There was a period of shaking magazines and bending notebooks. Then we adjusted this to shredding newspaper. Thankfully that has subsided as I touched up the walls around the house where his newspaper-printed hand prints were placed as he bounced off the walls. Currently the interest rotates between a tangle toy and ribbon wand.
Matthew’s recent Floor Time progress report noted the following:
Matthew will be able to co-regulate his range of emotions (with a focus on distress) and enter a regulated state, in less than 10 minutes, and return to purposeful interaction in a play activity with adult supports.
Baseline – When Matthew becomes upset and disregulated he will run around, vocalize, stomp his feet, and become aggressive. When Matthew becomes aggressive he may scratch, pinch, grab, hit, push and on occasion pull hair. Recovery time varies depending on Matthew’s mood, situation and the environment.
Some triggers can include, but are not limited to, - not getting his way, playful obstruction, doing challenging activities, not being able to get a toy to work the way he wants (i.e., if a toy is broken, when he tries to turn toys on/off that have a slide switch, which he cannot figure out).
Strategies: Utilize narration (simple language) and affect to help Matthew focus on the emotional experience. Use sensory support to help with regulation. Matthew will learn self-calming and co-regulation strategies with his mother when he becomes distressed.
I personally would add under recovery time it depends on whether he is sick and what time of the day it is. This is because he is on medication and over the course of the last six months the Floor Time therapy has taken place at various times of the day due to winter break and summer camp schedule. Matthew is more alert in the morning and early afternoon versus after school and camp later in the day, as this is also the time his medication is wearing off and a new dosage occurs after the session ends.
Many times a parent may hear that the therapist ended the session early because they lost the child. This could mean that the child was too disregulated and needed time to calm down and get back to their regular pace.
The progress report from this past summer camp session stated the following in regard to his behavior:
Matthew responds to general redirections, especially when using his interests (such as a game of choice), usually sequence for kids, or given pressure, after work is completed, to meet his sensory needs. When a change of the schedule occurs, or he is not comfortable with a new activity, Matthew shows frustration by vocalizing his anger, and pushing and running away from activity. However, he can quickly be redirected to participate in the activity, with some compromise.
When we go to the grocery store Matthew runs around the produce section to the end of the meet section and then back toward the front of the store and the swinging doors he gets to push through. Customers and workers will note this is done each time we go to the store. He might stop and squeeze bread, bananas, cheese packages, milk cartons, hot dogs and bacon before picking up his pace.
When I changed the routine for another store that has a pet club so I could save money on cat food Matthew was out whack. The store is not set up the same way and is very crowded with aisles packed up very high. While in the pet food aisle with Nicholas Matthew was on the outer aisle squeezing the steaks and meat packages. The manager approached Matthew who then ran up to me and scratched my face. The meat manager told me to keep my son away from the packages or we would have to pay for them. Matthew was puncturing holes in them and they had to toss them out.
Meanwhile my face was bleeding from the scratches and Nicholas was embarrassed and upset over the incident. We left the cart and walked out of the store. The ride back toward home gave Matthew time to recover and me to fix my face and help Nicholas deal with the episode. However, we still needed to get some items so we headed over to our usual store. Matthew hurled a scream as he zipped through the swinging doors, but was soon skipping around the store as I shopped for our items.
In the past when Matthew has seemed disregulated and needed some exercise we would pile into the minivan and drive down the street to the park and lake. One lap around the lake can be done in twenty minutes. Matthew must stop and sit at each bench, while Nicholas wants to feed birds and ducks. With the heat this summer we have not attempted this, but this is an idea for the next therapy session.
The Child Development Specialist (CDS) that does the floor time therapy went to camp one day for observing since she has done this at school and we wanted to compare and see how he does at camp. They allowed one half hour to sit and watch without participating. This particular year Matthew was in a class at camp with two girls and three boys. The class could have used an additional adult for support as the kids were loud and out of control often. There was only one large bouncy ball for these children to jump on and sit on during activities. When one child yelled and screamed the others would follow suit. The level was loud inside the class when we entered at the end of the day. They were left alone to do their pacing, screaming and bouncing. I felt bad for these kids since it seemed they needed a hug and more deep pressure. I was told by the CDS that the camp teacher would press down on Matthew’s chin and give him deep pressure. He was one of two kids who did not join in the scream-fest that took place while observing. The behavior escalated from one child to many with no relief in sight.
