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Vision

Sensory processing for the visual system uses light, colour, shape and movement to detect information through our eyes and then the brain interprets that information. Some children can become overwhelmed based on the stimuli in the environment such as having a reaction to bright lights/sunshine or cluttered walls and toy shelves.  On the contrary, other children may need additional visual stimulation in order to attend to and process visual information, such as toys that have bright lights or contrasting colours. 

Difficulties with receiving or processing visual information may result in either seeking or withdrawing from stimulating visual input. This may also lead to difficulties with aspects of vision such as depth perception (judging the distance of objects), hand-eye coordination, tracking moving objects or sustaining eye contact.

There are four patterns of sensory processing: low registration, sensation seeking, sensory sensitive and sensation avoiding. 

Low registration: A child with low registration does not recognize or process all of the incoming sensory information, and they do not compensate by trying to gain more sensory input to meet their needs. They may seem uninterested, and inattentive to their surroundings.  

Sensation seeking: A child classified as sensation seeking does not recognize or process all of the incoming sensory information, but contrary to low registration, they actively try to gain this sensory input to meet their needs. They may be hyperactive, touch others often or engage in unsafe activities like jumping from heights. 

Sensory sensitive: A child classified as sensory sensitive feels overwhelmed by sensory information, but they do not actively try to avoid the overstimulation, instead they may just display frustration. They may be easily distracted, and irritable, cautious, and uncomfortable in loud or bright environments. 

Sensation avoiding: A child that is sensation avoiding feels overwhelmed by sensory information and will actively avoid the stimulation. They may run away from loud, busy environments, cover their ears when overstimulated by noise, or wear gloves to avoid touching certain materials such as paint. 

Hyposensitivity 

A child who has low registration or is sensation seeking may require extra visual input in order to process their environment. 

If a child has a low registration pattern for visual processing they may: 

  • Trip or fall down stairs or curbs because they did not see them or cannot tell how far they are
  • Miss objects when trying to grab them, or be unable to locate objects that are obvious to others 
  • Often bump into objects or other people 

If a child has a sensation seeking pattern for visual processing they may: 

  • Stare or become excited when they see bright flashing lights or bright colours
  • Often watch others in the environment 
  • Gravitate towards high contrast pictures or patterns

Case example:

Adison is a 5-year-old girl and is new to your senior kindergarten class. On her first day of school you notice that Adison tends to bump into tables and cubbies, as if she is not aware of where they are and does not seem to be interested in many of the toys in the classroom. 

Adison has low registration. She does not notice many of the visual stimuli in her environment and does not actively seek out visual stimuli or compensate for this.

With a child who has challenges noticing, or processing visual stimuli, either because of low vision, or a high neurological threshold, you may want to provide activities or put them in environments that are very visually stimulating. Helpful tools for this are activities or objects with bright colours, lights or movements.

For example, you can try activities that include:

  • Bubbles, flashlights or flashing balls
  • Rolling a ball 
  • Creating a ‘visual wall’ with lots of colours and patterns to look at
  • Use brightly coloured paper or tape on the corners of tables to make them more noticeable

Hypersensitivity 

A child who is sensory sensitive or sensation avoiding may be very sensitive to visual stimuli in the environment and become easily overwhelmed with sensory input. 

If a child has a sensory sensitive pattern for visual processing they may:

  • Prefer environments with low lighting
  • Appear uncomfortable or frustrated in highly lit areas
  • Be uninterested in toys with bright lights or vibrant colours

If a child has a sensation avoiding pattern for visual processing they may:

  • Prefer dim lights or dull patterns
  • Avoid eye contact, cover or close their eyes or squint
  • Avoid bright stimulating lights

Case example:

Nolan is an 8-year old boy. Every day, when it is time for outdoor recess, Nolan refuses to line up with the rest of the class to go outside. He sits in his chair, closes his eyes and will not make eye contact when you try to talk to him. After trying to understand why Nolan does not like going outside, you discover that he avoids going outside because the sun bothers him and he cannot keep his eyes open. 

