Tools for Tots

Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
Tools for Tots:
Tools for Teachers
DVD
Sensory-Based Strategies
for Toddlers
and Preschoolers
with Special Needs
Diana A. Henry, MS, OTR/L, FAOTA
[email protected]
Co authors: Maureen Kane-Wineland, PhD, OT/L
Susan Swindeman, OTR/L
Cook : Rick Ruess
Bibliography is at the back of your book
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1
Downloadable Lyrics on CD
Today’s Schedule
9:00 – 10:30
1. Sing and dance
(preparing for sitting)
*For busy bees
2. My heels down flat
*For tippy toe tots
3. Get your wee in
the water
*For potty pleasers
10:30 – 10:45
10:45 – 12:00
12:00 – 1:00
Detective work…research
Sensations for body & brain: Let’s play
Morning break
Case study using SPM-P: Praxis
Lunch
1:00 – 2:15
Engagement & Sensory Spaces
2:15 – 3:00
Evaluations and Door prizes
3:00 – 5:00
Bonus SPM-P Quick Tips Session
3
Let’s first look at your
sensory needs
4
Detective work: Is David a Cautious Tot?
See Your Handout
7
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Read the Challenges for Cautious Tots
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1
Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
Or is he a Busy Bee?
Cautious Tots
Challenges:
Pg 13
I’m a
dancin’
man
• My tot avoids swinging, sliding,
climbing, riding toys, roughhousing or
walking on uneven surfaces
• My tot prefers to play quietly, do sitdown activities, or watch others play,
rather than ‘join in’
9
Read the Challenges for Busy Bees
11
These behaviors exist in typically developing tots too.
“It is only considered a ‘disorder’ when causes
significant difficulties with daily activities.”
Dr. Lucy Jane Miller
Busy Bees
Challenges:
• My tot has trouble sticking to one
specific task
Pg 23
• My tot is ‘on the go’ more than other
tots his age
• My tot takes movement risks that
compromise his safety
12
Typical infant-toddler
interactions
with the spaces and
objects of the home
14
Tools for Infants
Coming soon
Pierce, D., Munier, V., & Myers, C.T.
American Journal of Occupational Therapy,
63,273-287. (May-June 2009)
Title: Informing early intervention through an
occupational science description of infant-toddler
interactions with home space.
With parent permission, take videos  15
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
Is Ian being manipulative?
The adult had to ask 5x
Or,
is he doing
everything
he can
to please?
my videos Ian_edited:288 JELLO
What Our Sensory Challenged Tots Can’t Do
17
18
Touchy Tots?: Challenges:
 My tot does not like messy things
or getting dirty.
 My tot does not like to be touched,
hugged or cuddled.
Pg 15
Did You Know?
 Tots with over-responsivity
Pg 15
19
Pg 33
Touchy Tots
Or… Picky Eater ? Challenges:
 My tot is a very picky eater.
 My tot gets upset when offered
many foods.
 My tot gags when some foods are
presented.
Holding
hands
interpret many types of touch as
negative or painful.
 Touch from behind, fast touch,
and especially light touch can elicit
‘fear, fight, flight’ responses.
20
Picky Eater Tidbits
Movement tools
 Allow him to move before sitting...
Touch Tools
Pgs 33 &34
 Gradually add barely noticeable
amounts of non–preferred textures…
Muscle tools
 Offer weighted utensils...
21
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Making
Eye tools
food with
 Eat in a quiet place with dim lights…
you
22
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
Let’s Play!
Picky Eater Tidbits
29.5’’
Mouth tools
(75cm)
 Massage your tot around and in the
25”
(65cm)
21”
(55cm)
17.5”
(45cm)
14.5”
(35cm)
mouth as tolerated before meals
Pg 35
Jigglers
Finger
cots
23
24
Sitting ball activities

Standing ball activities
Sit and bounce
Bounce, bounce, bounce and freeze, add a pose
Go for a walk
– Add your arms, run
Go for a climb up a ladder
– Move your feet and your arms
– All the way up to the stars, so we can touch
At the top of the sky, grab 10 stars (left to right)
– One, two, three…all the way across
– Stretch them out in front of you, count them again
– Scoop them back up and throw them back in the sky

–



Paint a rainbow
Dip ball in paint, lift lift lift and paint a big red stripe
Next color: green, blue, pink…
Spread your legs, roll ball side to side
– Like playing ball by yourself
– Roll ball as far as you can and see if you can catch it
Feet together bring ball in front and give it a big hug
– You are the skin of an orange and the ball is the orange
Twist to one side, back to the middle
- Twist to the other side
Stand on one leg hold the ball over your head
– Stand on the other leg
–
–




25
Additional fun ball activities


Bridge: walk your feet, walk, walk, walk till you feel your
back against the ball
– Hands behind the head, 5 sit ups: count with me
– Come back up
Belly on the ball
Step back, roll on your tummy and back again
Roll as far as you can… and back
–

Musical balls (like musical chairs)… Sit on ball
When hear music, do anything away from the ball…
when music stops, sit on the ball
27
–
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Research:
3% to 16% percent of children in 4 yr olds
community sample, may demonstrate
sensory processing difficulties
Gouze, et al., 2009
Journal of Abnormal Child Psychology
 Sensory processing difficulties have been
reported in a high % of children with ASD
Tomchek, 2010 Autism: A comprehensive OT
approach (3rd ed.; pp. 135-162)
 Early childhood education teams are asked to
determine whether or not a child has difficulties
28
with sensory processing

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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
How?
