.530]and when they're ready to learn.
[00:06:14.160]So, sensory integration and autism.
[00:06:16.026]A commonly held theory is that people with autism.
[00:06:19.100]Have too many underdeveloped nerve endings
[00:06:21.770]due to inadequate pruning.
[00:06:23.720]So again, that pruning is a process of weening out
[00:06:26.950]unnecessary connections and strengthening
[00:06:29.700]the important ones based on the child's experiences.
[00:06:33.260]You're gonna hear that word a lot today, experiences.
[00:06:35.886]Some pruning begins very early in development
[00:06:38.710]but most rapid pruning happens around age three.
[00:06:42.340]Now, differences in sensory modulation
[00:06:43.950]among people with autism has been
[00:06:46.230]well documented in the literature.
[00:06:48.270]And sensory processing skills are
[00:06:49.850]fundamental to functional performance.
[00:06:52.128]So, difficulties with sensory processing play a role
[00:06:55.320]in the variable developmental performance
[00:06:57.240]of children with autism.
[00:06:59.350]Recognizing and addressing these sensory
[00:07:01.098]processing contributions as a vital component
[00:07:04.180]of development provides that direction
[00:07:06.550]for intervention plan.
[00:07:11.700]Now, there are seven primary sensory modalities.
[00:07:14.450]There's lots more but those are the seven
[00:07:16.700]that we primarily focus on.
[00:07:18.600]Especially with the sensory profile.
[00:07:21.790]Vision, hearing.
[00:07:23.550]Now, it's important to note that we are talking
[00:07:25.300]about the processing of vision and hearing.
[00:07:27.730]How that child takes in that information.
[00:07:30.130]It's not the physical ability to see and hear.
[00:07:33.014]Taste, smell.
[00:07:34.950]The touch system, the tactile system which is
[00:07:36.787]are light touch receptors.
[00:07:38.876]Proprioception, this is are deep touch receptors.
[00:07:42.210]We have proprioceptors in our muscles, tendons and joints
[00:07:45.840]that tell us where our body is in space.
[00:07:48.780]So again, I always explain it to parents that
[00:07:51.310]if I close my eyes I can still touch my nose.
[00:07:54.450]I can still touch my head.
[00:07:56.130]And that's because of those proprioceptors
[00:07:57.920]are telling my body where I am in space.
[00:08:00.830]Proprioception input is often described as
[00:08:03.270]the organizer of the brain.
[00:08:04.910]It often calms the nervous system.
[00:08:07.170]So, think of weighted blankets, think of massages.
[00:08:10.040]Think of all the heavy work that we often give our kids.
[00:08:12.760]That's very organizing to the brain.
[00:08:14.670]So, it's usually our go to to help get them on that line.
[00:08:18.974]Vestibular system, this system contributes to the balance
[00:08:22.010]and orientation in space.
[00:08:24.010]It is a leading system informing us about movement
[00:08:26.800]and position of head relative to gravity.
[00:08:30.490]Now, there's also an eighth set of senses
[00:08:32.650]that is getting more attention and that's intraception
[00:08:35.810]which is related to internal organs.
[00:08:39.470]It's related to the autonomic motor control.
[00:08:41.570]And I think it's important to bring up because
[00:08:43.500]I think it's one that we forget about.
[00:08:46.020]And it's really, really important that
[00:08:48.510]when we do our RBI and we do our assessments
[00:08:50.950]when we're talking to families.
[00:08:52.510]That if we don't forget about that eighth sense.
[00:08:55.065]A lot of children exhibit behaviors
[00:08:57.210]due to inner ear pressure, problems with digestion.
[00:09:00.350]That internal sense can have a big impact on development.
[00:09:07.440]Now, neuroplasticity.
[00:09:09.420]It's a big word in the birth to five.
[00:09:11.770]It refers to structural and functional changes in the brain
[00:09:15.210]that are brought about by training and experience.
[00:09:18.540]The brain is the organ that is designed to change
[00:09:21.260]in response to experience.
[00:09:23.230]So, at birth each neuron has 7,500 connections.
[00:09:26.437]These increase rapidly in the first two years of life
[00:09:29.880]until this synaptic connections are double that
[00:09:32.460]of an adult brain, I love that fact.
[00:09:34.500]That's just crazy.
[00:09:35.960]The neurons and synapsis that are activated repeatedly
[00:09:38.910]are preserved while those that are not activated are pruned.
[00:09:42.500]Now, pruning is great as beginning around age three.
[00:09:46.470]The human brain is highly dependent on
[00:09:48.490]and is modified and shaped by experience.
[00:09:51.430]So, for example, people that are born blind.
[00:09:55.610]The parts of the brain that normally process
[00:09:57.470]visual information are rewired and come to
[00:10:00.290]process sound, including language.
[00:10:02.470]And those that are born deaf, the areas of the brain
[00:10:04.830]that normally process sounds come to process vision.
[00:10:07.510]Which I think is just so amazing that the brain
[00:10:10.590]has such neuroplasticity.
[00:10:14.290]Now, on this next slide it's just kind of a review
[00:10:16.620]of what we talked about.
[00:10:17.630]So, I'm not gonna go over and read it.
[00:10:19.430]You guys can read it.
[00:10:20.870]But it's just kind of an overview
[00:10:22.210]and gives you some of those things that
[00:10:23.550]we've already kind of discussed.
[00:10:25.270]So, for time we're gonna go ahead and skip this slide.
[00:10:32.555]Now Krista, I might need you to help me
[00:10:33.900]out here a little bit.
[00:10:34.940]She's gonna step in.
[00:10:36.470]Autism is first manifested during this
[00:10:38.850]early pivotal period of life.
[00:10:40.880]Parents become concerned that their toddler
[00:10:42.730]is not developing speech.
[00:10:45.620]Not showing normal social and emotional reactions.
[00:10:48.650]Were not paying attention to
[00:10:50.240]and exploring their environment as normal babies do.
[00:10:53.480]Thus, early abnormal development is apparent
[00:10:56.470]in autism several neurobehavioral domains.
[00:10:59.480]Cognition, emotional, social, speech, language and motor.
[00:11:03.840]And that's why we address all of those issues
[00:11:05.915]so early on, starting at birth.
[00:11:09.661]The main one, I'll jump right in.
[00:11:11.770]The main one, because I'm a speech path
[00:11:15.700]the main one that I like to talk about is communication.
[00:11:19.530]And I like to, when I talk with parents.
[00:11:23.410]Communication is more than just speech or just language.
[00:11:27.920]It's actually an entire process.
[00:11:30.227]It has participants, there's an exchange.
[00:11:34.490]For successful communication the message
[00:11:36.890]should be conveyed in tact
[00:11:38.723]and with intended meaning preserved.
[00:11:42.080]Most of the time even for us as adults this is not easy
[00:11:45.890]because there's a lot of different parts to the process.
[00:11:49.681]I like this visual because it talks about
[00:11:54.060]there's two people.
[00:11:54.940]There's the sender, there's the receiver.
[00:11:56.630]There's encoding going on, there's some decoding going on.
[00:12:00.380]You get that, feedback.
[00:12:01.780]You send a message.
[00:12:02.900]Which way do you send the message?
[00:12:04.680]It all kind of is inner related.
[00:12:07.190]So, if you think about adult communication
[00:12:09.250]between like spouses or friends or family.
[00:12:11.647]This adult brain, the adult brain processes this
[00:12:15.630]but it's still very confusing.
[00:12:17.490]So, like all of us are home now.
[00:12:20.510]Well, most of us are home now.
[00:12:22.660]So, we are probably learning new
[00:12:24.790]and different ways of communicating.
[00:12:26.300]So, I often when we're talking my boyfriend will say
[00:12:30.010]I don't think you get what I'm saying.
[00:12:31.670]And so, that's him giving me that feedback.
[00:12:35.280]So, I decode that and I kind of say
[00:12:37.280]I usually respond with something like well.
[00:12:39.290]I get what you said, I'm just adding new information
[00:12:42.540]to kind of help that clarification.
[00:12:45.568]A lot of times we look, does hearing a voice help
[00:12:50.360]versus reading a text or an email?
[00:12:54.750]Decoding, the receiver receives it and it decodes it.
[00:12:57.871]If they're reading it, they're reading it in their own voice
[00:13:00.990]and adding their own information as to how
[00:13:03.630]they would have sent it.
[00:13:06.000]Whereas, if you can actually hear the voice
[00:13:08.950]and see the person.
[00:13:10.180]You could have additional information such as
[00:13:13.380]facial expressions and gestures.
[00:13:15.050]Which I don't know if you can see me doing
[00:13:16.531]underneath the screen.
[00:13:21.870]If it is red, like I said.
[00:13:24.080]Usually that head voice is added to it
[00:13:28.750]and if you think about it it's really exhausting
[00:13:31.500]for adults to figure it out.
[00:13:33.470]So, now pretend you have.
[00:13:35.460]Imagine you have a two year old brain
[00:13:37.550]with only two years worth of experiences.
[00:13:40.470]And then if there are sensory issues to kind of
[00:13:43.920]mess up that message even more.
[00:13:46.010]It could be very challenging.