From the case you can see that Nolan’s visual processing pattern is sensation avoiding as his nervous system becomes easily overwhelmed by the sun, and he reacts by actively avoiding this uncomfortable stimulus. 

With a child who becomes easily overwhelmed with sensory stimuli due to a low neurological threshold, you may want to use strategies that create a visually pleasing environment, and limit excess visual stimuli. 

Strategies that you can try to create a visually pleasing environment:

  • Whenever possible, limit excess visual stimuli. For example, you can dim the lights indoors when possible and remove wall art with vibrant colours.
  • Avoid the use of fluorescent lights wherever possible. If this is not possible, you can create a sensory friendly room or area for the child to go to for self-regulation in the event they become overwhelmed by the lights. 
  • Provide the child with a hat, or sunglasses while outside to limit visual input. 
  • Incorporate rhythmical, predictable activities such as lava lamp, hourglass timer, glitter bottle, tornado tube or clear magic wand filled with sparkles. These activities have a predictable visual flow and is less overwhelming for a child.

Taste/Oral Motor

Sensory processing for taste, also known as oral sensation processing, is the way that our brain processes information from our mouth and taste buds. Some children are hyposensitive to taste and oral input and need extra stimulation in their mouth and to attend to tastes, textures, and quantity of food. On the contrary, some children are hypersensitive to taste and oral stimulation and become overwhelmed by sensations in the mouth, tastes, textures, smells, and objects. A person’s sense of smell is closely connected to taste. When a person smells something, it can cause a reaction in their mouth such as watering or cause a negative reaction such as nausea. 

There are four patterns of sensory processing: low registration, sensation seeking, sensory sensitive and sensation avoiding. 

Low registration: A child with low registration does not recognize or process all of the incoming sensory information, and they do not compensate by trying to gain more sensory input to meet their needs. They may seem uninterested, and inattentive to their surroundings.  

Sensation seeking: A child classified as sensation seeking does not recognize or process all of the incoming sensory information, but contrary to low registration, they actively try to gain this sensory input to meet their needs. They may be hyperactive, touch others often or engage in unsafe activities like jumping from heights. 

Sensory sensitive: A child classified as sensory sensitive feels overwhelmed by sensory information, but they do not actively try to avoid the overstimulation, instead they may just display frustration. They may be easily distracted, and irritable, cautious, and uncomfortable in loud or bright environments. 

Sensation avoiding: A child that is sensation avoiding feels overwhelmed by sensory information and will actively avoid the stimulation. They may run away from loud, busy environments, cover their ears when overstimulated by noise, or wear gloves to avoid touching certain materials such as paint. 

Hyposensitivity 

A child who has low registration or is sensation seeking may require extra oral input in order to process tastes, textures, quantity of food and the environment (e.g., food utensils, straws). 

If a child has a low registration pattern for oral sensory processing they may: 

  • Have poor awareness of the temperature or amount of food.
  • Drool frequently.
  • Spill food or liquid from their mouth while eating or drinking.

If a child has a sensation seeking pattern for oral sensory processing they may:

  • Explore objects with their mouth, such as toys, books, sand, and clothes.
  • Crave certain foods, tastes, or smells.
  • Bite their tongue or lips more often than other children.

Case example:

Jackson is a 4-year-old boy. You are concerned that Jackson is constantly biting his lips and inner cheek throughout the day. You notice that he often places non-food objects in his mouth, such as toys and clothes. He also gets into trouble in class for biting the other children, although this does not occur when he is angry or frustrated. 

Based on this information you can see that Jackson is presenting with sensation seeking for oral input. He needs a large amount of oral stimulation and seeks it out by biting his cheek and other objects. 

For a child who has difficulty noticing or processing oral information, you can try to provide the child with foods or items that can provide extra, noticeable sensation for them.

