ConnectABILITY Homepage

H.E.L.P. Framework for Pain and Distress

H.E.L.P. Framework for pain and distress Play video

PRESENTERS: 

Victoria Bojda, University of Toronto Faculty of Nursing RN Clinical Placement Student, Community Network of Specialized Care/CNSC Toronto Region, Surrey Place 

Angie Gonzales, Health Care Facilitator and Nursing Professional Practice Lead, CNSC Toronto Region, Surrey Place 

H.E.L.P. framework in approach to support for addressing pain and distress, observation/ assessment guidelines and tools, case scenarios. This tool helps service providers supporting people with intellectual and developmental disabilities (IDD) to understand contributing factors when presenting with emotional distress and behavioural concerns. What might appear to be ‘psychiatric’ issues, might turn out to be undiagnosed medical conditions, unrecognized pain and support issues, and/or related to past adversity and trauma.

Download a copy of the presentation

Resource links

https://ddprimarycare.surreyplace.ca
https://nutsandbolts.ddtoolkits.com/

Spinclusion

A game celebrating differences and including everyone

What is it?

  • A fun, interactive game that creates a welcoming and inclusive environment for children of all abilities and cultures.
  • It teaches children and youth that everyone is different and has different abilities
  • Promotes the idea of disability as another element of diversity
  • An outreach tool to attract interest in inclusive programs

Who’s it for?

Anyone who would like to create an inclusive environment:

  • Schools (students grade 2- high school)
  • Teachers and staff groups
  • After school programs (mixed ages)
  • Camps
  • Youth recreation clubs

What will you learn?

  • To focus on people’s abilities
  • To think positively about differences
  • To consider people’s feelings

See brochure for more information

DSO Housing Navigation 101

DSO Housing Navigation Play video

 Highlights 

  • What is the DSO 
  • History of DSO housing navigation 
  • Overview of housing navigation role and resources 
  • Advocacy within the housing sector: needs of adults with a developmental disability 
  • When and how to reach out to housing navigation/DSO

Presenters

Aaron Firth (he/him) is a seasoned member of the DSO Service Navigation team, bringing experience from roles in the fields of Autism, Respite, and Behaviour Analysis. At DSO, he specializes in support to youth in the child welfare system, and has recently started acquiring knowledge related to municipal housing programs in Toronto. 

Alex Shannan (she/her) has worked as an Application Assessor, Service Navigator and Housing Navigator, since joining the DSO in 2015. She strives to support individuals, caregivers and other supporters in navigating services within and outside of the Developmental Sector, with a particular focus on informing the development of creative and individualized housing and support plans. 

Presentation

Developmental Services Council – Toronto

Developmental Services Council – Toronto (DS Council)

Developmental Services Council – Toronto (DS Council) is a voice for adults with developmental disabilities, their family members and community supporters.

An advisory group, we are a partner with the agencies funded by the Ministry of Children, Community & Social Services to deliver programs and services for adults with developmental disabilities.

We make recommendations to these partners from a client/consumer point of view. Most DS Council members are volunteers from the community:

  • Persons with developmental disabilities (self-advocates)
  • Families and caregivers of persons with developmental disabilities
  • Interested community members Council also includes representatives from the service provider agencies and Developmental Services Ontario (DSO).

We work on educating the general public, agencies, media, and government about disabilities so that they understand us better”.

https://youtu.be/7_HRLrSRSGI

Mission

  • Strengthen the voice of individuals with a developmental disability and their families and caregivers, by contributing to sector-wide planning and priority setting. 
  • Provide recommendations and advice on communication and outreach strategies. 
  • Gather information to identify service system gaps, issues and concerns. Work with our partners to address these.

Would you like to get involved?

We are always looking for people to get involved with DS Council – Toronto! 

DS Council – Toronto meets 9-12 times a year. Meetings take place downtown in the evening. Members may attend in person or virtually via Zoom or telephone. For members who attend in person, free parking is available. The meeting venue is TTC accessible and dinner is provided! 

Council meetings often include presentations by groups that support people with developmental disabilities and their families and caregivers. 

Help improve the quality of developmental services in Toronto and represent the voice and needs of this community! 

For more information, please contact DS Council – Toronto: 

DSCouncil.Toronto@gmail.com

Contact

Service Solutions: A collaborative planning process for adults with a developmental disability having complex needs

Service Solutions Play video

Presenter:  Tammy McCauley, Service Solutions Facilitator, Lumenus 

Join us to review and discuss the key components of Service Solutions, an individual-level planning process intended to mitigate the high level risks that individuals with developmental disabilities experience when their needs are complex and long term in nature. 