[00:13:49.230]This is one of my favorite graphics that I like
[00:13:51.380]to share with parents to just kind of talk about
[00:13:54.960]what is actually needed to develop communication?
[00:13:58.184]It looks at three different areas.
[00:14:01.160]Sensation, perception and response.
[00:14:04.292]The sensation or sensory takes into consideration
[00:14:08.600]all of the sensory processes that Tara talked about.
[00:14:12.120]The ability to hear, feel and motor plan for speech,
[00:14:17.480]is part of those sensations.
[00:14:19.440]An early intervention, one of the first questions we ask
[00:14:22.330]during the evaluation or RBI is about health history.
[00:14:26.440]History of ear infections or sinus infections.
[00:14:29.260]Just kind of figuring out is the child sensing?
[00:14:32.980]Can they hear, can they see?
[00:14:35.480]Do they have the motor movements to create that speech?
[00:14:39.640]Then we move to perception which is
[00:14:42.180]how those are experienced.
[00:14:45.010]So, the central processing works for us to, again,
[00:14:48.260]that brain function and wiring.
[00:14:50.820]Also, emotional quality.
[00:14:54.263]I read recently read an article that there was
[00:14:56.880]research released that linking tantrums in two year olds
[00:15:04.860]to be late talkers and language difficulties
[00:15:07.670]as in early intervention.
[00:15:09.510]My first thought was, you think?
[00:15:12.080]Two year olds do not have emotional intelligence yet
[00:15:15.420]to regulate that emotional quality part of their perception.
[00:15:21.490]And if you look, when we talk about language
[00:15:24.000]it's actually a very small piece of communication.
[00:15:28.470]It's not a small piece but it's only one piece.
[00:15:30.710]So, it actually means.
[00:15:32.680]It's the means in which the message is conveyed
[00:15:35.610]and it depends a lot on that event knowledge or experience.
[00:15:40.770]So, that experience is the way infants and toddlers
[00:15:43.580]learn the language.
[00:15:44.630]They pair what they hear and what they're seeing
[00:15:47.366]with the words they are hearing.
[00:15:49.600]And so, that brain changes in response to those experiences.
[00:15:57.740]That third part of it, then they learn.
[00:16:02.820]They respond and then they problem solve
[00:16:06.040]with those responses to figure out what is
[00:16:08.080]a good response and what is a bad response.
[00:16:11.760]They learn receptive language.
[00:16:14.820]Sorry, I lost my note.
[00:16:16.740]Receptive language is when the receiver
[00:16:18.640]understands the message based on the vocabulary.
[00:16:23.200]And the expressive language is how gestures
[00:16:25.280]and speech are used to communicate.
[00:16:27.380]So, it's all wrapped up within the
[00:16:29.840]shared social interaction.
[00:16:32.910]And then again, that feedback is provided.
[00:16:36.500]So, it is that process of going back
[00:16:39.150]and forth between two people.
[00:16:42.120]When we do our language intervention evaluations
[00:16:45.030]it's interesting to me because typically
[00:16:47.050]they look at social emotional and communication
[00:16:50.960]as separate domains.
[00:16:53.150]But a lot of if you look at the different skills
[00:16:56.880]within those domains, they kind of overlap.
[00:17:00.850]And a lot of times when we do those evaluations
[00:17:04.680]if a child has autism they will show
[00:17:06.842]developmental differences in both.
[00:17:09.975]I always find it really interesting.
[00:17:12.158]The brain is wired to sounds of a certain language
[00:17:16.060]inside the mother's womb.
[00:17:18.520]The baby in the womb has no event knowledge.
[00:17:22.010]Has no way to attach meaning to those sounds
[00:17:25.182]until it is born.
[00:17:27.260]And then immediately those experience start to create
[00:17:30.870]the meanings of those sounds.
[00:17:32.850]But, that's the start of learning to communicate.
[00:17:40.792]I have a student that when I evaluated her.
[00:17:45.200]These are my favorite types of students because
[00:17:47.420]they are very complex.
[00:17:50.723]And it kind of, I had to keep in mind this whole social
[00:17:55.140]and communication and everything all working together.
[00:17:58.500]Her same is Suri and she's Korean speaking.
[00:18:01.967]She has older siblings who are English speaking.
[00:18:07.450]She watched videos in English.
[00:18:09.240]So, she is almost three.
[00:18:12.390]So, her main vocabulary receptive language wise
[00:18:15.780]was colors, numbers, shapes and letters.
[00:18:17.570]And then the words to the songs that she had learned
[00:18:19.780]by watching the videos over and over.
[00:18:22.990]When I first evaluated her I knew she had
[00:18:25.210]some sensory issues.
[00:18:26.720]That there was a lot of those learned behavior issues
[00:18:30.250]because of the parents response to the way
[00:18:32.780]she was communicating.
[00:18:35.570]During the evaluation she constantly tried to escape me.
[00:18:38.940]She was still on a bottle.
[00:18:40.480]She had the bottle hanging from her mouth.
[00:18:42.600]And anytime the mom tried to take the bottle away
[00:18:45.045]her first reaction was meltdown.
[00:18:48.110]Which again, tells me that her perception.
[00:18:52.660]Her emotional quality was poor and the response
[00:18:55.360]was always the meltdown.
[00:18:56.440]But because the feedback with that sensation was rewarded.
[00:19:00.280]That was her go to because that's what was
[00:19:02.480]successful for her.
[00:19:04.330]So, she qualified.
[00:19:06.420]Started talking to mom through the interpreter
[00:19:09.000]about not rewarding those tantrums.
[00:19:11.160]Reducing that success rate with those tantrums.
[00:19:15.220]Once we figured a lot of behaviors.
[00:19:17.830]That's when I brought Tara out for the on the line talk
[00:19:22.650]with those sensory issues.
[00:19:24.270]But we figured out she didn't need any
[00:19:27.830]specific sensory tools or anything like that.
[00:19:30.880]The easiest way for her to calm is through
[00:19:34.280]that receptive language.
[00:19:35.710]So, anytime she tried to escape I would start
[00:19:38.560]singing the ABC song.
[00:19:40.334]And because it's something she knows and recognizes.
[00:19:43.600]Her response was oh, hey.
[00:19:45.250]You're speaking my language even though it wasn't Korean,
[00:19:47.990]it was ABCs.
[00:19:49.310]And then she was more willing to engage with me.
[00:19:51.890]So then, the more I coached her mom.
[00:19:54.970]The more Suri became more organized
[00:19:57.970]and able to self regulate.
[00:20:00.380]One of the slides earlier, there's a little girl
[00:20:03.570]bent over a hammock turning herself upside down, that's her.
[00:20:11.400]But she did, she became more organized.
[00:20:14.929]We figured how the common language.
[00:20:18.610]She's starting to now pretend play with her siblings.
[00:20:21.930]She hands over objects.
[00:20:23.353]She's starting to develop a proximal point to request.
[00:20:27.150]She's starting to imitate in both English and Korean.
[00:20:31.100]And she still has autism.
[00:20:31.993]There's still those underlying developmental differences.
[00:20:35.990]But getting on her level and using that social context
[00:20:40.640]and considering everything kind of helped her gain
[00:20:45.900]and develop those critical skills needed
[00:20:48.580]in any language to develop.
[00:20:50.562]I will also say the other thing that was great
[00:20:53.690]that happened is through coaching her mom.
[00:20:56.265]A lot of times her mom, we would coach.
[00:20:58.930]And during the visit I would model and she would take over.
[00:21:02.740]And then the mom was like nobody ever told me
[00:21:05.810]I was supposed to do this.
[00:21:07.080]The day we started pretend play, Suri loved Play-Doh.
[00:21:11.640]So, we brought out the Play-Doh and then we had the dishes.
[00:21:14.330]And then I started pretending to feed a stuffed animal
[00:21:17.870]and she started imitating me.
[00:21:19.617]And the mom almost cried and she's like I had no idea
[00:21:23.150]this is how I was supposed to be playing with her.
[00:21:25.460]So, kind of just taking into consideration
[00:21:28.040]that entire process is what we're going to
[00:21:32.820]kind of get into a little bit.
[00:21:37.800]And with that I'd like to.
[00:21:39.720]It brings me, manding.
[00:21:42.820]So, that's the key word.
[00:21:45.097]It just means asking for things with intention.
[00:21:48.750]So, pairing that perception
[00:21:51.500]and response portion of communicating.
[00:21:54.040]Again, needs that sender and receiver.
[00:21:57.430]The sender needs to be aware of the receiver.
[00:21:59.740]Which, again, with a lot of our kids with autism
[00:22:03.430]and sensory issues.
[00:22:04.950]They might not necessarily have that
[00:22:06.930]awareness in the beginning.
[00:22:08.914]Neurotypical children usually are aware
[00:22:11.520]and learn through trial and error
[00:22:12.950]without a lot of direct teaching.
[00:22:14.810]But for children on the autism spectrum
[00:22:17.629]manding looks a lot different
[00:22:19.600]and a lot of times needs to be taught.
[00:22:22.860]When working with families in the home the purpose for me
[00:22:26.170]is not to make the parents the therapist.