Strategies to assist a child with hyposensitivity for oral sensory processing:

  • Give the child items that are intended for biting, such as gum or chew jewelry (jewelry that is intended to chew on).
  • Incorporate oral activities throughout the day. For example, blow bubbles, drink thick liquids from a straw, or blow cotton balls across the table. 
  • Provide chewy or crunchy foods that will provide extra oral sensory input. For example, apples, granola, bagels, crushed ice, and dried fruit. 
  • Massage the child’s gums or use vibration provided from items such as an electric toothbrush which will help to decrease the need to chew by providing alternate input. 
  • Use hot packs and cold packs on the face and near the mouth to help develop a child’s awareness of different temperatures.
  • Use ‘alerting snacks’ such as salt and vinegar, hot or sour candies, and ice chips. These snacks provide intense oral sensations desired by children with hyposensitivity. 

Hypersensitivity 

Children who have sensory sensitive or sensory avoiding for oral sensation may be considered over-sensitive to tastes, textures or smells. 

If a child has a sensory sensitive pattern for oral sensory processing they may: 

  • Gag with certain food textures, food utensils, or a toothbrush in the mouth.
  • Be described as a picky or selective eater, especially with regards to food textures. When the child eats nonpreferred textures, they may become frustrated or upset. 
  • Only eat foods with specific, preferred tastes. 

If a child has a sensory avoiding pattern for oral sensory processing they may: 

  • Reject certain tastes, textures, or food smells that are typically part of a child’s diet. They may throw the food away from them, run away from the food, or just refuse to eat it. 
  • Only eat foods with specific, preferred tastes. 
  • Limit themselves to a very small variety of foods.
  • Refuse to try new, unknown foods. 

Case example:

Alex is a 7-year-old girl. Alex brings the same lunch to school every day, a white bread sandwich with cream cheese and the crust cut off. According to her parents, Alex refuses to eat anything else and will gag or cry when offered other food choices. She also refuses to join the other children in the general lunchroom at school because the different smells make her gag. Whenever she is in the lunchroom, she runs away to eat alone in a different room.

Alex has a sensory avoiding pattern for oral sensory processing. 

For a child with hypersensitivity to taste, textures, and smells, slowly increase their food tolerance and give them strategies to navigate their sensitivity to smells.

Strategies to assist a child with hypersensitivity for oral sensory processing:

  • Slowly introduce new foods by giving the child variations of their preferred foods. For example, if the child will only eat cereal and you want them to eat blueberries, you can start by introducing blueberry flavoured cereal, then introduce blueberries together with the cereal and gradually reduce the amount of cereal until the child is eating plain blueberries.
  • Encourage the child to drink between bites of food to clear their mouth.
  • Use unscented cleaners and soaps around the house or use essential oils to help lessen overall scents. 
  • Create a mealtime routine and serve meals at the same time every day.
  • To help prepare children for mealtime transitions.  Provide a consistent reminder prior to the meal, have child engaged in preparation for the meal (e.g., set the table) 
  • Wash the child’s face with a cloth or give them ice to chew on to decrease their sensitivity to textures and tastes.

Touch

Sensory processing for touch, also known as tactile processing, is the way that our brain processes information about our environment through messages from our skin. This includes light touch, pressure, vibration, temperature sensitivity and pain. With maturity and experience, children are able to process information about touch from our environment, put meaning to it and differentiate between elements of touch. 

Each child receives and processes tactile information in different ways. Some children are hyposensitive and need extra stimulation to experience light touch, vibration, pressure, temperature sensation or pain. On the contrary, some children are hypersensitive and may become overwhelmed by tactile information. If a child has difficulties with receiving or processing tactile information, they may have challenges in the development of their body awareness, and automatic reactions. For example, they may not develop the ability to pull their hand away when something is too hot.

There are four patterns of sensory processing: low registration, sensation seeking, sensory sensitive and sensation avoiding. 

Low registration: A child with low registration does not recognize or process all of the incoming sensory information, and they do not compensate by trying to gain more sensory input to meet their needs. They may seem uninterested, and inattentive to their surroundings.  

