1. Implementing Sensory Diets That Work By Erin Wilke, MA, OTR/L

2. What is A Sensory Diet? A sensory diet is: A program of sensory strategies/activities given throughout the day at regular intervals in order to help organize a person for optimal attention and learning An individually designed schedule of sensory input A sensory diet is designed so that the optimal level of arousal can be maintained at all times. The right frequency, duration, and intensity of sensory input should be determined as an appropriate sensory diet is being developed.

3. Sensory Diet To develop a successful sensory diet, the therapist should perform a comprehensive sensory evaluation in order to understand the student’s sensory difficulties. Sensory questionnaires and structured interviews completed by parents, teachers and/or loved ones, are frequently used to obtain information that is needed to develop an appropriate sensory diet.

4. There Are Not 5, But 7 Sensory Systems! 3 primary systems that are involved in sensory processing are tactile, vestibular, and proprioception. Visual Auditory Gustatory (taste) Olfactory (smell) Tactile (touch) Vestibular Proprioception

5. Tactile System Tactile input: sensory information we receive from touch Tactile Defensiveness (Sensitive) –Has an extreme reaction to being touched –Reluctant to get messy/dirty –Avoids hugs and kisses –Picky about what materials touch the skin –Dislike tags in shirts, seams in socks –Avoidance of large groups

6. Tactile System Tactile Under-Responsiveness (needs more input) –Unaware of touch unless it’s intense –Doesn’t notice when they are messy –Doesn’t notice intensely hot/spicy foods –Engages frequently in rough play or unintentionally hurting others –May not notice extremes in temperatures (dresses inappropriately for weather)

7. Tactile System Tactile Sensory-Seeking –Craves touch, tickles, or hugs –Strong need to feel and touch everything –Enjoys messy play activities –Has affinity toward touching soft or smooth surfaces –Has tendency toward self-harming behaviors (biting, head-banging)

8. Vestibular System Vestibular input- the information that we receive from the inner ear that detects movement and balance. The vestibular system gives us an awareness of our body position and movement in space. It also stabilizes our eyes during head movement.

9. Vestibular System Vestibular Defensiveness (Sensitive) –Fear of movement, fear of heights –Fear of going down stairs or leaning back in the bathtub –Dislikes car rides (may experience frequent motion sickness ) –Craves constant physical support from adults –Has tendency to exhibit controlling or uncooperative behavior (coping mechanism)

10. Vestibular System Vestibular Under-Responsiveness (needs more input) –Enjoys fast movement without seeming to get dizzy during intense spinning –Doesn’t notice movements in body position –Doesn’t ever appear to be afraid of heights –Doesn’t protect self when falling (unaware) –Has trouble holding head up when sitting and tiring frequently

11. Vestibular System Vestibular Seeking –Craves all types of intense movement –Loves amusement park rides, see-saws, trampolines more than others –Is always running, hopping, or jumping (considered hyperactive) –Has difficulty sitting still or staying seated

12. Proprioceptive System Proprioceptive input is the information our brain receives from our joints when we push and pull. It tells us where our body is in space, and allows us to know where our body parts are and what they’re doing without using our vision.

13. Proprioceptive System Proprioceptive Under-Responsiveness –Lacks motivation to move and play –Often clumsy with toys and materials –May be unaware of body position for dressing –Unaware of sitting in an uncomfortable position

14. Proprioceptive System Proprioception Seeking –Exerts too much force when doing things (walking hard, playing hard, pushing hard, writing hard) –Overall very rough and are often loud with the tendency to jump, run, bounce, and crash when moving –Cracks knuckles, chew on fingers, bite their nails until they bleed, chew on pens or inedible objects –Enjoys tight clothing (turtlenecks, jackets zipped, etc.) –Often inadvertently break toys and objects –Miscalculates the weight of objects

15. Proprioceptive System Proprioceptive input has the unique benefit of calming children who are over-aroused and alerting children who are under-aroused. Children are not usually sensitive to proprioceptive input, therefore it is universally accepted. When in doubt, use proprioceptive input!

16. Activities That May Be Part of a Sensory Diet Tactile/Touch Deep Pressure/Touch Movement Strategies (vestibular input) Proprioceptive Strategies (heavy work) Visual Strategies Auditory Strategies Oral Strategies Olfactory (smell) Strategies

17. Activities That May Be Part of a Sensory Diet Tactile/Touch Play in sand, rice, beans, water, shaving cream, Pla-Doh, Theraputty Texture toys and fabrics/blankets Fidget toys such as stress balls, Koosh balls, bendable toys, straws, paper clips, Velcro Lotion

18. Activities That May Be Part of a Sensory Diet Deep Pressure/Touch Weighted vests/blankets Pressure vests Massage Squeezes/hugs Hand hugs Wrapping Vibrating pencil

19. Activities That May Be Part of a Sensory Diet Movement Strategies (vestibular input) Running, sliding, swinging Songs with movement Animal walks Walking up and down stairs Rolling and bouncing on a large exercise ball Wiggles cushion/t-stool Movement breaks