[00:22:28.420]But to teach them how to encourage that skill development
[00:22:32.320]and through daily routines and natural interactions.
[00:22:36.120]So, anyone who's been to the getting ready training
[00:22:40.040]and are using it.
[00:22:41.543]We realize that this is the way.
[00:22:44.170]It sets the family up for successful intervention
[00:22:46.940]between visits, not just at the visit.
[00:22:50.030]So, when we talk about manding I usually
[00:22:55.800]start by coaching the parents and care providers
[00:22:58.880]to become those active observers.
[00:23:01.700]So, when talking about, obviously.
[00:23:05.370]It's the child's wants and or needs to communicate
[00:23:09.180]is kind of that basic.
[00:23:11.050]But then what I immediately go to is...
[00:23:20.190]What I immediately go to is finding those motivators
[00:23:23.220]because when talking about concerns with parents.
[00:23:26.120]Most parents say something along the lines of
[00:23:28.920]I just want my child talk.
[00:23:30.330]Or I would like to know how to communicate with her.
[00:23:32.550]Or I wish I knew what he was thinking.
[00:23:34.800]So, the easiest way to do that is to observe
[00:23:37.440]what motivates that child.
[00:23:41.150]What is he willing to work for?
[00:23:42.690]What causes the meltdowns?
[00:23:45.750]What is not as meaningful?
[00:23:47.120]If you hold out a little bit will the child just walk away?
[00:23:51.440]This is usually where we start with communication.
[00:23:56.220]So, helping those parents understand what this looks like.
[00:23:59.310]And creating that list of motivators to use as rewards
[00:24:03.140]is key when starting to work on those
[00:24:06.210]communication and play skills.
[00:24:09.270]Because those rewards are what you're going to use
[00:24:11.930]to make any communication or mand successful.
[00:24:16.300]And what is successful is what you see more of
[00:24:19.710]because experience changes the brains
[00:24:24.840]and those rewards matter.
[00:24:26.490]I would also like to point out that this is
[00:24:28.080]going to be very individualized.
[00:24:29.850]So, what works for one child might not
[00:24:32.120]necessarily work for another.
[00:24:34.050]So, it's very critical to have a solid list
[00:24:36.590]for each individual child.
[00:24:40.020]Then, I get into with the parents skills before first words.
[00:24:47.370]The tricky part is the number of words
[00:24:49.790]is the most obvious way to measure communication skills
[00:24:53.353]because they can be counted.
[00:24:55.400]So usually, again, what happens is the parents
[00:24:57.940]go in for the two year well child check.
[00:25:02.720]They use an ASQ and when the question
[00:25:05.260]is your child using 50 to 100 words asked.
[00:25:08.570]If the parent says no, then they are usually
[00:25:10.700]referred to early intervention.
[00:25:12.530]And then during the evaluation, the developmental
[00:25:15.240]assessment of young children obtains information
[00:25:19.460]on some of the communication skills.
[00:25:21.433]But there are still those skills needed before first words.
[00:25:25.340]And so, that these words are functional and meaningful.
[00:25:28.330]So, if a child is not talking or has no words.
[00:25:31.660]I would usually pull this chart out
[00:25:33.790]and go through it with the parents.
[00:25:34.973]So, we can determine together what skills are missing
[00:25:38.320]and where to start.
[00:25:40.510]This also gives the parents solid knowledge
[00:25:43.620]of what those skills look like and what to work on next.
[00:25:51.380]Sometimes, sorry my notes.
[00:25:58.970]A lot of times these skills happen before
[00:26:01.910]the actual words are used.
[00:26:04.630]Sometimes words are used but not meaningful at all.
[00:26:07.890]Which means they're missing that receptive language piece
[00:26:10.640]or that understanding piece.
[00:26:12.170]This is called echolalia.
[00:26:13.880]Again, I can talk another 20 minutes on echolalia.
[00:26:17.790]But for the sake of time I want to just
[00:26:20.150]kind of focus on the skills that we're looking at.
[00:26:22.960]So, when we go through the strategies
[00:26:24.740]they kind of relate back.
[00:26:28.930]I do want to point out that on here.
[00:26:31.139]Joint attention is not until number four
[00:26:35.251]but that's where mot people try to start with the teaching.
[00:26:38.200]They feel like they have to be sitting still
[00:26:40.010]and making eye contact and have joint attention
[00:26:42.299]in order to teach communication.
[00:26:46.800]But if we look at those three skills before hand
[00:26:49.720]they are the skills that are needed before
[00:26:52.420]joint attention can be achieved.
[00:26:54.650]So, if a child is not responding to things
[00:26:57.640]in their environment or not responding to people.
[00:27:02.030]Or doesn't have attention span
[00:27:04.160]and paying attention to objects.
[00:27:06.100]Then that's where we need to start
[00:27:07.730]as opposed to that joint attention.
[00:27:13.610]Again, the purpose of joint attention.
[00:27:17.550]I like to talk to parents a lot about how
[00:27:19.510]for a child with autism.
[00:27:21.200]Words don't hold any meaning or motivation usually.
[00:27:24.770]Just vocabulary and sounds floating in the air.
[00:27:28.010]And it's because of the lack of this joint attention.
[00:27:31.330]For a child with autism the language needs to be
[00:27:34.410]anchored to something or something tangible
[00:27:37.100]and meaningful to that child.
[00:27:39.220]There must be a one to one correlation with the word
[00:27:41.950]and response to that word or action.
[00:27:44.296]And it must also be consistent and predictable.
[00:27:47.610]So, that's how come screen and iPads and videos
[00:27:53.250]and colors, numbers, shapes and letters
[00:27:55.750]are very meaningful and motivating.
[00:27:57.410]Because a circle is always a circle
[00:27:59.660]and a B is always a B.
[00:28:01.280]And those are what are successful and motivating to a child.
[00:28:06.180]So, knowing the parents name or saying I want a drink
[00:28:11.350]is not as motivating because videos
[00:28:16.390]and songs are predictable.
[00:28:17.660]And the child memorizes the sequence of events.
[00:28:20.420]And the behavior of other people is unpredictable
[00:28:24.920]and not always the same.
[00:28:26.400]So, there's purposes of joint attention
[00:28:30.130]but the real purpose to keep in mind
[00:28:32.650]is to make a person more predictable
[00:28:35.470]and meaningful to the child with autism.
[00:28:37.580]'Cause this creates that need for people versus object.
[00:28:41.170]And that person then can build that vocabulary
[00:28:44.741]by anchoring those words to their functions.
[00:28:49.220]Again, we'll say it several times.
[00:28:51.120]The grade of changes in response to experiences.
[00:28:54.470]So, the more consistent and predictable parents
[00:28:57.150]can make the environment.
[00:28:58.400]The stronger the development of neural pathways
[00:29:01.490]will be for receptive vocabulary.
[00:29:06.120]Again, more about joint attention.
[00:29:08.970]So, when looking more specifically at joint attention.
[00:29:13.190]It's most basic definition is when two people
[00:29:15.770]focus on the same thing.
[00:29:17.473]So, when we look at communication as that process,
[00:29:21.720]a sender and a receiver are needed.
[00:29:23.892]Joint attention links those two.
[00:29:26.200]It's kind of like connecting your cellphone to wifi.
[00:29:29.240]Again, if you look at the different levels
[00:29:32.750]of joint attention or shared attention.
[00:29:34.797]Eye contact does not come in until level four.
[00:29:39.980]Yet, that's where most people start when learning skills.
[00:29:43.290]They feel like they need to have eye contact
[00:29:45.430]so that they have joint attention.
[00:29:47.770]Again, probably because it's the most measurable
[00:29:50.199]and that gives the most direct feedback.
[00:29:52.880]If I'm looking at you, I'm telling you
[00:29:55.120]that I'm listening to you.
[00:29:58.780]If you compare that skills before first words
[00:30:01.520]in the first level of joint attention.
[00:30:08.490]The third skill in the skills before first words was that
[00:30:14.220]attention to an object, action or person.
[00:30:16.700]Developing an attention span to the object,
[00:30:19.080]action or people.
[00:30:21.300]So that when there's a response.
[00:30:23.440]Like level one, response to hand on an object.
[00:30:28.199]Even though, you move the hand away or putting the hand on.
[00:30:36.500]It is a meaningful response because both the person
[00:30:41.810]owning the hand and the child are actually
[00:30:44.260]paying attention to that hand.
[00:30:46.090]Therefore, you're both paying attention to the same thing.
[00:30:49.630]I talk to parents a lot about magic hands.
[00:30:52.470]'Cause many children will take, you've seen it.
[00:30:55.140]They pull, they place the hand on the object
[00:30:58.330]and then stare at that hand like it's just
[00:31:01.260]supposed to know what to do.
[00:31:02.960]Most of the time the parents do know
[00:31:06.210]just what the child wants.
[00:31:07.810]So, the hand does what it's supposed to.
[00:31:12.600]Therefore, that mand was successful.
[00:31:14.720]It involved a sender, a child.
[00:31:17.570]A sender which was the child actually.
[00:31:19.856]A receive which was the hand.
[00:31:22.790]And the message was transmitted and decoded
[00:31:25.200]and the response was that the hand did,
[00:31:27.170]it opened the container.