• The Sensory Processing Measure
for Toddlers & Preschoolers
(SPM-P) for 2 to 5yrs
HOW do you know?

Pg 2

…sensory-based strategies are not
meant to replace other strategies
(e.g. behavioral, developmental, or
pharmacological)
A
tool
for teams,
not just
therapists
Some tots may need a referral for a
professional evaluation targeting
sensory integrative functions and
sensory processing issues
• SPM Infant Toddler
(SPM-IT) in development
• Email [email protected]
re developing items for SPM-IT
Bonus Session today 3:00-5:00
SPM-P Quick Tips
29
30
Sensory Buffet:
Nutrition for
body and brain
Includes
Social Participation
Pg 7
Is sensory
driving the
behavior?
• You are aware of basic
food groups
• The body and brain also
need a certain amount of
sensory input
• The brain takes in sensory
information from seven senses
• We are all familiar with five:
hearing, seeing, smelling and
tasting and TOUCHING.
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Familiar Senses
7
Tactile (touch tools)
Hearing
(Auditory)
Skin Receptors
Seeing
(Visual)
Touch
Pressure
Tasting
(Gustatory)
Pacinian
Corpuscle
Light
Touch
Smelling
(Olfactory)
Touching
(Tactile)
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Hair Follicle
34
35
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
Surface
vs.
Deep Receptors
Dorsal Column
Discriminative Touch Pressure
Calming (Inhibitory)
Spino Thalamic Tracts
Pain & Temp Light Touch
Alerting (Excitatory)
36
37
Hot Dog
Offers Firm
Maintained Touch
Pressure
and
‘Neutral warmth’
(body heat held in)
like swaddling a
baby
Holding
hands
39
40
Firm Maintained Touch Pressure
RibbitWear
Cuddleloop
Body
Sox
beyondplay.com
underarmour.com
schoolspecialty.com
weightedvest.com
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www.isnorkle.com
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
Tactile Activities
Proprioception (muscle tools)
(muscles, joints, tendons, ligaments)
Information which is received when
pushing and pulling occurs in muscles,
joints, tendons and joints.
unconscious
sensation
increases
body
awareness
and praxis,
‘puts the lid
on’ to calm
Pg 7
2ND
paragraph
43
44
Pulling…crawling
I Can preschool
Hanging
Melbourne,Australia
46
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Carol Kranowitz
begins Circle Time with…
Using muscles puts
the “lid” on!
From a parent:
“…Tonight the girls and
I did 'exercises' with the
bands before bed and I
only had to speak to
them once after tucking
them in ”
47
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
Pulling & Pushing
Building in Heavy Work
Proprioception:
muscles,
joints,
tendons,
ligaments
49
50
Vestibular (movement tools)
Head and/or body movement
Heavy Jobs
Transitions
Information received
when the head changes position.
Can increase attention and alertness
Pg 7
52
51
Calming Movements
Combine Slow Rhythmical Rocking
Slow, rhythmic, predictable movements
tend to be calming
with Flexion
11
Swinging in a Net Swing
in the Living Room
Rocking in
Your Lap
53
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
Repetitive rhythmic movements
In flexion tend to be calming
Floppy on the Ball
Fragile Egg
(in Tool Chest handbook)
55
Combine: Slow Rhythmical Rocking
with Weight Bearing (Muscle Tools)
Combine Slow Rhythmical Rocking
with Firm Maintained Touch Pressure
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Alerting Movements
11
Fast, dysrhythmic, unpredictable, irregular
movements tend to be alerting. These
movements may help ‘wake up’ a sluggish tot.