Presentation

Visual perceptual skills

Definition Visual perception is connecting what the child sees to what they do (e.g. doing puzzles, recognizing shapes etc.). These visual perceptual skills helps the children read and write as well as recognize and learn numbers and letters and development of handwriting skills. 

Types of visual perception

Visual Motor Integration 

Definition – involves good communication between the eyes and hands so that you are able to copy, draw or write what you see; very similar to hand-eye coordination 

Signs to look for – child may struggle to draw shapes and numbers when writing 

Activities – scribble lines, draw loops/ circles, draw diagonal lines, star with + and x, lazy 8 racing track 

Visual Memory 

Definition – Recall/ remember details of what you have seen 

Signs to look for – child can’t recognize numbers and letters, or remember sight words 

Activities – matching cards – concentration / memory game 

Visual Discrimination

Definition – correctly perceive letters and numbers where there is only a small difference between them 

Signs to look for – child is not able to match items such as clothing, socks or cutlery, can’t see the difference between similar objects (e.g., coins) 

Activities – spot the difference, spot the odd object out, sorting colour and shape of the object

Figure Ground Perception

Definition – be able to find the correct information in a busy environment 

Signs to look for – child loses place when copying work from board, struggles to find personal items in a cluttered place, struggles to find information on a busy blackboard 

Activity 1 – sort cereal / pasta (different colour, shape) 

Activity 2 – play I Spy with my Little Eyes, build a figure puzzles, and jigsaw puzzles

Form Constancy 

Definition – ability to recognize and label objects even when they are viewed from a different angle or in a different environment 

Signs to look for – child may not recognize shapes, numbers and letters when colour, size, font changes 

Activity 1 – ask the child to point to different objects in the classroom that are a specific shape e.g. table is a rectangle/square; this can be done with objects on a tray and items in a magazine/book as well 

Activity 2 – when out on a walk, ask the child to spot different letters and numbers 

Visual Closure

Definition – correctly perceive an object / word even when it’s partially hidden 

Signs to look for – child is confused by similar letters, words, and objects; child has challenges with worksheets, puzzles, and mazes.  

Activity 1 – use toys that child is familiar with, partially hide 1-2 toys under a cloth without the child seeing, ask child to name/identify them 

Activity 2 – practice incomplete geometric figures, play with jigsaw puzzles.

Link has free visual closure activities: https://eyecanlearn.com/perception/closure/ 

Note that this is not a comprehensive list of what visual perception is but is a starting point. 

Please see a registered occupational therapist for more information.

References

Cincinnati Children’s. (n.d.). Visual motor and visual perception. Retrieved from, https://www.cincinnatichildrens.org/service/o/ot-pt/visual-motor-perception

OT Mom Learning Activities. (n.d.). Visual perceptual skills. Retrieved from, https://www.ot-mom-learning-activities.com/visual-perceptual-skills.html  

The OT Toolbox. (n.d.). Visual motor skills. Retrieved from, https://www.theottoolbox.com/visual-motor-skills/  

Written by: Stephanie Wong OT Reg. (Ont.)

Socio-emotional regulation

Definition. Social and emotional development refers to a child’s understanding of who they are, what they are feeling and their response to daily interactions (e.g. interacting with peers, tasks and routines). It helps them form lasting positive relationships, express and manage their emotions as well as exploring the environment. Self-regulation is how a person deals with and recovers from stress. 

Why is it important?

  • Fewer behavioural difficulties
  • Help children manage challenges in their life
  • Process and organize sensory information
  • Help with executive functioning – e.g., thinking, learning, memory, and controlling impulses

Signs to look for

  • “Crabby” in the morning
  • Gets upset easily and have trouble calming down
  • Have trouble paying attention or hearing your voice 
  • “Volatile moods” – happy to sad to fearful to angry in a short amount of time
  • What are some of the factors (I.e., stressors)that affect self-regulation? We see the behaviour, but what stressors are contributing to it? 
    • Social – difficulty picking up on social cues, or understanding the effect of their behaviour on others
    • Cognitive – difficulty processing certain kinds of information 
    • Emotional – strong emotions, positive (over-excitement) or negative (anxious, fearful)
    • Biological – too crowded, noisy, visual stimulation, not enough sleep (could it be sensory processing concerns)
    • Prosocial – difficulty coping with other people’s stress

How to support children?