[00:31:29.300]So, why would a child learn to make eye contact
[00:31:32.930]when responding to a hand on an object was successful.
[00:31:37.280]That's kind of where we have to break it down.
[00:31:44.330]Sensory processing and joint attention in infants.
[00:31:47.210]There's some studies done here.
[00:31:49.200]So, there have been studies done in the
[00:31:52.720]pre-attentive stages or in infancy.
[00:31:55.056]So, before joint attention is actually a required skill
[00:31:58.390]there are two different responses from most infants.
[00:32:02.130]And that kind of starts the way that infants brain is wired
[00:32:05.940]for joint attention is based on these responses.
[00:32:10.280]So, orienting is where the infant is curious.
[00:32:16.970]Orienting occurs when a sensory event captures
[00:32:19.610]the child's attention.
[00:32:22.120]And it's important for an enabling further exploration.
[00:32:27.360]It shows that the infant is curious.
[00:32:29.530]It's focused and tuned in to learn.
[00:32:32.380]It's active learning when it's looking.
[00:32:35.610]The defense or startle happens when
[00:32:39.410]the stimulus is intense or overwhelming.
[00:32:42.360]And this kind of discourages joint attention.
[00:32:45.420]So, the infant does not have enough experience
[00:32:48.280]to recognize what is real and what is make believe.
[00:32:51.170]So, the startle reaction is the infant's system
[00:32:55.610]going into that fight or flight mode.
[00:32:57.460]It's the infant, a lot of time infants will stop crying
[00:33:01.990]but it does not stop crying and attend because
[00:33:05.070]it's calm and enjoying and it likes what it's seeing.
[00:33:08.120]It stops because she is trying to determine
[00:33:10.910]if it's in danger and it's life is threatened.
[00:33:15.274]These two very different reactions are
[00:33:18.210]the difference between active learning
[00:33:20.288]and passive or inactive learning.
[00:33:25.640]The orienting, if a child orients and the adult responds
[00:33:29.900]then there's interaction there.
[00:33:31.520]So, that a sender and receiver going back
[00:33:33.630]and forth with each other.
[00:33:36.010]The startle kind of shuts that brain down
[00:33:39.200]and wires it to constantly be on alert.
[00:33:44.730]Defensive or startle, I talk a lot about
[00:33:47.560]screen time with families and the infants
[00:33:50.000]response to screen time.
[00:33:51.820]Put a lot of stuff out on Facebook about it also.
[00:33:55.240]I have a good friend of mine who's a new first mom.
[00:33:57.890]Her name's Katie.
[00:33:58.972]And she called me, she was all worried about
[00:34:02.463]how much screen time her infant son was getting.
[00:34:06.396]Because they FaceTime with grandma every morning
[00:34:09.930]and grandma lives here in Omaha.
[00:34:11.580]And should she stop doing that because it's screen time?
[00:34:15.456]And I kind of tried to explain it to her
[00:34:17.900]using this and I said well.
[00:34:19.800]The difference is grandma is responding
[00:34:23.390]and interacting over that screen.
[00:34:25.820]So, it's more of an orienting in a positive experience
[00:34:31.640]changing the brain because there's interaction.
[00:34:34.240]Whereas, just passive watching video screen time
[00:34:38.300]does not provide any reactions from the brain.
[00:34:48.410]I want to also tag onto that and talk about strategies
[00:34:52.530]for initiating and rewarding joint attention.
[00:34:55.292]'Cause joint attention is a skill.
[00:34:57.660]Again, like we said, that anchors those words
[00:35:00.380]and makes language meaningful and intentional.
[00:35:03.030]So, these strategies can be used when providing
[00:35:05.710]sensory tools to help organize that brain more.
[00:35:09.580]So, for example, bringing in object for help.
[00:35:15.390]I love containers, they're my favorite.
[00:35:17.589]But if you think about putting a child's favorite toy
[00:35:20.450]in a container and then that child has to, again,
[00:35:24.840]respond to the object and attend to the object.
[00:35:28.340]So, they bring the container to the magic hand.
[00:35:32.230]And then by using the strategy we can also kind of
[00:35:38.700]up that ante a little bit.
[00:35:40.390]So, maybe the magic hands do not open
[00:35:42.470]the container right away.
[00:35:44.640]Creating unsuccessful communication.
[00:35:46.670]So, this gives that child that feedback
[00:35:49.730]and an opportunity to adjust to make it more successful.
[00:35:53.230]So, maybe the child then taps on the lid.
[00:35:56.350]So, we have the attention to an object
[00:35:59.250]and then that level two of joint attention
[00:36:04.070]responds to tapping.
[00:36:06.420]Now we have progress because that tapping
[00:36:08.700]will be rewarded by that hand still opening that container.
[00:36:13.870]So again, whatever is successful you see more of.
[00:36:16.990]So, these are just different natural ways then
[00:36:19.670]to reward joint attention.
[00:36:21.770]And the good news is since we're moving to more
[00:36:24.990]of the parents providing daily opportunities.
[00:36:29.720]Parents can use these during those daily routines.
[00:36:34.850]Okay so, in grad school we studied like all of the people.
[00:36:40.460]But Vygotsky spoke to my soul.
[00:36:43.430]It's probably the reason I settled in
[00:36:45.440]early intervention and never left.
[00:36:48.070]And this quote for me sums up approaching
[00:36:51.260]to working with family.
[00:36:52.800]So, for me here the key words are biologically determined
[00:36:56.680]'cause you can't change genetics.
[00:36:59.270]Cultural development, so that takes into account
[00:37:01.850]all the families we work in and takes into account
[00:37:04.200]different language, the different traditions.
[00:37:07.070]Those traditions and social rules, the different cultures.
[00:37:13.620]These rules are created or learned by the interaction
[00:37:19.640]of a growing child with other people.
[00:37:22.012]The brain changes in response to experiences.
[00:37:25.404]So, if we can go in and teach parents and caregivers
[00:37:28.840]how to change those interactions with the child.
[00:37:31.552]Because of the neuroplasticity in the first three years.
[00:37:35.050]We have an opportunity to change the development
[00:37:37.400]of that child's brain.
[00:37:39.280]I'm not saying it'll cure autism.
[00:37:41.152]But I also go back and think what if it happened sooner?
[00:37:48.990]In the book Discovering the Culture of Childhood
[00:37:51.320]Emily Plank who's the author talks about meeting a child
[00:37:55.960]where they are instead of where we think
[00:37:59.160]we as adults think they should be.
[00:38:00.970]So, she makes the point which I love.
[00:38:03.470]She makes the point that we do not practice our
[00:38:05.680]wheelchair skills at the age of 40 in anticipation of
[00:38:08.850]not being able to walk when we're older.
[00:38:11.330]Yet, there's constant emphasis being placed
[00:38:14.100]on what the child will need rather than
[00:38:16.430]what skills they currently have.
[00:38:18.570]So, for me it's much more than just looking at their
[00:38:22.640]play skills or their social emotional skills
[00:38:25.120]or the communication skills.
[00:38:26.560]We have to take into consideration that entire child
[00:38:30.370]and that entire social context.
[00:38:36.760]I do kind of want to touch on social and play skills
[00:38:39.370]but not very much because I can do another hour
[00:38:41.870]on different ways and explaining the social and play skills.
[00:38:46.730]They are very intertwined and they all lead to
[00:38:50.940]those communication skills.
[00:38:53.010]The way the child plays, if you observe.
[00:38:55.963]When the child plays reflects their motivation,
[00:38:58.700]problem solving and how organized he or she is.
[00:39:01.840]And a lot of the vocabulary, receptive
[00:39:07.040]and expressive vocabulary can be introduced in play.
[00:39:10.470]So, this is just kind of again.
[00:39:12.000]It goes through all of the people.
[00:39:13.590]Erickson, Piaget, Vygotsky.
[00:39:17.490]I just wanted to put this out there so
[00:39:20.170]a lot of you probably already know about
[00:39:22.060]the different stages and types of play.
[00:39:27.260]Which brings me to research that shows and the research.
[00:39:31.500]The main factors that influence whether the child
[00:39:33.920]will meet their language outcomes and learn to talk
[00:39:38.430]are these factors that influence the
[00:39:40.860]differential language outcomes.
[00:39:42.910]And those factors, it's inattentiveness.
[00:39:45.436]Social unresponsive behavior, restrictive
[00:39:49.010]and repetitive behaviors, those acting out behaviors.
[00:39:52.700]But, if we look at it and put a spin on it.
[00:39:56.020]It all could be a result of different types of sensory
[00:39:59.240]processing and what is successful to self regulate.
[00:40:02.530]So, if we start observing and adding sensory strategies
[00:40:06.900]and pair them with the language strategies
[00:40:09.287]to provide an incurve for that vocabulary,
[00:40:12.353]that would be helpful.
[00:40:14.040]But if these behaviors are looked at just from
[00:40:17.113]a sensory processing lens, they're interruptive.
[00:40:24.180]So, when I look at the behaviors.
[00:40:26.400]Rather then looking at them as their bad
[00:40:29.160]and we need to fix them.