#8 The
Rocking
Puppy
Rocking Puppy
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Linear Swinging
Vestibular Receptors
Otolith
Organs
with
Otoconia
Saccule / Utricle
Linear - Forward & Back
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
Linear Forward Movement
Linear Forward Movement:
*down the slide
*on the scooter board
Tools for
Teachers
DVD
Belly on
the Ball
61
Linear up and down jumping
62
Linear Up & Down Jumping
Bouncing
on chair ball
www.toysrus.com
Jumping
like a
kangaroo
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www.jumpright.com
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Vestibular Receptors
Semicircular Canals and Endolymph Fluid
Inside the
Canals
Structure
of a Crista
(Spinning)
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Ring around the Rosey
Orbital
Spinning / Twirling
Rotary
67
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
Orbital and touch pressure
Spinning opportunities
Sit and Spin
‘garage’
Merry-go-round
68
What: ‘Over – the – Counter’
sensory-based activities
69
Sensory-based strategies
in Tools for Students DVD
 Fragile Egg
Pg 1
(left hand
column)
Floppy on the Ball
 Rocking Puppy
 Home Play
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Why You Need Sensory Strategies?
1
“…need to provide nurturing
and safe environments for
toddlers and preschoolers.”
“…neuroscience
research: sensory
experiences & sensory
enriched environments
result in changes in brain
function and structure.”
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26 - 27
Managing ‘melt downs’
Spirited Tots
Behaviors may be related
to sensory issues and/or
communication problems.
They are a way of getting
attention, escaping,
wanting something, or fulfilling a ‘sensory need.’
Be sure to use sensory strategies proactively.
72
When you’re ready
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11
Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
Social Savvy
“Group events…different places
and people bring about new
sounds, sights, smells,
movement, muscle, and touch
experiences, plus incidental ones.
28 -30
Sharing
song
7
That is a
lot for a small
tot’s brain
to have to
experience
and organize!”
Let us look at some examples
when using the Sensory Buffet
Stretch Pet
Pg 7
Tote around Hound
Pack Away song
Pommchie
74
Integrate Sensory Strategies into
Daily Activities and Routines
 “Every tot has individual
preferences for calming,
waking up, concentrating,
etc.
 Discover which strategies
work for your tot and how
you can integrate them into
daily activities.”
76
Sensory Diet to ‘Sensory Buffet’
Emphasizes the abundance of possibilities
to create a sensory lifestyle
75
Sensory-based strategies
Reflect on the possibilities created
when we are open to collaboration
with other practitioners (SLP, PT,
psychologist, social worker etc.)
‘Upping the ante’ with everyone
participating! Jane Case-Smith stated: the
elements to effective intervention include:
“…Intensity, contexts and family
supports…” (AOTA Autism Conf Dec 2011)
77
Strategy used by the preschooler,
so the teacher made it part of the day
Seeking
proprioception
while lining up, by
pushing against
the door frame
Pg 7
Like the abundance of buffet choices
78
SPM Quick Tips
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
How to Use Tools for Tots
On the other hand…
• Like medications requiring prescriptions,
Supervised
1&2
As tolerated
Tuned into frequency,
intensity & duration
Pg 1
occupational therapy with a sensory
integration approach-OT/SI (Ayers SI® ),
requires a therapist with expertise in
practicing ‘fidelity SI intervention’
• Research increasingly shows that classic
intensive Ayres SI® results in improved
behavior and increased engagement
(Roberts, King, Boccia, 2007)
Kept playful & novel
Ever Changing
Can also complement
prescribed therapeutic
intervention
Go to Autism Speaks website for details re
SI research through Jefferson University
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Occupational Therapy Practice Guidelines
for Children and Adolescents with
Challenges in Sensory Processing and
Sensory Integration (AOTA, 2011)
Sensory-based strategies
sensory-based strategies Sensory Integration
ASI® (OT/SI)
“OT using
Siglobalnetwork.org
sensory-based
Requires special training to
interventions”
Often an integral part of
early intervention, schoolbased practice, and
community-based programs
Emphasize collaborative
team empowerment
May be used in conjunction
with ASI®
ASI® (OT/SI)
provide OT using an ASI®
sensory integration approach
Involves individualized
intervention
Using sensation in an
intentional manner
To support a child’s ability to
succeed in daily life activities
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OT/SI
O T with an SI approach
Fidelity to Ayres Sensory Integration ®
The Fidelity Measure
Provide sensory opportunities
Provide ‘just-right’ challenges
Collaborates on activity choice
Guide self-organization
Support optimal arousal
Create play context
Maximize child’s success
Ensure physical safety
Arrange room to engage child
Foster therapeutic alliance
Parham, et al. 2007
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Pg 1
84
SIGN (www.siglobalnetwork.org)
ot.usc.edu/research/symposium
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13
Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
Sensory Processing Disorder
(SPD)
Sensory Modulation
Disorder
 brain-based
problem with
information
processing
Pg 3
3
Pg 4
 characterized by
difficulty
understanding
and responding
appropriately to Eide & Eide 2006, p. 29
86
sensory inputs
 Very strong sensory likes and dislikes
Sounds
 Reactions to sensory input depart
surrounds
from typical expected responses.