20. Activities That May Be Part of a Sensory Diet Proprioceptive Strategies (heavy work) Climbing, jumping Wheelbarrow walking Carrying/pushing/pulling heavy boxes, back packs, or wagons Monkey bars Wall or floor push-ups Moving equipment and/or small furniture

21. Activities That May Be Part of a Sensory Diet Visual Strategies Fiber optic toys/lights Lava lamps Oil and water toys Using bright colors or colored paper Reducing clutter Organizing with color

22. Activities That May Be Part of a Sensory Diet Auditory Strategies Listening to music (all types: lively, soothing, rhythmic, arrhythmic) Listening to stories White noise Natural noises/background noise Headphones

23. Activities That May Be Part of a Sensory Diet Oral Strategies Blowing bubbles or blowing through a straw Sucking through a straw with thick liquids (applesauce, yogurt, pudding) Sports bottles Snacks (variety of tastes & textures: crunchy, chewy, salty, sweet, sour) Chewing (“chewelery”, therapy tubing)

24. Activities That May Be Part of a Sensory Diet Olfactory (smelling) Strategies Aromatherapy (different scents of lotions, candles, oils, diffusers) Creams or perfumes If perfumes are intolerable, unscented products

25. Sensory Diet Schedule Begin by looking at a daily schedule for obvious breaks and times when sensory input would be ideal: –Proprioceptive input may be a positive strategy prior to activities requiring motor coordination –Oral motor strategy may be beneficial in preparation for eating Consider more difficult times of day such as waking up or a non-preferred classroom time, and be sure to implement a preferred sensory strategy prior to that time. Start simple and work your way up. An example of when to give input may be before breakfast, mid-morning, after lunch, mid-afternoon, or before bed. A picture schedule of sensory input may be beneficial for some children.

26. Key Ideas for Successful Sensory Diet Implementation It is very important to work with an Occupational Therapist with sensory integration training to develop an appropriate sensory diet Sensory input needs to be given at regular intervals, but not when negative behaviors are occurring (to avoid reinforcing the negative behaviors) A sensory diet should be done throughout the day and in all activities in which the student participates A sensory diet should include calming activities (during stressful times), organization activities (for learning times), and alerting activities (for slow times) A goal for a sensory diet is that the child will identify themselves when a sensory stimulation or a break is needed, and request is appropriately.

27. Resources Recommended Reading – Books: The Out of Sync Child by Carol Stock Kranowitz Too Loud, Too Bright, Too Fast, Too Tight by Sharon Heller 101 Activities for Kids in Tight Spaces by Carol Stock Kronowitz Raising a Sensory Smart Child: The Definitive Handbook for Helping Your Child with SensoryProcessing Issues by Lindsey Biel and Nancy Peske – Websites: www.sensory-processing-disorder.com www.spdfoundation.net http://www.therapystreetforkids.com/Sensory2.html www.stickkids.com www.sensorysmarts.com And many many more!

28. Resources Research Articles – May-Benson TA, Koomar JA. (2010). Systematic review of the research evidence examining the effectiveness of interventions using a sensory integrative approach for children. American Journal of Occupational Therapy 64(3):403-414. – Miller LJ, Coll J, Schoen S (2007). A randomized controlled pilot study of the effectiveness of occupational therapy for children with sensory modulation disorder. American Journal of Occupational Therapy 61(2):228-38. – Parham LD, Cohn ES, Spitzer S, Koomar JA, Miller LJ, Burke JP, Brett-Green B, Mailloux Z, May-Benson TA, Roley SS, Schaaf RC, Schoen SA, Summers CA. (2007). Fidelity in Sensory Integration Intervention Research. American Journal of Occupational Therapy 61(2):216-27. – Schaaf RC, Nightlinger KM (2007). Occupational therapy using a sensory integrative approach: a case study of effectiveness. American Journal of Occupational Therapy 61(2):239-46. – Watling RL, Dietz J (2007). Immediate effect of Ayres’s sensory integration based occupational therapy intervention on children with autism spectrum disorders. American Journal of Occupational Therapy 61(5):574-83.

29. References Ayers, J.A. 1979. Sensory Integration and the child. Los Angeles: Western Psychological Services. Bundy, A., Lane, S., & Murray, E. (2002). Sensory Integration Theory and Practice, 2 nd ed. FA Davis Co., Philadelphia, PA. Dunn, W. 1999. Sensory Profile. San Antonio, TX: The Psychological Corporation. Miller, L.J. 2006. Sensational Kids. Hope and Help for Children with Sensory Processing Disorder. New York: G.P. Putman’s Sons. Roley, S.S., Blanche, E.I. & Schaaf, R.C. 2001. Understanding the Nature of sensory integration with diverse populations. San Antonio, TX: Therapy Skills Builders. Trott, M.C., Laurel, M., & Windeck, S. 1993. SenseAbilities: Understanding sensory integration. San Antonio, TX: Therapy Skill Builders.