[00:40:31.000]I look at it through and research out there
[00:40:35.520]looks at it through a different lens.
[00:40:37.960]So, help me out here Tara.
[00:40:42.090]Hypo responsiveness characterized by the absence
[00:40:46.380]of the expected response to stimuli or a delayed response.
[00:40:50.330]To me when I see hypo responsiveness I say, oh.
[00:40:54.930]We are not meeting this child's threshold
[00:40:56.910]because they have a really high threshold.
[00:40:58.850]And they might not be anchoring that vocabulary
[00:41:01.700]because they are not even aware it's happening.
[00:41:05.030]Hyperresponsiveness is exaggerated by that adverse reaction
[00:41:13.210]or that avoiding reaction.
[00:41:16.430]And again, they have a super low threshold
[00:41:19.210]and they might not be learning that vocabulary
[00:41:21.110]because they are actually avoiding those interactions.
[00:41:24.198]So, they aren't even aware of the vocabulary.
[00:41:29.320]Am I right?
[00:41:30.920]Yes.
[00:41:31.753]Did I get it right?
[00:41:32.586](laughing)
[00:41:33.419]Yes, very good.
[00:41:34.360]Hypo responsiveness, again, is a high line.
[00:41:37.370]So, an example I use for hypo responsiveness is
[00:41:41.800]I was asked to consult on a child that an
[00:41:44.130]early childhood special ed teacher was seeing.
[00:41:46.185]And she's like I just don't know what to do with them.
[00:41:48.470]He's not responding, he's not talking.
[00:41:54.199]He's just looks at me and there's no response.
[00:41:56.840]Well, when I went in there.
[00:41:58.980]I have a very different personality than her.
[00:42:01.040]I'm very loud, I have a loud voice.
[00:42:03.767]My service coordinators warn parents that I
[00:42:05.910]flip children upside down.
[00:42:07.547]So, I went in there and he and I started rough playing.
[00:42:11.140]We started playing with cards.
[00:42:12.710]We started running around, jumping, crashing
[00:42:15.470]and the teacher was just amazed.
[00:42:17.010]She was like it's a completely different child.
[00:42:19.680]He was engaged, he had eye contact.
[00:42:22.430]And the difference was I was meeting that threshold.
[00:42:25.050]She is very soft spoken, very calming.
[00:42:28.110]Which works for the majority of our children.
[00:42:30.370]But for him, she wasn't the right fit for him
[00:42:33.050]until she had to go out of her comfort zone
[00:42:35.304]and meet his threshold.
[00:42:37.260]And that's what that hype responsiveness is.
[00:42:39.431]The hyperresponsiveness, if you look at
[00:42:41.680]those picture on this slide.
[00:42:43.400]Here's a great example.
[00:42:44.690]This little girl I worked with, she's awesome.
[00:42:47.500]I still keep in touch with her.
[00:42:49.150]But if you look, again, normal beautiful photos.
[00:42:52.520]But if you look at her feet.
[00:42:53.930]Her feet are not touching the ground because
[00:42:55.720]that tactile responsiveness.
[00:42:57.650]She is very defensive to her environment.
[00:42:59.920]So, that's our hyperresponsiveness.
[00:43:01.811]Her threshold is really low and she's going too high
[00:43:04.770]and she's responding to it in a negative manner.
[00:43:10.980]So, the next slide.
[00:43:13.290]Sorry, I'm not (laughing).
[00:43:14.830]On the developmental strategies.
[00:43:16.590]Again, I just really like this quote.
[00:43:18.990]It's a good reminder that the brain
[00:43:20.510]and the body are connected.
[00:43:21.800]Look for clues from the body.
[00:43:23.370]The body is essential for learning.
[00:43:25.470]I used to use this all the time when I worked in schools
[00:43:27.750]but I think schools are doing so much better with this
[00:43:30.840]than they were 20 years ago.
[00:43:32.440]Teachers are now letting the kids move their, you know.
[00:43:35.460]They've really figured out that the brain
[00:43:37.150]and the body are connected.
[00:43:38.327]But also it's critical that we
[00:43:40.310]coach parents on this concept.
[00:43:42.130]Many parents still need to be educated that
[00:43:44.320]the children learn best through play.
[00:43:46.380]And obviously that's what we do birth to three is play.
[00:43:49.210]Experience, experiences changes brain.
[00:43:52.240]Not flashcards and seated tasks.
[00:43:55.360]Another handout that I wanted to make sure you guys had
[00:43:57.660]is another one that we use a lot with our parents.
[00:44:00.799]Especially I bring it up a lot when
[00:44:02.955]I'm asked to be a consult.
[00:44:05.580]When again, I'm not the primary.
[00:44:06.920]When I'm not the primary service provider.
[00:44:08.900]Say a child was referred for speech
[00:44:11.780]and that's the only area on the DACI that
[00:44:13.740]they qualified in was speech.
[00:44:15.700]And so the speech therapist working with the child
[00:44:17.790]and all the parents want to do is have that child talk.
[00:44:20.960]The speech therapist is like Tara, I need you to come out.
[00:44:23.530]This is how we explain to parents why an
[00:44:25.102]occupational therapist is coming into their home.
[00:44:27.940]Because a lot of them are confused.
[00:44:31.100]My child has no issues other than not talking.
[00:44:33.740]But if you look at the bottom of this pyramid.
[00:44:35.640]It's really easy to explain to parents.
[00:44:37.498]You have to have those foundations
[00:44:39.650]of good sensory processing.
[00:44:41.400]They have to be adequate tactile, vestibular,
[00:44:44.650]proprioceptive input in order to reach that top level.
[00:44:48.020]Which is academic learning, daily living skills,
[00:44:50.860]behavior, language.
[00:44:52.660]So, I really use this pyramid a lot with families
[00:44:55.820]and it really helps parents understand.
[00:44:58.160]Especially dads, it's a very visual.
[00:45:01.170]So, it's a really good way to explain why
[00:45:02.878]we're hitting at the bottom of the pyramid
[00:45:05.110]instead of trying to start at the top.
[00:45:09.090]Another good visual that we use and I love this
[00:45:12.400]because it explains.
[00:45:15.550]It's a great way to organize your approach
[00:45:17.410]to figuring out what works with the child.
[00:45:19.770]I really like how this diagram shows
[00:45:21.490]four different core components.
[00:45:22.960]Sensory, behavior, motor and physiology.
[00:45:25.980]It also shows the other factors that
[00:45:27.630]influence self regulation.
[00:45:28.940]Including environment, cultural differences.
[00:45:31.520]So, a good example is that child Suri that
[00:45:33.486]Krista was talking about earlier.
[00:45:35.870]Her pie graph was heavy on behavioral strategies
[00:45:38.620]that needed to be addressed first.
[00:45:40.350]She does have sensory needs.
[00:45:41.830]Using music to organize, using inversion on the hammock.
[00:45:45.000]But that's only a part.
[00:45:47.250]So, on the second slide here are examples
[00:45:49.530]about every chart looks different for every child.
[00:45:51.820]You guys don't have this slide
[00:45:53.360]but I kind of threw this in there because
[00:45:54.820]I didn't want you to think that that graph was static.
[00:45:58.170]It should look different for every single child.
[00:46:01.520]Again, when I go in sometimes even the
[00:46:04.294]primary service provider is confused because
[00:46:06.940]they bring me in because the child has sensory issues.
[00:46:09.780]And they're expecting me to give the typical sensory tool.
[00:46:12.670]And I do, I'll a lot of times say, okay.
[00:46:17.140]Let's have a water bottle out for them to self regulate.
[00:46:20.178]But a lot of the strategies I give are
[00:46:22.243]they need a visual schedule.
[00:46:23.880]They need to limit the amount of toys in the environment.
[00:46:26.880]Social stories, let's start with social stories.
[00:46:29.146]So, it's really important to determine what
[00:46:31.530]is primarily driving the child.
[00:46:33.560]And it's not always sensory.
[00:46:34.910]Krista and I a lot of times walked out of visits.
[00:46:38.350]And I'm like, yeah.
[00:46:39.183]They are driven by behavior or other things
[00:46:41.950]not primarily sensory.
[00:46:43.960]So, we have to look at the child
[00:46:45.530]and address those things first.
[00:46:47.110]It's not saying that we're not going to address the sensory
[00:46:49.258]but we might not start there.
[00:46:54.020]Okay, so sensory integration tools.
[00:46:55.920]I know I just got a question saying
[00:46:57.180]are you guys gonna get to strategies?
[00:46:58.510]We are but the key to strategy is honestly,
[00:47:03.298]understanding when that child is on the line.
[00:47:06.150]It can mean anything and I love it when I walk
[00:47:09.010]into a home and the parents are like, oh my gosh.
[00:47:11.470]She was on the line all morning.
[00:47:13.074]And then I know they got it.
[00:47:14.738]It's not like they said, oh.
[00:47:16.570]Well I had her jump on the trampoline
[00:47:18.360]and then I had her use her weighted blanket.
[00:47:20.375]That's not what's important.
[00:47:22.350]What's important is that she was on the line
[00:47:24.310]and that she was getting that information.
[00:47:28.380]And able to understand what we were trying to
[00:47:32.109]get her to learn from her environment.