88
us
Subtypes of
Sensory Modulation Disorder
Sensory Over-Responsivity
Pg 5
Sensory Over-Responsivity
Pg 5
Definition
Sensory Under-Responsivity
Sensory Seeking/Craving
Responds to
sensation from
just one sensory
system or from
multiple sensory
systems faster,
with more
intensity, or for a
longer duration
than peers
89
90
Tot enjoying Dad’s play
Sensory Over-Responsivity
Behaviors may include:
• Covers ears with loud sounds
• Is sensitive to bright lights
Pg 5
• Fears movement or changes of position
• Avoids touching certain textures
• Has strong clothing preferences
• Does not like to be held or cuddled
Tots with vestibular
Over-Responsivity
do NOT like this!
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• Has difficulty transitioning to new food
91
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
Characteristics disclaimer
• Separated for ease of reference, though
may coexist in several subtypes of SPD
Pg 6
Parent concerns: unable to attend
daycare or preschool
 Hesitant with
movement impacting
gross motor skills
• Your tot may not exhibit all behaviors or
may have some in several categories
 Over-responsive to
tactile (e.g. shaving
cream, dried beans)
• May help identify areas of concern
• May occur in typical tots too
Got your
toothbrush
Bottom of page
Chippy choppy
93
So gave Angel’s mom: Touchy Tots
Pg 15
Did you know?
• Proceed slowly and provide many
supervised tactile activities daily to help
the brain learn that the input is not
negative
 Poor tolerance to ADL
(tooth brushing,
nail clipping, washing,
and hair combing
94
Parent Interview and 1st OT/SI Session
2 yrs. 4 mos.
Safety First!
• Allow your tot to touch things as
tolerated
• Forcing him to touch things may
increase fears and intolerance
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Angel’s OT/SI Treatment
Touchy Tots
Muscle Tools
 Get him to move, climb, push and
pull before offering tactile activities.
Pgs 15 & 16
Touch Tools
 Gently, but firmly, wipe off things
that feel yucky. Try not to do it
immediately.
Eyes Tools
 Hide his favorite toys in a bucket of
beans, sand or rice for him to find.
97
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
Did you Know? Tubby Time Tips
Pg 37
• Over responsive tots may have
trouble with all the tactile
experiences (soap, washcloths, hair
washing)
Tubby Time Tips
Movement Tools
Use a non skid mat to promote
security
Pgs 37 & 38
Consider this…
Give him squeeze toys or sponges
• Schedule a tubby time routine.
Give firm towel massages
Safety First!
Nose Tools
• Monitor water temperature
• Never leave tot unattended
99
Rubba
scrubba
Hair Care
Did You Know?
Pg 43
100
Hair Care
 Offer him a surface for his feet
Pgs 43 & 44
Consider This…
Use distractions and motivators.
Find ‘tot friendly’ stylist.
101
 Massage his head prior to hair care
My hair
looks
smooth
shiny
Angel’s Follow Up Video
After 6 Months of OT/SI
3.
Ear Tools
 Try scissors instead of buzzer cuts
102
Sensory Seeking
Seems to have an insatiable desire
for strong levels of sensation
2. Now, not
only touching
it but skating
in it and
requesting!
 Use a spray bottle instead of tilting
back his head to wet it
Muscle Tools
Over-responsive tots may be fearful
of tilting back their heads.
2 yrs, 9 months
Use calming/unscented soaps
Movement Tools
Over-responsive tots may interpret
the light touch of water, a comb, or
scissors on their heads as painful or
dangerous.
1. ASI®
Intervention
and sensorybased
strategies at
home
Muscle Tools
Pg 5
characteristics
Breakthrough
VIDEOS:
9:03 – 9:52
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led to
opportunities to
incorporate fine
motor & math
concepts in
preschool 103
Click
here
Sensory Seeking
(Evian commercial) 104
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
Summary of Parent Concerns for Matthew:
Sensory Craving
Change in thinking:
Sing and
dance
• Sensory craver ( movement,
muscle, and tactile) constantly
“on the go”
“Become more disorganized
with input unless provided:
• Cannot even stand still
o in a specific manner
• Several ‘melt downs’ a day
o with a functional goal
o and for a specific parameter of
Bialer, Miller (2011)
time”
• Difficulty with transitions
105
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So gave mom: Busy Bees
Matthew’s OT/SI Intervention
DID YOU KNOW?
Pg 23
Provide more movement and more
intensity in play than what a typical tot
needs.
o
o
o
o
SAFETY FIRST!
Designate safe places (with impact pads
under swings and climbers) for
movement, and supervise closely.
o
o
Swings him in extension
Down ramp (linear
vestibular)
Crawls out of
pizza…touch pressure
/proprioception)
Toe walks… so go up
ramp to put weight on
heels
Repeats sequence
Transitions with
“Ready-Set-Go”
107
Tippy Toe Tots
Did you Know?
