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Q&A with Lindsey Biel on Sensory Processing Disorder - featured March 26, 2010

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Q&A with Lindsey Biel on Sensory Processing Disorder

By: Lindsey Biel, OTR/L
Coauthor, Raising a Sensory Smart Child

© 2010, Lindsey Biel, OTR/L. This article is printed here with the express permission of Lindsey Biel

Question: What’s a simple way to explain sensory processing disorder (SPD) to parents?

Answer: Usually parents request an evaluation for their child because they are worried about speech or motor delays. Because sensory processing abilities form the foundation for most developmental skills, it’s not uncommon for parents to walk away from an evaluation mystified by an SPD diagnosis that they have never heard of.

It’s important to speak with parents compassionately and to avoid professional jargon. Parents often feel helpless when a child struggles with everyday sensory experiences. This is a scary time in their lives and they need the optimism that comes with knowing that there is SO MUCH they can do to manage and even overcome sensory challenges.

I keep my explanation of SPD quite simple, keeping in mind that most parents do not want a neurology or psychology lesson. I explain that a child learns about the world through his senses, with all of the sounds, sights, touches, movement, tastes, and smells working together to provide an accurate picture of the world. For most kids, sensory processing happens automatically.

Kids with sensory processing problems experience the world differently. They may have trouble with being oversensitive or under-sensitive to certain types of sensory input, or have trouble putting all the input together and wind up easily overwhelmed. Using personal examples helps. For example, “your daughter is extra sensitive to sounds. When there are a lot of kids in the playground, your daughter feels she is being bombarded and it hurts her ears. That’s why she retreats to the sandbox in the corner instead of climbing on the jungle gym with the other children.” Or “being afraid of a bleating goat at the petting zoo is not unusual for a toddler, but having a meltdown every time you take her to the supermarket or the toddler gym class tells us she is seriously uncomfortable and needs help.” The more examples you use the better since it keeps it real for the parent—and for you.

By all means, answer any questions that come up, and remember that your initial discussion with a parent on this matter will not be your last. It will take time for a parent to become “sensory smart” and recognize how her child’s sensory issues impact his everyday function. Follow up your discussion with written materials, addresses of informative websites such as http://www.sensorysmarts.com and http://www.spdfoundation.net, and refer them to books such as Raising a Sensory Smart Child for more detailed information about the SPD diagnosis, sensory diet activities for home and school, and practical solutions for everyday problems such as auditory and tactile sensitivity, picky eating, sleep issues, tooth brushing, hair cutting, and more.

Question: How can you tell if something is behavioral or sensory?

Answer: There are so many reasons why children don’t behave as we’d like them to, including changes in routine, being tired or hungry, feeling ignored, frustrated, or anxious, actually enjoying negative attention, and, certainly, struggling with sensory processing and sensory overload. Therefore it is essential to analyze what is causing the behavior rather than focus on the behavior itself. Only once you understand the root of the behavior, can you take appropriate steps.

When a person feels overwhelmed by sensory experiences, he will typically cope by either tuning out or acting up. If a classroom is very noisy, crowded, and chaotic, a hypersensitive student may become self-absorbed, hide under a desk in a corner of the room, use self-stimulatory behaviors like handflapping to block out the environment and feel more pleasurable sensations, or have a full-blown meltdown. The under reactive child who needs more input for it to register may seem oblivious, lethargic or rev up into overdrive in order to cope. Either way, you wind up with undesirable behaviors that are, underneath it all, due to poor sensory processing skills.

There’s a big difference between being cranky because your shirt is kind of itchy and feeling like that shirt is coarse sandpaper rubbing off your skin. It’s hard to understand unless you have sensory issues yourself. But you can imagine that if you were to wear a sandpaper shirt, you too probably couldn’t sit nicely at circle time, and you too might lash out against someone who bumped into you because that innocent touch might be the last straw. If you treat just the behavior, the underlying problem doesn’t go away. With enough incentives, enough rewards, enough threats, you might be able to get a child to sit still during circle time. You might be able to get that child to not scream and poke his classmate. But he’ll still be wearing that hurtful shirt. Better to give him a more comfortable item of clothing while desensitizing him and have him enjoy his school experience and the company of his peers.