[00:47:34.420]So, these are the different tools.
[00:47:35.620]These are just some of the tools that we use.
[00:47:39.310]Again, I have cinnamon up here.
[00:47:40.880]A lot of times kids are very alerting.
[00:47:42.620]So again, if their line is really high.
[00:47:44.600]Higher flavors are alerting.
[00:47:46.540]Jumping on a trampoline, I love mini trampolines.
[00:47:49.720]That's a great way to get input throughout the day.
[00:47:52.980]Music, especially for our little ones.
[00:47:55.470]I love music, it's like drumming.
[00:47:58.383]So, Native American drumming, shaman drumming.
[00:48:02.627]Different things like that that have that rhythm.
[00:48:06.663]It doesn't have to have the words to it.
[00:48:09.130]So, having the music in the background.
[00:48:11.530]It's good for kids with low registration
[00:48:13.360]and with high registration.
[00:48:14.550]Again, depending on how you use it.
[00:48:17.090]The vibrating toothbrushes, I love anything with vibration.
[00:48:21.840]That's a lot of proprioceptive input.
[00:48:24.090]So, just depending on the child is depending
[00:48:26.890]on what tool we use.
[00:48:28.370]I'm not gonna go over every single one of these tools,
[00:48:31.410]there's thousands.
[00:48:32.940]If you look, if you just do a Pinterest search
[00:48:35.880]for sensory strategies.
[00:48:37.150]There's thousands and thousands of strategies out there.
[00:48:39.830]So again, the strategy.
[00:48:41.489]The tool is not what's important.
[00:48:43.870]It's what gets the child on the line that's important
[00:48:46.560]and you're gonna have to use a lot of those.
[00:48:48.960]I do use the vest, the vest is in the middle.
[00:48:51.320]I use it a lot.
[00:48:54.060]I usually use it in the beginning because it's an
[00:48:56.630]easy way to get parents to understand
[00:48:58.660]and see a neurological change in their child.
[00:49:01.800]So, when we put the vest on the parents are like oh my gosh,
[00:49:04.430]they're calm.
[00:49:05.410]Oh my gosh, they're paying attention to me.
[00:49:07.007]And I'm like, that's it.
[00:49:08.300]That's what it looks like when they're on the line.
[00:49:10.340]So, that vest shouldn't be used alone
[00:49:13.290]but at the same time.
[00:49:14.320]I use it a lot as a tool to get parents to recognize.
[00:49:18.170]And then I come back and the parents are like, oh.
[00:49:20.769]They need to wear the vest in the morning
[00:49:22.620]but the afternoon they don't need it.
[00:49:24.010]They can stay on the line without it.
[00:49:25.187]And I'm like yes, you've got it.
[00:49:27.260]So, that's how we use these tools is getting that
[00:49:30.780]parent to understand when they work, when they don't work.
[00:49:33.500]And having that big toolkit to be able to grab out
[00:49:36.125]when they see their child falling off that line.
[00:49:38.580]Oh no, they're falling off the line.
[00:49:39.900]What can I do to get them back on the line?
[00:49:43.380]I also usually explain the vest as if you have a child
[00:49:46.120]with a very high threshold.
[00:49:47.570]It brings that threshold down.
[00:49:49.620]So, it's a lot easier for them to register input.
[00:49:52.240]So, it gives them just enough input
[00:49:53.730]that it literally lowers that threshold line.
[00:49:56.350]So, I use the vest a lot of times for that.
[00:50:01.130]Okay, sensory diet.
[00:50:03.440]That term has been around for a very long time, since 1971.
[00:50:07.610]To describe a therapeutic method to maintain
[00:50:10.060]an optimal level of arousal in the nervous system.
[00:50:13.210]By offering the right combination of sensory information.
[00:50:16.185]Now, I explain it to parents as just as
[00:50:18.680]we need food throughout the day.
[00:50:20.960]We also need sensory experiences throughout the day.
[00:50:23.410]Again, that word experiences.
[00:50:26.384]We have to be able to feed the nervous system
[00:50:28.797]and gain those changes in the brain.
[00:50:33.810]So, providing that input throughout the day
[00:50:35.996]is essential to giving that brain the sensory experiences
[00:50:39.550]it needs to strengthen those neural pathways
[00:50:42.069]so we can literally wire.
[00:50:43.950]And if needed rewire the brain through neuroplasticity.
[00:50:48.610]So, here's some more strategies that I use.
[00:50:51.020]Again, we use the sensory tools but those should be a part.
[00:50:55.440]The goal is, again, anything.
[00:50:57.300]If the child is organized, if the child is calm and alert
[00:50:59.747]and the child is on the line.
[00:51:01.690]Then that's a sensory strategy you should be using.
[00:51:05.010]Visual schedules, I love visual schedules.
[00:51:07.519]I get a lot of well, you're an OT.
[00:51:09.560]Why are you using visual schedules?
[00:51:11.240]I use them because it helps organize the child.
[00:51:14.040]Giving them that, if one sensory system is not
[00:51:17.320]working well which is auditory.
[00:51:18.910]Then go through a different system.
[00:51:20.200]Go through the visual system.
[00:51:21.690]And so, that's why I use visual schedules.
[00:51:24.480]Social stories, I love social stories.
[00:51:26.700]Again, children need to know what's coming next
[00:51:29.820]and what is making things predictable.
[00:51:32.630]Predictability organizes the brain.
[00:51:35.600]Utilizing an object or picture for transition.
[00:51:39.070]Utilizing songs for transition.
[00:51:41.680]Incorporating routines into the day.
[00:51:43.560]There are so many strategies that we use
[00:51:46.110]that help organize children.
[00:51:48.950]Again, a big one that I use again is that heavy work.
[00:51:51.646]Pushing, pulling, carrying, weighted backpacks.
[00:51:55.860]Any of that heavy work, those proprioceptive
[00:51:58.470]is usually the most organizing for a child.
[00:52:01.200]Sometimes you'll have a parent that says again.
[00:52:04.360]The child loves to rock and rock and rock.
[00:52:06.110]But does it actually organize the child?
[00:52:08.600]You have to ask those clues.
[00:52:10.840]Okay, well are they more organized after they rock?
[00:52:14.130]Well, no.
[00:52:14.963]Okay, well that's fine.
[00:52:15.796]They can rock but that's not going to be
[00:52:17.810]what gets them on the line.
[00:52:19.970]And so again, whatever it takes to get that child organized.
[00:52:24.890]Another big key here is the parents and caregivers
[00:52:27.520]become the sensory integration tool.
[00:52:29.700]They, at first, have to be able to see
[00:52:33.000]when that child is on the line.
[00:52:34.630]And the awesome thing is the more that child is on the line
[00:52:38.270]like I talked about earlier.
[00:52:39.586]The more that will become their normal.
[00:52:41.620]And then the child will start doing these tools on their own
[00:52:44.510]and seeking it out.
[00:52:45.870]So, I love it when we get to a point where
[00:52:48.730]instead of the parent saying, okay.
[00:52:50.520]You need to go jump on the trampoline.
[00:52:51.910]The child just knows I need that.
[00:52:54.170]I need to go jump on the trampoline.
[00:52:55.950]I don't feel like I'm on the line anymore.
[00:52:58.670]And then we know that that true sensory integration
[00:53:01.350]is really happening.
[00:53:03.120]And that brain change is happening
[00:53:05.430]because the child is starting to feel what it feels like
[00:53:09.310]to be calm and alert the majority of the time.
[00:53:17.400]So again, from Vygotsky.
[00:53:19.650]This is kind of my version of calm and on the line.
[00:53:26.150]Everybody just disappeared.
[00:53:28.150]Am I missing something?
[00:53:30.240]Okay, I don't like this format.
[00:53:33.730]So, parents and children alike.
[00:53:36.240]You can use this zone of proximal development
[00:53:38.610]because it just talks about that focused teaching.
[00:53:43.690]It's helpful with coaching strategies.
[00:53:45.850]So, parents feel comfortable in using them.
[00:53:49.140]So, the zone of proximal development just
[00:53:52.010]shows the balance between what is known
[00:53:54.160]and what needs to be learned.
[00:53:56.160]Again, everything else just disappeared.
[00:53:59.500]So, I'm not sure people can hear me or not.
[00:54:05.560]There you go.
[00:54:06.900]Okay, sorry.
[00:54:08.200]This is crazy.
[00:54:09.033]I just--
[00:54:09.866]I can't see you but I can hear you so.
[00:54:11.806](laughing)
[00:54:13.590]All right, can you see me now?
[00:54:15.200]Yes, you're good.
[00:54:16.033]Okay, sorry.
[00:54:17.246]My whole screen went blank.
[00:54:19.280]So, it was kind of, whoa.
[00:54:22.070]Anyway, so this just kind of shows that approach.
[00:54:27.390]And trying to find when you're coaching
[00:54:29.090]that balance between what is known
[00:54:31.800]and what needs to be learned.
[00:54:33.430]So, the line here actually represents those skills
[00:54:36.810]that are too difficult for the child or parent
[00:54:39.098]to master on his or her own.