• Tots with overresponsivity to textures
may toe walk more on
some surfaces (e.g. grass
or ceramic tile) than
others (e.g. soft carpet or
mats)
Pg 21
109
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Tippy Toe Tots
Many different reasons for
toe walking
Pg 21
3 yrs, 4 mos
2nd OT session
Title 2 chapt 1
•
Other tots may toe walk to avoid weight
bearing on any surface.
•
Tots with postural disorders may toe
walk due to difficulty adjusting the
position of their feet to various surfaces.
•
Poor processing of vestibular input could
also cause some tots to get increased
extensor muscle tone by walking on their
toes during gait.
110
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
Tippy Toe Tots
Pg 21
My
heels
down
flat
23 -25
Tippy Toe Tot: Strategies
Safety First!
Talk to a therapist to
rule out sensory
issues and to your
tot’s doctor about
possible contributing
medical conditions.
Movement Tools
 Have your barefoot
tot walk forward up
ramps and backward
down ramps.
Pg 21
 Lie tummy
down when
riding on
a scooter board
 Prone
swinging
and when
looking at
books
 Place bubble wrap under heel
 ‘Bear walk’ on hands & feet
 Squatting stretches tightness
111
112
Busy Bees
Movement Tools
Busy Bees
 Set up obstacles.
Move before sitting (e.g. play at the park before
going out to eat, or run outside before sitting)
 Hang suspension swings.
Offer a cushy seat or partially deflated beach ball
for circle, story, or table activities.
Designate safe places (with
impact pads under swings
and climbers) for movement,
and supervise closely!
Pgs 23 & 24
Muscle Tool
113
Gentle Joe
for
transitions
114
Busy Bees
Muscle Tools
Benefits of Swinging
Allow him to push
cart
Pg 25
Touch Tools
Have him wear a neoprene vest
Eye Tools
Use natural or
incandescent lighting
Mouth Tools
 Offer a variety of
tot safe ‘mouth fidgets’
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Chewelry
115
116
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
47 -48
Starballs
with feet
used as
a ‘chair’
Beddie Bye Bliss
Lots of movement during the day, but at
least one hour before bedtime, switch gears to
quiet play.
Offer your tot heavy body pillows, blankets,
sleeping bags, or stuffed animals (not
recommended for infants).
Use calming scents such
|as lavender in the bath
17.5”
14.5”
(45cm)
(35cm)
Close
your
eyes
117
Download this page from www.ateachabout.com
Matthew’s Progress: 3 mos after evaluation
Parent
understands
and supports
sensory needs
121
Dyspraxia
Developmental Coordination Disorder:
(DCD)
Pg 4
3 yrs, 7 mos
HYPERLINK
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Dyspraxia may include:
Dyspraxia
• Is clumsy
Dys = difficulty with
praxia = praxis
• Eats messily
• Has a disheveled appearance
Pg 6
1.
2.
3.
Cognitive visualizing or imagining an action
(ideation)
Planning and sequencing
Carrying out (motor execution)
…a sequence of novel
or unfamiliar actions
124
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• Mouths or licks non-food items
• Frustrates easily
• Has trouble maneuvering around
obstacles
• Has difficulty following directions
for activities that require more than
one step
125
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
Dyspraxia
Consider this: Assist by
 breaking tasks into smaller steps
 offering simple directions
 helping him to complete one step
at a time.
Slide example
1. Sees slide, decides it would be fun and
Executes. No problem!
Pg 19
2. Wants to, but can’t figure out how to get on it
Motor Planning: organization of the action and sequencing
3. Has no idea what it’s for…looks at it…licks it…
Ideation (or conception) …
Coming up with an idea of what he wants to do
126
Fumbling Tots
19 - 20
Movement tools
 Provide lots of opportunities to
go under, over, in, out, on, and off
different surfaces, starting with
stable surfaces and progressing to
moveable surfaces.
Have him run, climb, and
jump.
127
Obstacle courses promote praxis
Make up push, pull and
tug games.
Massage him with firm
maintained touch
pressure.
Show your tot how to do it.
Catch a balloon while
jumping.
128
In day care or
in the classroom
On the playground
129
Challenging your praxis
Sensory Songs for Tots
His praxis
is working!