  • Offer a predictable, comfortable safe space for children to go to when they feel dysregulated
    • Create this physical and sensory space (pillow, fidget toy, blanket, bubble tubes, blackout curtain etc.) with the children 
  • Keep routines and expectations as consistent as possible – provide advanced warning to children before transitioning to another activity, provide notes to supply staff to keep expectations the same
    • Timers, visual schedules, first –> then cards
    • Use steps to breakdown a task e.g., toileting; use short and simple sentences “hat on.”
  • Co-regulation – being present with the child in moments of stress and being responsive to their needs
    • Model your own self-regulation with the children, while teaching children to self-regulate their own emotions (what is my own body language like? tone?) Are you demonstrating supportive words, sounds, gestures for the child? Simple language, soft tone, low volume
    • Give some time to the child to take in your body language and tone
    • Make sure the child is paying attention to you (know through body language, sounds)
    • Ask what would help the child/ their body to feel safe and calm
    • Sitting quietly in the space beside them
  • Breathing exercises – stop and count deep breaths when upset 
    • Blow out birthday candles – pretend fingers are candles, blow with long breath
  • Grounding exercises – help child feel more regulated by identifying negative thought patterns
    • Favourite colour- have child pick colour and name everything in the room that has a colour
  • Remember – not all strategies would work for children, observe or ask the child how to best support them! 

Resources

References

Center on the Developing Child. (n.d.). A guide to executive function. Retrieved from, https://developingchild.harvard.edu/guide/a-guide-to-executive-function/  

Connectability. (n.d.). Understanding self-regulation in young children. Retrieved from, https://connectability.ca/2021/01/05/understanding-self-regulation-in-young-children/  

Kid Sense. (n.d.). Self regulation. Retrieved from, https://childdevelopment.com.au/areas-of-concern/sensory-processing/self-regulation/  

The Mehrit Centre. (n.d.). Self-reg 101. Retrieved from, https://self-reg.ca/self-reg-101/ 

Written by: Stephanie Wong OT Reg. (Ont.)

Gross Motor Skills

What are gross motor skills? 

Large body movements such as walking, jumping, skipping and crawling to help the child engage in different activities. It involves coordinating the movements of the larger muscle groups to complete whole body movements. These skills are important for sitting and paying attention in class, taking part in gym class, donning and doffing clothing. 

Why are gross motor skills important to develop?

  • Assists with balance
  • Strengthens large muscles of the body such as shoulder, core, and trunk
  • Hand-eye and bilateral coordination
  • Builds a strong and stable base to complete fine motor activities like handwriting, brushing teeth and combing hair  
  • Develops body awareness

What to look for

  • Stiff movements i.e., lack of fluid movements; awkward, clumsy; can’t maintain an upright posture; 
  • Avoid physical activity or participates in short periods of time (low endurance)
  • Not able to follow multi-step instructions to complete a physical task e.g., obstacle course
  • Not able to plan and correctly sequence events or steps in a process (e.g., step forward and throw)
  • Make the gross motor activity fun for the child, ask them what it is they would like to do or give them a choice!

Gross motor activities indoors: (make sure to have enough space for big movements)

  • Bean bag toss 
  • Freeze dance 
  • Indoor obstacle course – pillows, tables, blanket sheets 
  • Jumping over stepping stones or make your own with paper plates (children can colour/draw on them) and jump over them – farther apart big steps, closer small steps
  • Use recycled plastic water bottles to create a bowling game with a ball 
  • Move like an animal – bird (outstretched hands), snake (wiggle on floor), frog (hop/jump), elephant (heavy stomping), waddle like a penguin 

Gross motor activities outdoors:

  • Balance bean bag on top of head and ask child to walk on a line drawn on the ground/ length of rope; the child can also walk around obstacles or pick things off the floor to make it harder
  • Object relays – children stand in a line and pass an object / ball to the person behind them 
  • Passing the ball to others; tossing the ball up in the air; bouncing the ball against the wall
  • Hopscotch; skipping rope; hula hoop 

References

KARP Rehabilitation. (n.d.). Fine and gross motor skills – pediatric OT services

Retrieved from, https://karprehab.com/fine-motor-skills-gross-motor-skills-occupational-therapy/   

Kid Sense. (n.d.). Gross motor activities. Retrieved from, https://childdevelopment.com.au/areas-of-concern/gross-motor-skills/gross-motor-activities/  

The OT Toolbox. (2022, March 9). Gross motor coordination activities. Retrieved from, https://www.theottoolbox.com/gross-motor-coordination-activities/ 

Your Therapy Source. (n.d.). 50 Screen free gross motor skills and activities for home. Retrieved from, https://www.yourtherapysource.com/blog1/2020/03/23/gross-motor-skills-and-activities/   

Written by: Stephanie Wong OT Reg. (Ont.)