[00:54:42.240]That can usually be successful and achieved
[00:54:45.330]with guidance, encouragement and coaching
[00:54:48.350]from the more knowing other.
[00:54:50.720]So, if it shows if a challenge is too hard
[00:54:54.270]it causes anxiety.
[00:54:55.510]Kind of like I just had and it's too easy.
[00:54:59.230]It creates that boredom reaction.
[00:55:01.940]So, trying to find that balance between
[00:55:05.340]what the learner achieves independently
[00:55:07.750]and what the learner needs help with.
[00:55:14.800]Teaching parents what on the line looks like.
[00:55:18.490]And what organized looks like is kind of part of that
[00:55:23.560]because then we can coach them once they recognize that.
[00:55:26.940]Then we can coach them on strategies to use
[00:55:29.870]to keep that child on the line.
[00:55:32.090]They have the confidence to mix and match
[00:55:35.300]and use those strategies daily.
[00:55:37.390]And then that's where that rewiring
[00:55:39.570]the child's brain happens.
[00:55:41.360]So that when the pruning occurs those other neurons.
[00:55:45.010]The play, the social communication
[00:55:47.660]and the cognition are not lost.
[00:55:52.490]Those familiar with getting ready might recognize this
[00:55:56.190]because this is kind of what getting ready is all about.
[00:56:01.200]Although it's not called the zone.
[00:56:02.960]In getting ready, the support of the more knowing other
[00:56:06.370]is provided by the providers through coaching
[00:56:08.680]and scaffolding those skills.
[00:56:11.470]And then the parents and caregivers play the role
[00:56:14.140]of the learners in this scenario.
[00:56:17.340]And I just thought this morning that as early intervention
[00:56:22.100]moves to supporting families virtually.
[00:56:25.660]The role of the parent and care providers.
[00:56:28.870]Our job is to make sure that they are that
[00:56:31.420]more knowing other when working with their children.
[00:56:33.920]So, how do you coach parents?
[00:56:38.604]Here's the different things that you're not
[00:56:40.770]teaching this to the child.
[00:56:42.020]You're coaching the parents on how to use these
[00:56:44.760]evidence based language strategies.
[00:56:47.650]And combining them with those
[00:56:48.960]sensory integration strategies.
[00:56:51.000]So, you do not have to wait till the child is on the line
[00:56:53.720]to start working on how to get joint attention from them.
[00:56:57.520]Because you will be rewarding it all at the same time.
[00:57:02.550]Rewarding those communication attempts.
[00:57:05.090]So, teaching the parents what communication attempts
[00:57:07.810]look like helps because then the parents are like, oh.
[00:57:10.280]I didn't realize that we're doing that
[00:57:11.867]and you're going to have a lot more
[00:57:13.850]communication attempts rewarded.
[00:57:16.150]Your classic parallel talk.
[00:57:17.730]Again, that's that parallel talk is talking about
[00:57:20.900]what the child.
[00:57:21.840]The adult talking about what the child is doing
[00:57:24.050]and that's part of anchoring that vocabulary
[00:57:26.950]to those specific actions.
[00:57:29.330]Visual cues, a circle is always a circle.
[00:57:32.940]A picture of a fruit snack is always
[00:57:34.810]gonna get a fruit snack.
[00:57:36.030]So, my two hardest ones that I have to talk to parents about
[00:57:41.500]are those delaying responses to gestures
[00:57:44.060]and not anticipating these desires.
[00:57:46.960]Because those two, if you can get the parents to kind of
[00:57:50.890]back off on doing that.
[00:57:52.100]That will create those communication attempts
[00:57:55.670]and then rewarding successful communication.
[00:57:58.630]And then what you see more of is
[00:58:01.080]or what is successful is what you'll see more of.
[00:58:04.760]A lot of these look similar to that previous list.
[00:58:10.940]They just are the way that we can change that interactions.
[00:58:17.730]Change those interactions so that growing child,
[00:58:21.230]the other people are involved.
[00:58:25.160]A lot of these are the same.
[00:58:28.160]People games are one of my favorites.
[00:58:32.330]They're fun, they're easy to do.
[00:58:35.890]And anyone knows, who's been around toddlers.
[00:58:39.650]Knows that you cannot make a toddler do anything
[00:58:43.050]but you can control your response and what you do with them.
[00:58:47.050]So, what are people games?
[00:58:49.080]Came directly from Caden.
[00:58:52.140]And the people games you just observe the child
[00:58:55.550]and then join in on the activity.
[00:58:58.460]And turn it into an interactive back
[00:59:00.890]and forth turn taking game.
[00:59:02.170]So, kind of going over some of those
[00:59:04.580]sensory seeking behaviors.
[00:59:06.610]If your child enjoys running you can
[00:59:08.390]turn it into chase or tag.
[00:59:10.062]If they enjoy you can start playing Ring Around the Rosie
[00:59:14.632]or you can have them spin in a chair.
[00:59:17.220]And then to scaffold on that you spin them
[00:59:19.280]on a chair and then stop.
[00:59:20.650]And then they have to say go or indicate
[00:59:22.780]that you want them to go again.
[00:59:25.430]Jumping, Five Little Monkeys Jumping on a Bed.
[00:59:28.080]Everybody knows the words to that rhyme
[00:59:31.250]and it hasn't changed.
[00:59:32.680]You can jump together while holding hands.
[00:59:35.350]So, they're getting that touch and proprioceptive together.
[00:59:40.920]If they like to feel soft fabrics or textures
[00:59:43.838]using a blanket to play peekaboo.
[00:59:48.400]Tickles with a feather.
[00:59:51.310]Watching hands or fingers move.
[00:59:54.030]Finger play games like Daddy Finger or This Little Piggy.
[00:59:59.080]Deep pressure or strong hugs.
[01:00:01.970]Giving a big, like if you're playing the chase game.
[01:00:04.500]You catch him, you give him a big squeeze.
[01:00:06.365]I also if they like deep pressure or strong hugs.
[01:00:09.980]I didn't put it on here but I usually like to try to
[01:00:12.780]pair either a word or a sound effect.
[01:00:15.300]So like, if they are doing joint compressions
[01:00:18.380]every time they change a diaper.
[01:00:21.010]They might use like squish squish or boom boom
[01:00:24.580]every time they do a joint compression.
[01:00:26.370]So again, that word is anchored to a specific activity
[01:00:31.610]that is motivating and meaningful to the child.
[01:00:34.720]Again, music or sounds.
[01:00:36.900]Singing a song and dancing with the child
[01:00:40.210]rather than passively just letting the child
[01:00:42.450]listen to and repeat the song over and over.
[01:00:47.810]That is all that we have.
[01:00:52.620]Here is our email addresses.
[01:00:57.350]If anybody has any questions.
[01:00:58.680]I can't see any of the chats or anything.
[01:01:00.670]So, I don't know--
[01:01:02.110]If you guys would like to use the chat
[01:01:04.270]to ask specific questions then I can
[01:01:05.670]always read them out loud.
[01:01:07.290]Yeah, that would probably work best.
[01:01:08.990]Okay.
[01:01:14.250]Okay, can you share more information about getting ready?
[01:01:17.990]Some people are not familiar with that.
[01:01:19.590]You've kind of referenced it a few times.
[01:01:22.160]Getting ready, so there's state resources
[01:01:25.700]about getting ready that is for early intervention
[01:01:28.900]that's kind of the new.
[01:01:32.550]I don't know what it's called.
[01:01:33.560]Model, yeah.
[01:01:35.060]The new model.
[01:01:37.650]It goes along with like routines based interview and--
[01:01:43.840]If you're a parent, essentially what it is
[01:01:46.170]is the state is training us on specific strategies
[01:01:51.010]as we go into the home.
[01:01:52.490]Like how to coach parents.
[01:01:54.145]And so, they want everybody in the entire state
[01:01:57.268]using the same strategies and using the same approach.
[01:02:00.680]So, it's like a home visit or training.
[01:02:03.150]So, we're all kind of using the same language
[01:02:05.220]and the same coaching model.
[01:02:06.470]Is that the right way to explain it Krista?
[01:02:09.840]Yeah, it's a--
[01:02:12.200]I'm guessing it's more parents asking that question,
[01:02:14.360]I could be wrong but.
[01:02:16.360]It's a model and an approach for home visitors
[01:02:20.230]to use so that it's consistent across the state.
[01:02:27.560]Does that make sense?
[01:02:31.160]Makes sense to me and no one asked another question so.
[01:02:33.668](laughing)
[01:02:35.124]It's hard when we can't get feedback, sorry guys.
[01:02:38.640]Okay--
[01:02:39.473]This is really hard.
[01:02:40.306]It is--
[01:02:41.160]Okay, actually OT, EDN and Westor.
[01:02:43.250]Okay, I think they started with certain school districts.
[01:02:47.710]So, I think they're trying to go statewide with it.
[01:02:49.880]So again, it's a straight training.
[01:02:52.300]What they're trying to do is get everybody on board
[01:02:54.324]using the same approach in early development.
[01:02:57.860]Awesome.
[01:02:59.110]Okay, so do you have any recommendations for a child
[01:03:01.790]who gives up on every item?