Chorus
Here they are, these parts of me
All together, on my body
I’ll know them all, soon you will see
Stanzas
Nose, toes, knee cap, and tummy
Chin, shin, shoulders, and my feet
Eyes, thighs, elbows, and my ears
SPM-Preschool
(SPM-P)
looks at Praxis

130
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
here’re my ears
here’s my nose
 Knee
cap, toes, tummy, nose
Nose, toes, knee caps and tummy
Typical
toddlers &  Shoulders, chin, feet, shin
preschoolers Chin, shin, shoulders and my feet
love this song
 Elbow, thighs, ears, eyes
Eyes, thighs, elbow and my ears
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Ideation
Motor Planning
134
2-09
135
Praxis: Motor planning
“The ability to carry out a series of
Gave SPM-P Home Form to mother
Gave SPM-P School Form to teacher
movements in proper sequence”
All areas typically seen in a preschool are
addressed in the one School SPM-P Form
Dress up
Circle time (movement to music, playing instruments etc)
Snack time
Bathroom
Nap time
Table top activities (glue etc)
Playground/recess
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DX: Autism
Receives inclusive school based OT in a
developmental preschool
Receives outside speech therapy
School not seeing the huge ‘sensory’
problems reported by mom
School OT called back and said “Perhaps we
need to use another student for your SPM-P
case study as sensory problems may not
show up”
Praxis
Scales: SOC, PLA, & all sensory systems
as in SPM
Ears, eyes, nose, mouth,
tongue in me
o Shoulders, side, bottom and
thighs on me
o Kneecap, calf, feet,
toes on me!
o
Student (5 yrs)
Test and Re-test follow up
2-13 through 4-17-09
Thank you staff & parents Desert Sun Elementary
We made the sequencing easier
for those with praxis challenges:
Scored Always on these Home Form items
69: Confused about proper sequence (ex dressing…
71: Difficulty imitating demonstrated actions
Scored Always on these School Form items
70: Difficulty correctly imitating demonstrations
74: Fails to complete tasks with multiple steps
136
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
Warren Fried President: Dyspraxia USA
Initial SPM-P: 2-09
Avoids sensory motor challenges when left on her own
138
On the playground
Difficulty motor planning
139
Initial SPM-P: 2-09 Speech
140
Praxis: difficulty sequencing picture cards141
private speech therapy
Initial SPM-P: 2-09 Speech
How high can you go?
How low can you go?
Strategy: moving her body to act out sequence
Cranium Hullabaloo game
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143
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
Strategies suggested at home
Cranium Hullabaloo
(confusion with ‘lie on your tummy’)
 High-energy. Simple.
 Players move from one colorful shape to
another.
 Use their bodies to perform the many
moves -- touch your nose to a circle, spin
to a red, put your elbow on a musical
instrument.
 When Hullabaloo says, "Freeze!" the
player on the lucky pad wins!
Ages: 4 & Up (about $21)
Click
here
All over body deep pressure touch
144
Create opportunities for
movement on belly, muscle and
pressure touch input
145
Provide opportunities for proprioception
I encouraged parents to find playgrounds
At home:
Click here
146
Initial SPM-P: 2-09
Circle time challenges:
Click here
147
Imitation of Postures
Sequencing
Click here 1:00
Attempts to trace numbers in the air
Is unsuccessful even when assistant
attempts to provide hand over hand
assistance (1:00)
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148
No movement: generic seating
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
Integrated sensory activities in
the classroom
Click here
150
Two months post 4-09
Difficulty motor
planning to lie
on her
stomach
Has to ask
‘How do I get
out?
Classmate
joins in 
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Two months post 4-09
Teacher:
Teacher:
“She now traces actual
numbers
“Better able to attend
and sequence rhymes
because of the
sensory input we now
provide -- chair ball,
t-stool, rocking chair,
etc to sit on”
To help with sequencing too,
we verbalize and ask…
What do we do next?
Now what do we do?”
152
Two months post 4-09: SLP email
Ability to sequence 2 to 3 cards has improved
Just weeks prior to your visiting us at the
clinic, she did not exhibit even the slightest
ability to do this.
153
Re-test team meeting 4-17-09
22:06-25:44 mother
SPM-P promoted
understanding re
challenges with…
Sequencing
Riding a bike
Dressing
One shoe
off
Now able to act out 2 or 3 card scenes
Potty training
Riding bike
154
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Put in a swing set at home
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
Potty Pleasers
Safety First!
Challenges:
45
Pgs 45
• My tot does not appear to notice when she
has to go to the toilet.
 An infection can cause discomfort with
urination and can lead to ‘holding it’
Did you know?
 Dietary issues and illness can cause
constipation or diarrhea
• Your tot must be able to receive and interpret
sensory information from her body that signals
a full bowel or bladder.
 Talk to your tot’s doctor, nutrition
specialist or registered dietician if you
have any concerns
• Sensory information from bowel & bladder is
subtler than from other muscles.