Fine Motor Skills

Definition: Small movements of the hands that allow us to manipulate materials like pencils, clothing buttons, and containers. 

What fine motor skills do these activities help the child to develop?

  • Pencil grasp
  • Strengthen pinch and grip
  • Hand-eye coordination
  • Precision of their fingers – e.g., isolating fingers
  • Builds the foundation for other activities that they enjoy  
  • Coordination of both hands

Fine motor activities to complete for toddler/ preschool (1-4 years old)

  • Use spoons to transfer small objects from one dish to another
  • Use sidewalk chalk to draw on the playground and on walls
  • Tear up recycled paper to make confetti
  • Create a water bin – spray bottle, plastic cups, small sponges
  • Stringing together beads / macaroni
  • Build a tower of 10 blocks
  • Making snips on cardboard paper or stiffer paper
  • Tracing sand with a stick

Fine motor activities to complete for school age (5+ years old)

  • Paint picture using Q-Tips or fingerpaint
  • Make a lacing card with cardboard and with a hole punch
  • Cutting different shapes, lines
  • Complete puzzles
  • Drawing and colouring using broken crayons
  • Spreading margarine with a knife
  • Self-care skills – tie own shoelace, button shirt, zippers and snaps, opening and closing containers
  • Scrunch up newspaper and toss them in the bin 
  • Create a water bin – include syringes, eye droppers, buckets

What to look for

  • Include these fine motor skills during day to day activities – play, transition between activities
  • Incorporate a variety of materials for the children to use e.g., paper clips, tweezers, stencil tracing, pom poms, clothespins so that it is more fun for them!
  • Use different sizes for the children for example small, medium and large beads 
  • Work on different surfaces to support the development of pencil grasp e.g., chalkboard, slanted surface (use a 3 inch binder)

Links to developmental milestones and implications

Written by: Stephanie Wong OT Reg. (Ont.)

Sensory Processing

Definition – What is sensory processing

We all have 8 different sensory systems and process sensory input/ information daily from our environment. Our brain helps to keep us organized and less overwhelmed when we focus on one sense at a time. Our brains keep us in an optimal state of arousal and attention to help us stay engaged and calm to complete our activities. When we move below our optimal state of arousal we adjust our behaviour to bring us back to the optimal state.

What are sensory processing differences?

Some individuals react to sensory input differently. They may be over-responsive to sensory input and can experience sensory overload (e.g., activate nervous system in fight, flight or freeze – acting aggressive towards others, running away). They can also be under-responsive to sensory input and tries to seek out this sensory input (e.g., touches other students/ objects frequently, use too much/little pressure when writing, leaves chair to walk/run around). 

Tactile/touch 

refer to pressure, pain, temperature, texture

Hyperreactive responses – what you may see- avoid physical touch/hugs, reacts strongly to wearing clothing with tags

  • Encourage child to take the lead when they get dirty during play, avoid unexpected light touch, try a ‘touch and feel’ box – different objects for child to explore, at different times include different textures  

Hyporeactive responses – what you may see – constantly touches people/ objects, unusual high pain tolerance, unaware of own strength – rough play

  • Activities – sensory bins filled with rice, flour and beans; sensory doughs e.g., playdough, cloud dough; finger painting; 

Proprioceptive

in our muscles and joints; sense of body awareness – control force and pressure

Hyperreactive responses – what you may see – appears uncoordinated in their movements, move their whole body to look at something, refuse to participate in activities that require physical effort ex. Riding a bike, climbing

  • Activities – use calming strategies frequently, tightly squeeze playdough, squeezy ball, try out animal walks, yoga stretches, activities that focus on fine motor skills (beading, stacking), create a quiet area for the child to go to when feeling overwhelmed 

Hyporeactive responses – what you may see – appear floppy and lean against people, furniture and wall for support, limited sense of personal space, prefer to run, jump and stomp, play roughly with other children

  • Activities – crab walk; gorilla jumps; hand squeezes; stretches; squeezing playdough;