[01:03:04.610]So, this person's tried something similar
[01:03:07.760]to the container activity you mentioned.
[01:03:09.520]That child like looses interest immediately.
[01:03:13.820]So, what where I would start is I would start with
[01:03:17.710]that observation piece.
[01:03:19.330]And try to get a bunch of things out
[01:03:23.030]and then just kind of observe what
[01:03:24.800]the child gravitates towards.
[01:03:26.430]Because again, when I was talking about that motivators.
[01:03:29.058]The motivators is what the child is
[01:03:31.330]motivated and interacting with.
[01:03:33.410]So, a lot of times kids on the spectrum are not interested
[01:03:38.750]in interacting with humans and people.
[01:03:41.810]But they might have favorite toys
[01:03:43.950]or they might have favorite activities.
[01:03:46.630]Again with Suri, every time she started having a meltdown
[01:03:51.960]she would sing the ABCs to herself.
[01:03:54.050]So again, I observed that and I came in and said, oh.
[01:03:56.650]Well I'm gonna start singing with her
[01:03:58.354]just to let her know that I want to interact with her.
[01:04:01.500]So, it's kind of like that reverse parallel play
[01:04:04.730]if that makes sense.
[01:04:06.142]So, what I would do is if they had favorite foods,
[01:04:09.150]favorite toys, favorite videos.
[01:04:11.970]And just kind of see what the child is willing to work for
[01:04:15.730]and then start there.
[01:04:20.010]And also make sure those threshold are hit first.
[01:04:22.880]Because again, if the child is focused on
[01:04:26.160]meeting those neurological needs.
[01:04:28.060]They're not gonna be focused on communication as much.
[01:04:30.810]So, you have to make sure those thresholds are met first
[01:04:33.090]and those neurological needs are met first.
[01:04:34.878]So, that way they are engaged enough
[01:04:37.038]to want to do other things.
[01:04:39.270]Again, think back to that driving a car in a storm.
[01:04:42.340]If all they're worried about is meeting that
[01:04:44.350]neurological need and just trying to
[01:04:45.990]keep themselves regulated.
[01:04:47.690]They're not gonna be focused on anything else.
[01:04:49.700]But sometimes you do have to start there.
[01:04:54.860]All right, okay.
[01:04:56.050]Looks like, what time is it?
[01:04:58.410]We'll do one more.
[01:04:59.790]How do you find time to explore or practice
[01:05:02.270]sensory activities in already full school day
[01:05:05.340]or a non-supportive/busy home?
[01:05:08.420]So, this person has limited time to work with kids
[01:05:11.220]and is pressed to hit academic goals.
[01:05:13.890]So, how do you fit in those sensory components?
[01:05:17.885]I've never written, well I can't say never.
[01:05:22.340]I haven't in a very, very long time.
[01:05:23.890]I will not write a sensory goal on an IFSP or an IEP.
[01:05:29.153]I don't agree with it because sensory
[01:05:32.410]integration should be the.
[01:05:36.360]It should be the foundation of meeting that academic goals.
[01:05:39.970]So, the math goal.
[01:05:41.580]I'm going to be working on a math goal
[01:05:43.530]as an occupational therapist to make sure
[01:05:45.400]that child is organized enough to meet that math goal.
[01:05:48.470]Or if a child has a reading goal or if the child.
[01:05:50.864]Get even younger, IFSP has a goal of eating.
[01:05:54.470]We write the goal for eating,
[01:05:55.650]we don't write the goal for sensory.
[01:05:57.470]So again, the whole point is you can't pull them apart.
[01:06:00.680]So, when I worked in more schools or in preschools.
[01:06:05.090]Again, you have incorporate it in.
[01:06:06.960]So, if you're working on say learning.
[01:06:09.820]Again, I hate flashcards.
[01:06:10.960]But say you're working on letters.
[01:06:12.930]I've had children that need that vestibular.
[01:06:14.730]So, I spread the letters all over the floor
[01:06:16.810]and they've had to bend down.
[01:06:18.370]Pick up the letter and then show it to you.
[01:06:20.440]So, that way you're still working on the academics
[01:06:22.590]but you're getting the vestibular input that they need.
[01:06:26.460]I've had a lot of special ed teachers that have put
[01:06:29.480]balance beams or trampolines in the corner of their room.
[01:06:32.260]If the child gets off the line and they're realizing
[01:06:35.020]that they're not able to focus, they say go walk.
[01:06:37.290]Those balance beams are great for centering
[01:06:39.780]and getting them back organized.
[01:06:41.260]So, they can then go back and do that academic work.
[01:06:43.610]So again, it shouldn't be separate, it should be part of it.
[01:06:46.890]So, trying to incorporate movement into
[01:06:48.888]your learning strategies.
[01:06:52.031]I don't believe in doing sensory and having a sensory goal
[01:06:55.471]and then having academic and having an academic goal.
[01:06:57.970]It should be the same.
[01:06:59.330]It should be all in the same.
[01:07:01.430]Again, I worked on math goals.
[01:07:03.020]I worked on reading goals.
[01:07:04.200]I worked on language goals when I worked in the school.
[01:07:06.780]I never once had a sensory goal.
[01:07:09.440]And in the home, like I have parents.
[01:07:12.820]Once they learn what on the line looks like
[01:07:16.638]and what helps their child get them there.
[01:07:18.830]I have one mom that they have a trampoline
[01:07:21.034]in their living room.
[01:07:23.090]And when the child goes and jumps on it.
[01:07:24.966]She holds him by his hips.
[01:07:27.440]So, she's giving him that extra input
[01:07:29.510]and she's helping him jump and she sings this jumping song.
[01:07:33.850]And then when she's done singing the jumping song she stops
[01:07:37.030]and waits for him to indicate that he wants that song again.
[01:07:40.850]So, it's not separate.
[01:07:43.000]She's providing him the center integration
[01:07:46.410]strategies needed to keep him on the line.
[01:07:49.630]And then she's rewarding those joint attention strategies
[01:07:52.608]and creating those communication strategies
[01:07:55.320]when they come up.
[01:07:56.153]So, it's not you have to do this, then you have to do this.
[01:07:59.600]The trick is to work with the family
[01:08:01.610]and see what works for them in that busy household.
[01:08:04.970]Figure out how you can combine the two
[01:08:07.080]and what motivates that child.
[01:08:08.815]And then you can just naturally reward that together.
[01:08:13.210]Does that make sense?
[01:08:14.230]Yeah, I mean let's face it.
[01:08:15.810]Having a child with special needs in the home is hard.
[01:08:18.480]It's really, really hard and I think that's what number one.
[01:08:21.940]Taking that parent wherever they're at.
[01:08:23.607]And I used to, when I was younger and naive.
[01:08:27.420]I used to write these beautiful sensory diets.
[01:08:30.690]And I would hand parents a sensory diet
[01:08:33.310]saying in the morning do this, in the afternoon do this.
[01:08:35.790]I don't do that anymore.
[01:08:37.107]I say I don't care what you do.
[01:08:38.800]I don't care how you get that child on the line.
[01:08:41.710]You've got to get that child on the line.
[01:08:43.130]And once they get on that line and the parents see that.
[01:08:45.390]It makes our life so much better.
[01:08:47.860]A lot of times because of the behavioral.
[01:08:49.500]We have so many less tantrums.
[01:08:51.610]So many less communication fits where
[01:08:54.180]they can't communicate.
[01:08:56.670]So, it is a lot of work at first.
[01:08:58.740]But like I always explain to the parents.
[01:09:00.450]If you can get there it's gonna make your life
[01:09:02.770]a thousand times easier and it does.
[01:09:05.330]But I don't give the parent a specific
[01:09:07.630]you have to do this during the day
[01:09:10.030]because it doesn't work that way.
[01:09:11.660]So again, incorporate in the diaper changes.
[01:09:13.900]Incorporate into, you know.
[01:09:15.690]If you're going somewhere, put weight in that backpack.
[01:09:19.650]That doesn't take any more time.
[01:09:21.700]It takes like an extra 10 seconds to put
[01:09:23.280]a backpack on a child.
[01:09:24.610]So, I've kind of changed my strategies where I don't
[01:09:27.350]really give out those huge sensory diets where I used to.
[01:09:30.260]And we really just function on what's
[01:09:32.210]already going on in the home.
[01:09:33.800]And again, RBIs for those of you that are
[01:09:35.890]familiar with those really help with that.
[01:09:37.860]Really help kind of figure out what's
[01:09:39.120]gonna work for each family.
[01:09:42.720]All right, thanks guys.
[01:09:43.790]I love that, love that.
[01:09:45.660]Okay, so that is all of our time for today.
[01:09:47.940]I know there's a couple questions we didn't get to.
[01:09:50.180]We apologize, but email either Krista or Tara
[01:09:53.640]or myself and we can get you connected on that.
[01:09:56.570]So, everyone enjoy your lunch
[01:09:58.810]and we'll see you for the next session.
[01:10:00.710]Thank you Krista and Tara, that was amazing.
[01:10:02.680]Bye, thank you.
[01:10:04.830]Thank you.

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Sensory Integration and Improving Developmental Skills: Beyond Vests and Chewy Tubes

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