• Poor body awareness
 Consider medical influences
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Potty Pleasers
Potty Pleasers
Ear Tools
Pgs 45
Movement Tools
 Use tools such as jumping on a mini tramp
to develop abdominal control
Pgs 45
 Consider a musical potty or a musical
diaper for your under responsive tot
(www.tinkletoonz.com)
Linda Veldman’s idea 
Muscle Tools
 Encourage rough housing, pushing and
pulling to help develop overall body
awareness
Put your
wee in the
water
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Praxis: Ideation 2-09
159
Some Ideation items and QTs
“The ability to create a concept
or mental image of a novel task”
SPM-P items Home Form
73 Has trouble coming up with new ideas during play
activities
75 Tends to play the same activities over and over rather
than shift to new activities when given the chance
SPM-P items School Form
69 Requires props (cell phone) to engage in pretend play
67 Has trouble coming up with new ideas during play
(Never wears dress up clothing)
160
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
http://www.filthwizardry.com/2010/09/craftfoam-bath-murals.html
Re-test Team meeting 4-17-09
5:36-6:24 teacher
SPM-P Praxis
(Ideation)
“Creativity has
blossomed…she
is putting on
clothes and
playing different
parts”
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Engagement is:
Promoting
Early Engagement
Pg. 8
8
Pg 8
“…intentional, persistent, active and
focused interaction with the
environment, including people and
objects “ Watling & Dietz, 2007
164
Early Signs of ASD
Greenspan (2006)
TYPICAL
MILESTONE
EARLY WARNINGS
ASSOCIATED SIGNS
Shared attention/
regulation 0-3
Lack sustained
attention to different
sights and sounds
Pays little attention to
people, aimless visual
regard
Engagement and
relating 2-5 mo.
No engagement or
fleeting, adult does
work, enjoyment brief
Self-absorbed,
withdrawn
Purposeful emotional
interactions 4-10 mo.
No interactions or
brief back and forth,
little initiative by child
Unpredictable,
random, impulsive
behavior
Long chains of back
and forth interaction
10-18 mo.
No engagement, brief,
or fleeting, much adult
effort required, affect
often flat, somber
Self-absorbed,
withdrawal, repetitive
behavior,
unpredictable
166
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 We can’t get them to deal with
us, or interact with us
 How can we address the issue
if we can’t get them to pay
attention to us?
 We need to promote
engagement
165
Videotaped Signs of ASD
Autism Speaks, ASD Video Glossary (2009)
http://www.autismspeaks.org/video/glossary.php
167
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
Responsive Teaching
Child centered
relationship focused
rather than
teaching structured skills
NIMH study 11-09
Early intervention for
Toddlers with Autism is
Highly Effective
Combination of
 Carefully
structured teaching
 A relationship based approach with many learning
opportunities embedded in PLAY 
Therapists and Parents collaborated in using strategies
during routine and daily activities… throughout the
day… with opportunities to learn to interact with
others
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Dr. Gerald Mahoney & Perales in 2005
Enhancing parents’ ability to interact improved
language, social, & emotional development
Journal of Developmental &
Behavioral Pediatrics
SCERTS model (AOTA, 2013)
169
www.scerts.com
Research on Engagement
Free play
teaches
self regulation skills!
8
Go to www.ateachabout.com
articles link to read more.
Click here
A play oriented
approach
elicited more
affection,
verbalization,
and initiation
than an
instructional
approach
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3 Challenges are discussed:
#1 Engagement Challenges:

Pg. 8


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Where do we begin ?
Sensory Integration and Floortime principles
Hard to get attention
or to pay attention
to me
Rarely demonstrates
affection or enjoyment
Does not show emotion
Did You know? (Why)
 Sensory overload-overwhelmed
 Driven by competing sensory needs
(dust coming thru the light)
 Difficulty processing information
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Dahl-Reeves, 2007
• Observe what child’s interests are
Worms
• Look at sensory preferences
• Follow her lead or cues
• Slowly build and expand
• Match pace and animation
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
www.hanen.org
Gives good ideas of how to get on their level for
very low level kids
 Keep talking to a
minimum or match
his pace
 Avoid trying to
‘teach’
 Build anticipation
with your voice
 WAIT
 Show your pleasure!
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How do we know it is working ?
•
Pg 9
•
Subtle changes: eye glance,
facial expressions, stop moving
away, make or stop sounds etc.
Very gradually look for more(e.g., stops turning away or
looking for longer
periods of time, etc.)
176
‘Circles of Communication’
Greenspan
& Wieder
 Look
for back and forth responses
 I did something and he does something back
 Conversation (verbal or non-verbal) where two
active participants respond to each other
 Learn how to reciprocate – joint attention
it cannot only go one way
 Goal is increasingly more ‘circles’
177
Drew
Early engagement On DVD disk
‘Talking’ Twin Babies
PART 2 – on Youtube
Spandex game
He loved the spandex
He loved the slide
So put both together to make a
new game
178
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We got into his world through
the sensory items he
loved…and created a new
game
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
#2 Engagement
Challenges:
Strategies:
 Join in and make yourself the source of
the pleasure.