Vestibular/ balance

detects speed and direction of movement

Hyperreactive responses – what you may see – avoiding activities that take feet off the ground (jumping and swinging), motion sickness, has trouble changing directions when walking

  • Activities – yoga (movements that keep child’s feet secure on ground, when using unfamiliar equipment – keep a firm hand on their shoulder, waist or arm (helps them feel more secure)

Hyporeactive responses – what you may see- difficulty sitting upright, bumping into objects, need to constantly move

  • Activities – skipping; jogging around playground/ on the spot; star jumps; bouncing on an exercise ball; chair push-ups

Taste

linked to our sense of smell; processes flavours such as sweet, sour, bitter

  • Activities – comparing ice cubes and frozen fruits to water and room temperature fruit; try crunchy, chewy, dry, soft foods; blowing bubbles

Smell 

Hyper-reactive responses – what you may see – becomes agitated/ gags around certain smells, tell other people they “stink”

  • Activities – unscented/fragrance-free environments, seat child away from triggering scents (garbage bin), provide child with preferred scent (if they have one)

Hypo-reactive responses – what you may see – enjoy strong scents, doesn’t notice “dangerous smells”, trouble identifying smells of food

  • Activities – set up a smelling station – use cotton balls with essential oils, spices, smelly objects; use food and cooking to stimulate smell

Visual 

Hyperreactive responses – what you may see – shield eye from bright/fluorescent light, refuse to go in room with too much on the wall 

  • Activities – make shapes/ letters and numbers using different materials; “eye breaks”, reduce clutter 

Hyporeactive responses – what you may see – looking at things out of the corner of their eye, shining bright light (sunlight), directly in eye, unaware of new people in environment, holds item close for inspection

  • Activities – flashlight tag, sensory bottles, light table activities, match the picture with the word

Auditory/hearing  

Hyperreactive responses – what you may see- covering ears and running away from noises or loud environments 

  • Activities – Calming music, matching sound game, rhymes and chants

Hyporeactive responses – what you may see- creating loud noises, yelling repeatedly

  • Activities – Musical instruments; group story telling; sound machines

Interoception

sensations from inside the body including perceptions of physical sensations e.g., hunger, thirst

Hyperreactive responses – what you may see – avoid going outside in certain weather conditions, frequently uses the washroom to not have a full bladder, drink excessive amounts of water to not be thirsty

Hyporeactive responses – what you may see – does not take off heavy clothing despite sweating, does not respond to injuries, frequent accidents because they do not react to full bladder 

  • Activities –  Label the way your body feels during everyday activities; allow students to notice the way their body feels during daily activities (e.g., during outdoor play when they are sweating, heart racing); animal yoga poses

What to look for

  • There is no one size fits all approach, be a sensory detective! Observe your students and know if your students are sensitive to different senses
  • Behaviours such as throwing tantrums, screaming when face gets wet, unusually low/high pain threshold can mean that the child has a sensory processing issue
  • For more personalized recommendations, please see an Occupational Therapist
  • Note that for young children, they may not always be experiencing sensory dysregulation. Make sure that the other basic needs of the child are met (e.g., thirst, hunger) and that other factors aren’t contributing to the children’s behaviours! 
  • For more information visit this website on what over and under responsiveness looks like: https://aidecanada.ca/learn/sensory-regulation/sensory-processing-differences-toolkit and https://www.sensorysmarts.com/sensory_diet_activities.html 

Sensory Lifestyle 

A sensory lifestyle is an individualized approach to meet the sensory needs of a child 

throughout the day so that they are able to meaningfully engage in the activities that they want and need to do. This includes making lifestyle changes that have sensory supports within it. 

Goals for creating a sensory lifestyle 

  • Helping professionals understand a child’s sensory profile 
  • Being proactive about managing the child’s reactions to sensory stimuli and preventing sensory overwhelm 
  • Understand why a behaviour is occurring for a child 
  • Provides the sensory supports for a person to self-regulate and support optimal levels 
  • of functioning and participation for children. 
  • Including sensory inputs throughout the day help us feel more regulated and stay within our optimal level of arousal. For example, if our energy is low, having a movement break for the entire class or refilling a cup of coffee may help us feel more awake. 
  • A sensory lifestyle can also be beneficial for the whole class, rather than for one child. The same activity can be both alerting or calming to different children. 

Written by: Stephanie Wong OT Reg. (Ont.)