Occupational Therapy (OT) What we do and some tips…..

Overview of Talk Who are we and what do we do? How do we deliver the service? What is Occupational Therapy? How we can help? Sensory Processing…… Practical strategies that you can carry out at home.

Please ask me to speak slower at any stage….I tend to speak fast!!! Please ask questions…

Who are we? Autism (South Lee) Support Services

Early Years Team Up to the end of first class Social Work – Helen Forde Speech and Language Therapy – Charlotte Coogan Psychology – Micaela Connolly Occupational Therapy (OT) – Ashwini Rao Pre-School therapist – Aileen Ahern & Susan O’Brien Home Support Workers – Pippa O’Sullivan

Middle Years Team 2 nd class - The end of 5 th class Social Work – Maureen O Brien Speech and Language Therapy – Jane Hegarty/Jennifer Cahill/Aoife Ni Riordain Psychology – Catherine Hallissey/Paula Prendeville Occupational Therapy (OT) – Marianne Ryan Home Support Workers – Bernadette Finnegan/Amy Buckley

Teen Years Team Sixth Class - to the end of secondary school Social Work – Speech and Language Therapy – Noreen O’Sullivan Psychology – Seamas Feehan Occupational Therapy (OT) – Lesley Morrissey Home Support Workers – Roisin McDaid & Sarah Keohane

Autism Services (South Lee) What do we do? –Diagnostic –Intervention – work closely as a multi- disciplinary team

Model of Interventin Service Delivery Environment Group Intervention Individual Therapies

What is an Occupational Therapist (OT) An O.T. is a medical professional who evaluates and treats children and adults who have difficulty in meaningful activities (or “occupations”) relevant to their daily lives. As well as relating to work or a job, occupation can mean any activity a person engages in. This can include self care, play and leisure activities, and work. For a child “work” often involves playing, learning and going to school (Stensaas, 2007). An O.T. helps your child build or compensate for skills in everyday life (Tilton 2004).

Areas that are assessed. Gross motor activities Fine motor activities Sensory Processing Activities of daily living How a child’s performance of these factors influences their ability to learn and play and participate in all activities of daily living.

What are Gross Motor Skills? Gross motor development involves the larger muscles in the arms, legs and torso. Gross motor activities include walking, running, throwing, lifting, kicking etc. These skills relate to body awareness, reaction speed, balance and strength. Children develop gross motor skills in a step by step progression. Development occurs at an uneven pace and this is part of typical development.

What are Fine Motor skills? Fine Motor skills generally refer to the purposeful and controlled movement of the fine muscles of the fingers and hands. These movements usually coordinate with the larger muscles of the arms and trunk for stability and with the eyes for eye hand coordination.

Additional Role of Occupational Therapists with Children with ASD Provide generic ASD recommendations Organisation skills Activities of daily living - ? Sequencing, motor difficulty Advise around play skills – particularly in school yard with MDT Team Problem solving with MDT Team

Why might you avail of Occupational Therapy Input? If your child is having difficulty in their performance of everyday tasks (play, self care tasks, school tasks) or If your child’s gross motor or fine motor skills are not to a developmentally appropriate level, or Your child’s sensory processing is impacting on their ability to carry out everyday tasks. Problem solver/detective

Intervention The Occupational Therapist will treat your child by working on specific areas of difficulty highlighted by the assessment. This may include some of the following: –Working on motor skills or encourage more adaptive responses to sensory input. –Parent Training –School Training – including consultation and recommendations to school –Home/school programme –1:1 or group therapy to address a specific skill deficit.

Let’s look at Sensory Processing

What are our senses?

EXERCISE: VESTIBULAR AND PROPRIOCEPTIVE SYSTEMS IN ACTION Finger to nose eyes closed Sequential finger touching Balance on one leg eyes open and closed

Our Senses touch taste sound vision smell Balance/Movement/vestibular Body awareness/proprioception

What is Sensory Integration/processing?

What is sensory processing Continuous flow of information through sensory systems Brain must sort, prioritise and emphasise to understand and decide what to do

How is sensory processing related to ASD?

What problems can arise with Sensory Processing? For some children sensory integration does not occur as it should. Dysfunction in sensory integration happens when the brain cannot sort out, filter, organise or integrate sensory messages. This does not mean that the brain is damaged, but that the information from the senses is not flowing and integrating efficiently.

Effects of Sensory Processing on Children Fight or flight, irritable excited, on the go, stressed, anxious Energetic, over stimulated Overwhelmed bombarded Calm alert state of arousal Ready to learn, focused Can appear lethargic, tired, bored, Unmotivated, lazy

Sensory processing Secondary to difficulties with tasks Poor postural control sensitive to touch or seeking touch Overwhelmed by smells or seeking out smells Too bright Or visually distracting Need to Move in seat Too much Noise, or slow to register sounds What do we see?