Fortunately, “sensory people” and “behavior people” are working together more and more because truly effective interventions are never purely sensory and never purely behavioral. Sometimes a student, especially one with exquisitely sensitive hearing, is simply unable to tolerate the sound of a fire alarm, despite your best efforts to desensitize, to protect via earplugs, to reduce loudspeaker volume, to rehearse behavioral responses. In such a case, this student can be removed from the building before the alarm goes off. He can learn to stay calm when anticipating the fire drill and to exit and re-enter the school safely. That can be a huge leap forward for a student that once had daily meltdowns in anticipation of the dreaded, painful fire drill.

Start by keeping track of when and where unwanted behaviors occur, making note of what led up to the event. You may uncover some interesting patterns such as the child shutting down when there are too many transitions or becoming hyper just before lunch each day.

As you and the families you work with increase your “sensory smarts,” you’ll more easily recognize when sensory issues are driving unwanted behaviors, learn to predict and avoid triggers, and know how to help a child recover from maladaptive sensory-based reactions.

Question: How can I get classroom teachers to buy in to the idea that students with sensory issues need special help?

Answer: There is a large section on school issues, learning, and organization in Raising a Sensory Smart Child. Sensory processing and learning are also discussed in the Sensory Processing Master Class webinar I did with Drs. Brock (a primary care physician) and Fernette Eide (a neurologist), now available on DVD. It is helpful to share some of the many such resources out there with teachers and school staff.

Most general education and many special education programs expect students to sit still, be quiet, and to look and listen carefully—and to tolerate what may be noxious sensory experiences. This can be a major problem for students with sensory challenges.

If a student is preoccupied with being touched unexpectedly, bothered by the flickering of a fluorescent light, or uncomfortable in his chair, he will not be available for learning. If he has visual difficulties, letters may jiggle on the page and glare may hurt his eyes. One child may learn better if she is able to move constantly, while another child may be so intolerant of vestibular sensations that he focuses on avoiding postural challenges rather than on what is being taught. Many children with sensory challenges, especially those on the autistic spectrum, need to turn off one or more “sensory channels” in order to focus. For example, a child may need to block off his visual sense in order to hear effectively. Such children learn best through a multisensory approach that taps into their most reliable senses.

Most teachers are open to the idea of sensory issues, but they are unsure how to meet specialized needs while teaching to a classroom full of students. In my experience, both seasoned teachers and new ones are open to practical strategies that make the child more available for learning. Quite often, a simple accommodation or behavioral strategy can be worked out informally with an understanding teacher. In other cases, a sensory solution may need to be added to the student’s IEP.

Here are some strategies and accommodations many students with sensory issues have found helpful:
  • A classroom aide accompanies the student on five-minute walks approximately once every two hours (or other interval).
  • The student eats lunch in a quiet, low-stimulation environment instead of in the cafeteria.
  • The student may avoid eye contact when answering a question if he needs to block off his visual sense in order to focus.
  • When lining up with other students, the student should be at the front or end of the line to avoid being bumped by classmates.
  • The student is allowed to use adaptive devices that help him stay calm, organized, and focused. These may include an inflatable seat cushion Movin’ Fit, Disc O’Sit), weighted vest or lap pad, hand fidget, and oral comfort item such as “chewies.”

Question: I work with older kids in elementary school and they don’t want to work on their handwriting. Any suggestions?

Answer: Chances are, a 3rd, 4th, or 5th grader receiving handwriting help is very self-conscious about writing and has been working on it for several years. In such a situation, it’s time to step back and consider two things.

