Resources

Definitions

Sensory Integration

Sensory Integration refers to the organisation of sensory information within the nervous system allowing for the planning of smooth, co-ordinated movements and attention to task. The senses include the five in our everyday understanding (touch, sound, vision, taste & smell), and also two body senses. These are the vestibular sense which responds to movement and gravity, and proprioception which is the sensation from our muscles and joints giving us our sense of position in space. Vestibular and proprioception work closely together to influence our balance, posture, co-ordination and control of eye movements. Theorists divide sensory integration into sensory modulation (the ability of the nervous system to respond appropriately to sensory input) and sensory processing affecting praxis (co-ordination).

Dyspraxia

Dyspraxia translates literally from the Latin as ‘difficulty doing’. It is a term used more commonly than the official diagnosis of Developmental Coordination Disorder (DCD) and refers specifically to a difficulty motor planning and learning new motor skills. DCD is characterised by difficulty performing age appropriate tasks in the areas of self care (e.g. dressing, feeding), leisure pursuits (e.g. bike riding, ball skills) and schoolwork (e.g. writing). It is frequently accompanied by marked sensory issues (sensitivities, sensory seeking and poor registration). The sensory issues combined with frustration due to poor motor skills often result in concerns in the areas of emotional control and social skills. The diagnosis of DCD is only given when there is no other neurological explanation for the symptoms and when motor skills fall below that expected for the child’s level of development: “Performance in daily activities that require motor coordination is substantially below that expected given the person’s chronological age and measured intelligence” – Criteria A DSM IV.

Good practise guidelines suggest that diagnosis is given only with multi-agency consensus. If assessment provides evidence for Dyspraxia / DCD then this will be stated in a report for a Paediatrician to consider.

Autistic Spectrum Disorder

In addition to difficulties with social communication and flexibility of thought, sensory issues frequently accompany Autism. These include:

• sensory seeking behaviours – walking on toes, being heavy handed and heavy footed, being unable to sit still, making lots of noise
• sensory sensitivities – struggling to cope with hair washing, nail cutting, loud noises and eating a limited range of food
• poor registration of sensory input – not noticing if shoes are on wrong feet or seeming switched off when being spoken to

Attention Deficit Hyperactivity Disorder

As ADHD results in a child’s nervous system running ‘too fast’, they frequently have sensory sensitivities or engage in sensory seeking behaviours in order to try to meet their need. Facilitating sensory modulation can assist in focusing attention.

Attachment

Attachment theory was first described by John Bowlby, with Mary Ainsworth’s research adding to the knowledge of the effect of an absent or inadequate attachment figure on child development. It is a growing field of work with recent advances in neuroscience supporting clinicians’ observations. Although poor early attachment experience can affect the child’s ability to form a secure attachment with adoptive or foster parents, the expression ‘Attachment Difficulties’ is often used to refer not to the bond with new parents but rather the impact on the brain of non-optimal care pre and post-birth and during the critical early years of development. This affects emotional regulation (due to impact of the stress hormone, cortisol), attention (both applying to task and excessive need for), motor skills, social skills, organisation, coping with change to planned activity, and the effectiveness of standard rewards and sanctions. In the field of attachment, this pattern of brain development is now often referred to as ‘early childhood trauma’. Neuroscientists confirm that the changes to the brain with resultant behaviour patterns is as that experienced by adult survivors of trauma who are diagnosed as having Post Traumatic Stress Disorder.

The dual training in physical and social-emotional development facilitates Occupational Therapists to work with children whose early experience affects brain processing. Eadaoin Bhreathnach’s many years experience in the field of sensory integration led to her development of a theory of Sensory Attachment Intervention (SAI). She describes how children develop behavioural strategies in order to survive their attachment environment. Their pattern is either to dissociate (freeze) or to flee and fight. Eadaoin links this with the attachment styles of avoidant, ambivalent and disorganised and teaches sensory strategies to address processing throughout the day with the knowledge that any seemingly innocuous event can trigger a trauma response (e.g. teachers perfume may be the same as that of a social worker who removed child in the middle of the night – triggers subconscious stress response – child’s behaviour is seen as bewildering to adult; when asked to justify their behaviour, the child cannot give an answer).

Cool Kids

Cool Kids is an exercise programme devised by Joy High, former Head Occupational Therapist that follows a sequence of developmental activities. It is designed to be undertaken by teaching staff ideally on a daily basis. It aims to develop:

• Sensory Processing
• Modulation of arousal levels and the ability to self calm
• Body awareness – a sense of position in space
• Postural control – in lying, sitting, kneeling and standing
• Praxis – organisation of actions / ideation and motor planning
• Bilateral sequencing- left / right and crossing midline
• Basic skills: skipping, hopping, ball skills

Although aimed at developing gross motor control, Cool Kids has also been shown to improve writing (Joy High, 2006). However some children require further direct input to develop their writing, particularly if they were not ready to write at the age that letter formation is initially taught.

Cool Characters

The Cool Characters programme provides activity advice for developing fine motor skills in general and supports the skills needed for fluent writing by improving body awareness, grouping letters for learning formation, while enjoying a variety of sensory media. It is designed for use with individuals or small groups of children, although principles could be applied as whole class activities.

• Establish a baseline – can child draw basic shapes e.g. triangle
• Note their posture, position of paper, pen
• Address body awareness (i.e. Cool Kids)
• Begin with tactile processing and finger isolation activities (feely bags, playdough)
• Use sensory media – sand, flour, shaving foam (but be aware of tactile issues)
• Group letters according to starting point
• e.g. l, i, t, u, y / c, a, d, g, q / r, n, m, h, b, p
• Does the child respond well to auditory cues / sing-song voice?
• Once basic letters shapes emerge, consider 4 line paper for positioning
• Do air writing of these letters for sensory snacks (Gemex)
• Cognitive awareness – the 4 ‘p’s: presses, pen, paper, position (practise)
• Pencil grips – to use, or not – consider age, the reason for their grip, emotions, practicality
• Paper ~ 20’ for right handers, 45’ for left
• Position – upright back, chair pulled in, sloping desk?
• Word searches, dot to dot, Cbeebies magazine! – fun ways to develop pencil control