Strategies you can try for the child who is sensitive to noise or slow to register sounds Reduce the noise if possible Allow the child a breaks out of the noisy environment Watch your own tone and pitch when communicating with your child Use reduced language, give the child time to process what has been said before repeating using the exact same language. Use of visuals instead In some cases headphones may be necessary Use the child’s name when addressing them Make sure the child sees you. Use deep pressure to help the child be calm

Sensory Processing Secondary to difficulties with tasks Poor postural control sensitive to touch or seeking touch Overwhelmed by smells or seeking out smells Too bright Or visually distracting Need to Move in seat Too much Noise, or slow to register sounds What do we see

Strategies you can try for the child who is sensitive to touch Allow the child to use gloves, utensils to avoid directly touching messy materials Allow the child to see you before you touch them. Consider tags and different types of clothing Consider queuing Consider shower vs bathing Consider toilet Never force the child to participate Allow the child to use wipes or wash hands if they need to Use visual borders on the desk to highlight children’s space Use firm rather than light touch Deep Pressure Strategies to try with the child who seeks a lot of touch Schedule sensory breaks where the child gets touch input: rice play, shaving foam sensory walk etc Use fidgets (where, when and how?) Materials/objects with extra texture (spiky ball)

Sensory Processing Secondary to difficulties with school tasks Poor postural control sensitive to touch or seeking touch Overwhelmed by smells or seeking out smells Too bright Or visually distracting Need to Move in seat Too much Noise, or slow to register sounds What do we see?

Strategies you can try for the child who is overloaded by visual stimuli Reduced ‘pictures/posters’ on the walls Use blinds if light is too bright Highlight the important visuals for communication Sun glasses Consider homework – how much doe the child SEE that they have to do – can you reduce this?

Sensory Processing Secondary to difficulties with tasks Poor postural control sensitive to touch or seeking touch Overwhelmed by smells or seeking out smells Too bright Or visually distracting Need to Move in seat Too much Noise, or slow to register sounds What do you see

Strategies you can try for the child who is overloaded by olfactory (smell) input or appear to seek out smells constantly Schedule sensory breaks where the child gets smell input : make a smell bank air fresheners, scented hand cream, scented candles etc Create opportunities to get extra smell input in everyday activities: art, cooking, make an orange air freshener, make scented playdough etc – add essential oils Use visuals (‘rules’) to explain what is appropriate and not appropriate to smell Reduce smells in the classroom: no strong perfumes please! Eat separately to other children Find out which smells they don’t like.

Sensory Processing Secondary to difficulties with tasks Poor postural control sensitive to touch or seeking touch Overwhelmed by smells or seeking out smells Too bright Or visually distracting Need to Move in seat Too much Noise, or slow to register sounds What you might see

Children who have poor postural control (this can impact writing – consider the following in particular for homework) Ensure the chair is the correct size and the child can put their feet flat on the floor Armrest? Cushion? Footrest? Slant board? Visual cues as reminder to adjust position in chair Sit beside wall for extra stability Practice sitting balance on the gym ball

Sensory Processing Secondary to difficulties with tasks Poor postural control sensitive to touch or seeking touch Overwhelmed by smells or seeking out smells Too bright Or visually distracting Need to Move Too much Noise, or slow to register sounds What do you see?

Children who need to move Scheduled or unscheduled movement breaks: gym ball, walk, heavy muscle work (crawling, rolling, animal walks etc) Jobs for group Move-n-sit or disc-o-sit cushions Sit on gym ball for activities

Additional sensory/movement break suggestions Bounce on peanut ball, roll over ball Weightbearing activities: animal walks, wall push ups, chair push ups Trampoline Deep pressure: self squeeze, hand massage, push 5’s In school you could suggest that your child’s teacher gets him/her to hand out milk, pages, opening windows, going to the office etc

Activities that provide enhanced proprioception Stretchy scooby Theraband Animal walks Playground equipment: e.g. climbing apparatus, monkey bars Tug of War Row your boat Heavy Jobs at home or at preschool - carrying and giving out books - carrying and giving out art materials - opening doors for others - carrying toys -organising classroom space e.g. moving furniture Alternate positions for activities e.g. kneeling, standing and lying.

Sensory processing Reduced attention and concentrati on with homework etc Poor postural control sensitive to touch or seeking touch Overwhelmed by smells or seeking out smells Too bright Or visually distracting Need to Move in seat Too much Noise, or slow to register sounds What do you see?

Children who are distractible or have reduced concentration and attention Look at all other possible causes: (break it down) Is there a schedule – visual supports in place? Has the child sufficient sensory breaks, before and during homework etc Anxiety around certain tasks Poor motor planning and coordination Dyslexia, dyscalculia, Dysgraphia

Sensory Break symbol

SticKids sensory break activities

Provide enhanced sensory input: vestibular (movement), proprioceptive (heavy muscle work) tactile (deep pressure touch). Provide a range of activities to sustain interest. Visual supports to show the child what’s expected, help child to focus on activity, how to assume positions (motor planning), increase understanding, reduce language, consistent, opportunity for choice. Instructions to help the child to plan and sequence the activity

Sensory Passport Are all people who work with your child aware of their sensory needs?!?!

Role of Parent Parents play the biggest role in a child’s life Parent’s own knowledge Your knowledge of your child’s needs Your child spends most of their time with you.

Question Time Any questions or any tips etc you want to share with the group.. ??????????????????????????????

ADDITIONAL RESOURCES Useful companies

Useful Books Building Bridges through Sensory Integration, Second Edition [Ellen Yack, Paula Aquilla, Shirley Sutton] The Out-of-Sync Child [Carol Kranowitz, Lucy Jane Miller] Sensational Kids: Hope and Help for Children With Sensory Processing Disorder (SPD) by Lucy Jane MillerSensational Kids: Hope and Help for Children With Sensory Processing Disorder (SPD) Can't Eat, Won't Eat: Dietary Difficulties and Autistic Spectrum Disorders by Brenda Legge Book can be purchased online on ‘Amazon’ or on the ‘Book Depository’

Useful websites –See tips on support children who are picky eaters here Facebook Pages The Sensory Integration Network Sensory Play Ideas for Children