Sensation seeking: A child classified as sensation seeking does not recognize or process all of the incoming sensory information, but contrary to low registration, they actively try to gain this sensory input to meet their needs. They may be hyperactive, touch others often or engage in unsafe activities like jumping from heights. 

Sensory sensitive: A child classified as sensory sensitive feels overwhelmed by sensory information, but they do not actively try to avoid the overstimulation, instead they may just display frustration. They may be easily distracted, and irritable, cautious, and uncomfortable in loud or bright environments. 

Sensation avoiding: A child that is sensation avoiding feels overwhelmed by sensory information and will actively avoid the stimulation. They may run away from loud, busy environments, cover their ears when overstimulated by noise, or wear gloves to avoid touching certain materials such as paint. 

Hyposensitivity 

A child who has low registration or is sensation seeking may require extra tactile input in order to process light touch, pressure, vibration, temperature sensitivity and pain. 

If a child has a low registration pattern for tactile processing they may: 

  • Be able to tolerate very hot or cold temperatures. They may seem unaware of these extreme temperatures and changes in temperature. 
  • Be able to tolerate high levels of pain or seem unaware of pain. For example, they may not notice a large scrape on their knee or complain of any pain after a bad fall.
  • Be unaware when their hands or face is dirty. For example, they may not notice if their hands are covered in dirt after playing outside. 

If a child has a sensation seeking pattern for tactile processing they may:

  • Seem unaware of their own strength, and as a result, play in a rough way.
  • Squeeze too hard while holding hands with others.
  • Rub or scratch at parts of the body to gain extra input.
  • Touch people or objects and show a need to touch toys, surfaces, or textures more than others.

Case example:

Laith is a 6-year-old boy who loves to play roughly with other children. As a parent you notice that he is always hitting hard surfaces with his hands and feet and pushing other children at the park. In addition, he often squeezes your hand very tight while you are crossing streets together. He also tends to feel and touch everything in his environment. When you went to the park the other day, Laith wanted to rub his hands in the sand, touch every swing and slide, and even went over to touch a stranger’s picnic blanket.  

Based on the case you can see that Laith is sensation seeking for tactile input. He needs a large amount of tactile stimulation, and seeks it out by squeezing, playing roughly with other children and touching objects.  

For a child who is hyposensitive to tactile information, you can try to provide the child with tactile input to provide extra, noticeable sensation.

Strategies to assist a child with hyposensitivity for tactile processing:

  • Use firmer brushes and different textured cloths to provide extra tactile sensation. 
  • Encourage the child to play with playdough and goop as they can provide tactile input for children who like to squeeze things. You can change the texture by adding small beads or other materials into the playdough or goop.
  • Play games such as One Potato, Two Potato or Hot Potato with hot packs and cold packs. This can help your child become aware of and sensitive to different temperatures.
  • Encourage your child to pop bubble wrap or provide them with other fidget toys such as a fidget spinner or squeezy ball.
  • Engage your child in tasks that involve “heavy work” such as pulling a peer in a wagon, stacking chairs or picking up heavy toys at tidy up time. These activities provide children with tactile stimulation through the use their muscles. 

Hypersensitivity 

Children who are sensory sensitive or sensory avoiding of tactile sensation may appear over-sensitive to light touch, pressure, vibration, temperature sensitivity and pain. 

If a child has a sensory sensitive pattern for tactile processing they may: 

  • Show distress and anxiety during grooming. For example, while brushing their hair, washing their face, or cutting their fingernails.
  • Strongly dislike light or unexpected touch.
  • Become anxious while standing close to others. 
  • Become irritated while wearing shoes or socks.
  • Become irritated if their hands or face are messy.