Pg 9
 My tot likes to
move rather than to
play with me
Pg 9
 ‘Action routine’ (e.g., Ready, Set, Go, or
1-2-3-STOP!) so there is a beginning and
an end…then leave out ‘go’
 Watch for challenging vs. upsetting.
 ‘Play dumb’ or look puzzled - don’t help.
 The goal is to ‘up the ante’ so that
- he has to deal with you more
- he has to interact more - and - it is not as fun or easy to do alone.
 My tot runs back
and forth constantly,
twirls, or spins in
circles
180
Get the routine going
Pg 9
181
- THEN WAIT!
Watch for a response and
repeat it again.
Slowly up the ‘ante’ by:
 moving farther away
 waiting for more
sounds or actions
 changing the activity
slightly to see if he will
tolerate it
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183
# 3 Engagement
Challenges:
Video Examples
#2 Engagement
Challenges (pg 9)
Pg 10
‘Likes to Move’
Ryan
1. Carpet ride
2. Ready set go
Jumping
3. Lycra swing at home
4. Chase & run
Why?
• ‘Comfort zone’
activity
Try playful obstruction!
184
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Plays with same toys
over and over, in the
same way. (blocks,
train, Legos) Very
isolating
• Unsettling to try
something new
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Tools for Tots
Pg 10
Diana A. Henry, MS, OTR/L, FAOTA
Strategies
 Watch what he does
and join him.
1. Moving
puzzle
pieces
 Be in control of toys
or use containers.
2. Knocking
legos over
 ‘Playfully ‘sabotage’
his plans.
3. Accepting
change
(should
have had
intervention
long ago!)
 ‘Accidentally’ knock
over or drop things.
 Be playful and silly, or dramatic.
Video Examples
of Engagement Challenge #3
3 tots who need help to:
Learn to play a new way
186
Creating Sensory Safe Environments
‘Sensory buffet’ for use in
more than one environment
187
Develop environments which
provide challenging opportunities
Greater ability to meet
sensory needs to work
towards optimal regulation
and attention
Better results if done more
often
188
Lycra swing on tree in backyard
189
Kraig’ s Sensory
‘Tools’ at Home
Sam’s
club
12” from
floor
IKEA
190
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4 -5 yds
Dance
Swimwear at
Joanne
Fabrics
191
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
Swings for Home Use
To Hang a Swing at Home, School, Day Care
To hang from ceiling /beam
To hang lycra swing:
Carabiner
Eye Bolt
into beam
9 inch. nylon
runner to hook
carabiner to(www.rei.com)
www.takeaswing.com
www.ikea.com
Nylon sewn
runner tied to
fabric/lycra swing
(www.rei.com) 192
Carabiner to
hook swing
to- allows to
put up/take
down
More Swings
www.indoorswings.com
193
Spinning and Twirling
www.swingset.com
www.airpogo.com
Sit and spin
www.hammocks.com
www.swingset.com
194
‘Impacting’ and Jumping
The Twirler
(inside or
outside)
195
Jumping
(folds
down)
www.toysrus.com
www.jumpright.com
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Inflatable bounce house
196
www.toysrus.com
www.BallPitPlus.com
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31
Tools for Tots
Home Made Impact Mats
Diana A. Henry, MS, OTR/L, FAOTA
More Opportunities to Impact
Cotton
ribbing
Donated
scraps
from
upholstery
store
Cleaning (not sterile):
use hydrogen peroxide
and steam cleaning
198
Firm Maintained Touch Pressure
199
Modern Version of Temple Grandin’s Hug Machine
200
Remember to give tots the
intensity that they seek!
201
At the Beach
202
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
At Preschool or Child Care
At the Park / Playground
Circle Time options
204
205
In the Backyard
Nancy Barden
[email protected]
206
At Home, in the Basement
207
In the Bedroom
Bunk bed & hammock
208
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Tools for Tots
Diana A. Henry, MS, OTR/L, FAOTA
In a ‘Womb’ Space…& Inside a Body Sox
Learning to BE Together
Pea Pod
\
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211
What challenges are we seeing in USA?
Increased push for early academics, before
developmentally appropriate
Cool ideas for pre-K writing
adaptations & smart board
programs
http://prekese.dad
eschools.net/AS/p
rewriting.html
Decreased opportunities for play and
movement
Taking away recess
Increased time in front of
computers, screens etc.
Lack of information about
how sensory processing impacts behavior
(Increased frequency of being kicked out of
212
preschool because of poor ‘behavior’)
214
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 Video
clips re our program
 Webinar ‘on line’ courses for cont ed credit
 Articles including SPM-P, research
 Additional upcoming workshops:
Pg 53
Who would like to read
A Letter from a
Toddler?
Thank you!
[email protected]
Please complete the
Tot Workshop Evaluation
 Developing items for SPM-IT
 Participating in QT case study
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See some of you soon in the
Bonus Session 
215
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