Years ago when Mathew attended preschool special education we obtained a weighted vest. Several years ago we tried a deep pressure vest while at feeding therapy, but Matthew did not like the feel of it. I thought a vibrating brush would help with the knots in his hair, but Nicholas preferred it more.
Matthew also utilized a seat cushion for his sensory needs when sitting at the table attending to school work. These can be used for twenty period intervals throughout the day. This was on loan from the Occupational Therapist department and kept in the classroom. This past year there was a similar cushion at his chair, but this was for posture purposes. One year the Occupational Therapist put masking tape in a circle around the classroom. The OT or teacher would weigh down his backpack with books and have Matthew pace around the section. Since his classroom opens out onto the playground he would also do laps with an adult from the class. At his previous Elementary School the whole class ran a few laps around the playground after circle time. I really like the implementation of that activity into the routine.
Lately Matthew has been walking around whacking the walls with the palms of his hands. When he is in session with the CDS they sit at the table with hands open and take turns hitting the hands. He really likes that, but with severe eczema on my hands this is something I cannot partake in.
While waiting for Matthew at the previous clinic for Floortime therapy I noticed a male with this long glove on his arm. I inquired to this and he told me about the product. It was something that you would wear if working with animals to protect your arms and was like armor. I thought it was really neat and something to get, if I could find it. An alternate product would be recycled disposable sleeves for the child who bites or to protect the adults.
When Matthew first started at the feeding clinic the majority of the time was spent at the gym. He did a lot of swinging on a variety of swings and liked the tire one the best. He would be given food items while sitting on the tire. Then we progressed to another room to start therapy and would bring in the trampoline or large bouncy ball. In between taking bites of new food Matthew and the Occupational Therapist would jump together or bounce. When the therapy moved to the home Matthew would run into the living room after a bite to jump on our trampoline. Matthew also likes to sit on the peanut ball we have that is situated behind the couch and push his face onto the quilt we have on top of the couch with a soft blanket covering it. Matthew would have his socks with him as well. In the past Matthew would sit on the couch and have me put pillows on him and wrap him up in a blanket or have the animal arby dog on top of him. We also had a large Goofy stuffed animal that worked well. These large stuffed animals are easy to find at Toys R Us stores.
The present level of performance report for OT last year’s IEP notes the following:
Matthew demonstrates adequate sensory modulation/organization to sit more than 30 minutes during circle time. The behavior plan includes – having the student walk with backpack in classroom, providing frequent breaks, having the student squeeze the hands of others, slowing down his work pace and taking walks
His three-year re-assessment in OT stated the following:
Sensory Processing and Sensory Modulation:
Visual Processing – Matthew needs maximal-moderate prompts to visually attend to tasks. He appears to be highly distractable to visual stimuli in the environment.
Tactile Processing – Matthew appears to be *hyperresposive to tactile input, as he does not tolerate light touch or unexpected touch. Difficulty with tactile processing may impact his ability to perform more complex in-hand manipulation skills.
Vestibular Processing - (ability to sense movement based on head position and gravity for balance and equilibrium) Matthew appears to be *hyporesponsive to vestibular input and appears to seek this input, as demonstrated by fidgeting and moving while seated.
Proprioceptive Processing - (ability to sense movement based on muscle and joint input) Matthew appears to be hyporesponsive to proprioceptive input, as demonstrated by using light pressure on writing utensils. He appears to seek this input, as demonstrated by walking on his toes and pushing back into his chair.
Sensory Modulation - (appropriately regulate sensory input to interact functionally within the environment and maintain an optimal level of arousal/alertness for participation in classroom activities) Matthew appears to have difficulty regulating sensory input. His activity levels fluctuate from low to high. He continues to benefit from intense amounts of sensory input and from a sensory diet in which he engages in proprioceptive (ex. heavy work, push and pull activities) and vestibular (bouncing on a ball) activities throughout the educational day.