If a child has a sensory avoiding pattern for tactile processing they may: 

  • Try to avoid being touched or show an emotional response when they are touched. For example, they may push you away if you try to hold their hand. 
  • Hold objects using only their fingertips and avoid using the palms of their hands.
  • Avoid signs of affection such as hugging or holding hands.
  • Insist on exclusively wearing soft clothing and the same clothing for multiple days. They may even prefer to be naked and require you to cut out clothing tags.

Case example:

Jessica is a 5-year-old girl who does not like to be in crowded areas. She becomes anxious when others stand near her and yells when others touch her. She also does not like to give or receive hugs and kisses from anyone, including her family. She is very selective with the clothes that she wears. She insists on wearing the same cotton t-shirt with no seams or tags every day. 

You notice Jessica has a sensory avoiding pattern for tactile processing. She is hypersensitive to feelings of touch, textures, and pressure and actively tries to avoid them. 

Strategies to assist a child with hypersensitivity for tactile processing:

  • Give the child advanced warning before doing an activity. For example, you can say “after your bath, we’ll brush your hair.” This allows for the child to process what is going to happen and prepare themselves.
  • Encourage your child to take the lead when they get dirty during play. You can inform the child but allow them to clean up themselves, if possible. 
  • Try to avoid unexpected light touch and try to promote deep pressure such as through hugs, a weighted blanket or weighted toys. 
  • Try to show affection in alternate ways. If the child does not like being hugged, it is possible that a “high five” or encouraging words can accomplish the same feeling of affection. 
  • Provide the child with a ‘touch and feel’ box or bag. Place different objects into a box for the child to feel and explore. This allows for the child to experience different tactile sensations in a controlled setting. Examples of objects to put in the box at different times include sand, beads, marbles, wooden blocks, and slime. Over time you can add to the number of texture or objects in the box as the child’s tolerance and enjoyment increases.

Hearing

Sensory processing for hearing, also known as auditory processing, is the way our brains process the things that we hear. We spend a majority of our day listening to many different sounds. For example, the sound of an alarm clock in the morning, the sounds your family members make while speaking, and the sounds of cars going by during the day. Some children are hypersensitive to sounds, and become overwhelmed with common, everyday sounds like the sounds of other children in their class. On the other hand, some children are hyposensitive to sounds and need extra stimulation to attend to certain sounds, like their name being called in a classroom. 

Children that have difficulties with auditory processing may seek or withdraw from auditory input. They may have additional issues understanding speech, remembering instructions, or following a conversation. Children with auditory processing challenges are sometimes misunderstood to have hearing problems, when their hearing may be completely intact. 

There are the four patterns of sensory processing: low registration, sensation seeking, sensory sensitive and sensation avoiding. 

Low registration: A child with low registration does not recognize or process all of the incoming sensory information, and they do not compensate by trying to gain more sensory input to meet their needs. They may seem uninterested, and inattentive to their surroundings.  

Sensation seeking: A child classified as sensation seeking does not recognize or process all of the incoming sensory information, but contrary to low registration, they actively try to gain this sensory input to meet their needs. They may be hyperactive, touch others often or engage in unsafe activities like jumping from heights. 

Sensory sensitive: A child classified as sensory sensitive feels overwhelmed by sensory information, but they do not actively try to avoid the overstimulation, instead they may just display frustration. They may be easily distracted, and irritable, cautious, and uncomfortable in loud or bright environments. 

Sensation avoiding: A child that is sensation avoiding feels overwhelmed by sensory information and will actively avoid the stimulation. They may run away from loud, busy environments, cover their ears when overstimulated by noise, or wear gloves to avoid touching certain materials such as paint. 

Hyposensitivity

A child who has low registration, or is sensation seeking may require extra auditory input in order to process their environment. 