First, what are the underlying weaknesses that are contributing to the problem? Is there intrinsic hand muscle weakness? Are there deficits in proprioceptive processing? Has the child’s vision been assessed by a qualified vision care professional (not just a school screening or pediatrician’s assessment)? How are the child’s visual discrimination and visual memory skills? What are some alternate ways that you can address these foundational skills? Does the sensory experience distress the student—do you need to change the writing tool, writing surface, lighting, seating? Is cursive easier for the child since it flows along rather than has a lot of abrupt starts and stops like print?

You may need to put away the pencil and paper and work on proximal strength and stability, hand strength, dexterity, and proprioceptive processing. The child may need to practice nearpoint scanning and build visual analysis and memory skills. Many children benefit from structured, multisensory handwriting programs such as Handwriting Without Tears. Computer-based letter practice using items like the See N’ Write computer from Educational Insights reinforces how to form letters in both print and cursive, upper and lower case, as many times as a child needs without the embarrassment of having the teacher or occupational therapist demonstrate it again and again. Instead of endlessly working on letter formation, work on drawing skills using a sequenced drawing book like Usborne’s I Can Draw Animals. You’ll find these handwriting helpers and more on the Toys & Equipment page of the http://www.sensorysmarts.com website.

While it’s important to keep working toward legible handwriting, it’s even more critical that a student focus on developing his ability to communicate in writing. When you are focusing on how to form and sequence individual letters and words, you can’t possibly think about what you want to express. A student struggling to produce letters and words will keep written work as short as possible. If a student is able to think and speak in a more complex way than he is able to write, consider recommending a scribe for written work and teach keyboarding so that a student can show what he knows instead of what he is able to write. There are loads of good typing tutorials on the market now, such as UltraKey from Bytesoflearning.com. The child may be greatly more able to take class notes, fulfill writing assignments, and let us know what she knows if she uses a computer such as the durable, portable Alphasmart or a traditional laptop computer. Writing solutions such as a scribe or computer will need to be formally added to the student’s Individualized Education Plan (IEP).

Question: How did you come to write your book and how did you get Temple Grandin involved?

Answer: My first career was as a writer—advertising, magazine articles, short stories, and bad poetry. I was unfulfilled and mulled over life experiences I had found most satisfying. One of those was volunteering at a nursing home. Another was watching my cousin undergo physical rehabilitation after he was paralyzed in an airplane accident. One day, I came across Temple Grandin’s Thinking in Pictures. It set me on fire! Here was a person who experienced the world in a completely different way, whose sensory experiences were unlike anything I had ever heard about. After reading this and Dr. Grandin’s other book, Emergence: Labeled Autistic, I delved into Oliver Sacks’ wonderful books which introduced me to the universe of neuropsychology. I wanted to be part of this! I was fortunate to receive a full tuition scholarship from the NYC Department of Education, and wound up working with children rather than the adults I had originally envisioned.

Today I am in private practice in Manhattan. My coauthor’s son was one of the children I treated through early intervention. Because there was so little practical information out there about how to raise a child with sensory challenges, and because we both had strong backgrounds as writers, it made perfect sense to write a book together from both parent and OT perspectives. Thus, Raising a Sensory Smart Child was born.

Because she had been such an inspiration, Temple Grandin was the first person I thought of to write the foreword. I contacted her through her website, and she immediately responded. Her enthusiasm and profound insights into sensory problems have remained guiding lights in my work and it is a huge honor to have her beautiful foreword in my book.


This Month's Featured Author: Lindsey Biel, M.A., OTR/L

Lindsey Biel, M.A., OTR/L is a pediatric occupational therapist based in New York City. She is the coauthor of the award-winning Raising A Sensory Smart Child: The Definitive Handbook for Helping Your Child with Sensory Processing Issues, with a foreword by Dr. Temple Grandin, published by Penguin Books. She is the co-creator of the Sensory Processing Master Class DVD program, along with Drs. Brock and Fernette Eide as well as a contributing writer for Autism Asperger Digest Magazine. She is a popular speaker, teaching workshops to parents, teachers, therapists, and other professionals across the country. Please visit her website at http://www.sensorysmarts.com.

Tags: 26 March 2010 Sensory Processing Disorder Article Newsletter OT Proprioception