I remember Matthew being the one to stack the chairs in his preschool class. This is one example of push activity that is heavy work. Therapists gain their insights from classroom and playground observations, as well as from parent input via sensory motor profile forms.
* - hypo means needing more input, hyper means no more is needed
Sensory Integration - Practical Strategies and Sensory Motor Activities for Use in the Classroom has a great list of suggested equipment and supplies. This covers – slant board, vibrating pens, pencil grips, latex gloves, bubble wrap, weighted mitts, tactile bin, bubble solution, lacing cards with strings, earplugs, headphones, scooter board and beanbags.
Their pre-referral motor screening checklist covers:
Sensory functioning/movement – fears falling, avoids climbing and jumping, cannot find body parts, twirls or spins self
Auditory Sensations – misses sounds, holds hands over ears, cannot work with background noise, has hearing loss
Poor Posture - holds head to one side, bowlegged, slouches
Excessively Distracted by Tactile Stimulation - unable to calm down after motor activity, decreased awareness of pain or temperature, avoids getting messy
Clumsiness, Poor Coordination - falls easily, poor use of one side of body, poor awareness of space, makes facial grimaces
There are three more pages with many more questions and examples. This is a great resource to have for parents, therapists and teachers. I remember when Matthew was in an Early Intervention program at two years of age. He was the only child outside during playtime that looked up in the sky to see a helicopter. Also at this young age he could not tolerate shopping at a particular Kmart during the summer due to the loud noise of the air conditioning. When our grocery store put in some signs that hung down in the checkout aisle he could not walk under or by them. He crunched his head down whenever he saw them and noticed new designs on floors.
A Treasure Chest of Behavioral Strategies for Individuals with Autism suggests to "Integrate sensory-based activities into the daily schedule about every 90 minutes to two hours whenever possible."
Also noted in the self-regulation section of the book, " self-regulation is essential to developing independence. Teaching self-regulation is advantageous when it decreases acting out behaviors, shutdowns or meltdowns. Often, reducing incoming sensory information will help the individual regain control. The sensory stimuli that is removed does not need to be the same stimuli that triggers the behavior."”
The case examples within this book are very helpful. There is a list of strategies to teach self-regulation that states to use a safe area and deep breathing exercises. That sounds very useful for the parent as well!
The daily activities book shows pictures of a student working with a slant board, which is what I showed the teacher thinking it would help Matthew keep his work intact. One of his triggers is when a schedule changes and he has less time to put all his cards into the baggie, etc and this would eliminate that stress and keep his items in easy reach,
The Child with Special Needs by Stanley Greenspan covers self-regulation in Chapter 13. He says:
" To strengthen your child’s ability to modulate sensory input, achieve states of calm, and focus attention, offer him several chances throughout the day to have 15 or 20 minutes of jumping; running or changing directions; swinging and spinning; deep tactile pressure, such as deep massage; and perceptual motor exercises, which involve looking and reaching or listening and reaching, when possible reaching past the midline of his body."
Is It Sensory or Is It Behavior?: Behavior Problem Identification, Assessment, and Intervention
Behavior Books
Diana Henry workshops
Developing self-regulation scholastic article
The pros and cons of assessments
Sensory Modulation Training
Sensory Integration Dysfunction my essay from 2000
The Alert Program
Building Play Partnerships
Sensory Integration Tips IRCA article
Harcourt Assessment Forms
How Does Your Engine Run? A Leader's Guide to the Alert Program for Self-Regulation
When you become scared of your child
Illuminating the Connection Between Sensory Integration Treatment and Improvements in Language Comprehension - ASA 2006 National Conference
Sensory Integration Products Helping Children With Sensory Processing Disorders Overcome Dysfunction Using Specialty Toys, Resources, And Equipment
Sensory Diet Activities for Home and Away
Educational Autism Tips for Families 71 page resourceful ebook for families entering the school system with a recent autism diagnosis. Find out what issues take place over the course of a school day and meet these challenges head on.