If a child has a low registration pattern for auditory processing they may: 

  • Need you to repeat things multiple times to understand what you are saying 
  • Not respond when their name is called 
  • Be unable to locate where sounds come from 

If a child has a sensation seeking pattern for auditory processing they may:

  • Be very excited with loud music or noises
  • Listen to the TV or music with a very high volume 
  • Be described by others as loud or noisy 

Case example:

Hugo is a 4-year-old-boy. Hugo’s parents complain that he ignores them when they call his name. Hugo often does not answer or make eye contact with his parents. His parents find that they need to repeat things many times, in a loud voice for Hugo to acknowledge them. Hugo’s parents recently brought him to the doctor and confirmed he does not have any problems with his hearing. 

Based on the case you can see that Hugo has a low registration pattern for auditory processing. He does not notice his name being called or the sound of his parents speaking to him and does not actively try to seek out more auditory stimulation or sounds to compensate for this. 

With a child who has difficulty in noticing and processing auditory stimuli you can put them in environments that are stimulating with a variety of different sounds. 

Strategies to assist a child with hyposensitivity for auditory processing: 

  • Have them play with musical instruments, practice humming, or sing. You can do all of these activities alongside the child! Making music offers children a fun, engaging activity while teaching them to attend to different sounds in the environment.  
  • To teach children to respond to their name, first practice calling their name in an environment with no distractions. Once they start to respond to their name with no distractions, slowly build up the distractions in the room. 
  • Use visuals whenever possible. Show pictures of your request, to remove auditory demands. 
  • If the child cannot detect where a sound is coming from, play games with them such as “find the noise.” Hide an object that makes a noise (cell phone playing music, buzzer, etc.) under a blanket, or table, and have them try to locate the sound. 
  • If the child prefers to listen to loud music or a loud TV, provide them with headphones to accommodate this need. 

Hypersensitivity 

Children who are sensory sensitive or sensory avoiding to sounds may be considered over-sensitive to everyday sounds such as a class bell, a car honk, or the voices of other children. 

If a child has a sensory sensitive pattern for auditory processing they may: 

  • Cry from loud or sudden noises. 
  • Be able to hear and become distracted by background noise others may not notice. 
  • Prefer the TV or music volume to be low, or off. 
  • Become upset while eating crunchy foods due to the noise from the crunch.

If a child has a sensory avoiding pattern for auditory processing they may: 

  • Run away from or avoid situations with loud or sudden noise such as a toilet flush, hair dryer, or lawn mower.
  • Avoid situations or places with large numbers of people, such as an indoor playground.
  • Place their hands over their ears in situations with loud or sudden noises. For example, during a fire drill at school.

Case example:

Lia is a 7-year-old-girl. Lia frequently becomes overwhelmed by noises at school. During outdoor recess, she will cover her ears, cry, and run inside if the children playing around her are laughing loudly, yelling, or singing. She uses this same pattern of behaviour in shopping malls, and parks. 

Based on this case you can see that Lia has a sensory avoiding pattern for auditory processing. She becomes easily overwhelmed by sounds from others in busy environments and responds by trying to avoid these sounds. 

With any child that may be hypersensitive for auditory stimuli, or sounds, you may want to give them strategies to limit the overwhelming sounds in loud environments, and provide them with a quiet, calm environment wherever possible. 

Strategies to assist a child with hypersensitivity of auditory stimuli: 

  • Use white noise. This can include noise from a white noise machine, a fan, or radio static. White noise can help to soften and minimize the effects of loud and overwhelming sounds. 
  • Give the child advanced warning anytime a loud sound, such as a fire alarm will be going off. Helping them feel prepared can minimize the effects of these sounds. 
  • Use noise-cancelling headphones, or earplugs to muffle the effects of loud sounds in overwhelming situations. 
  • Create a quiet, calming room at home, or in the school for the child to go to when they feel overwhelmed to calm their nervous system down. 

Occupational Therapy and Paediatrics Part 2

How is an Occupational Therapist different from a Physical Therapist? 

An Occupational Therapist is commonly confused with a Physical Therapist as the two professions often work side-by-side. The main difference is that Occupational Therapy is centred on the person’s ability to perform activities of daily living, and Physical Therapy treats the person’s physical ability and focuses on movement and function. 

For example: Sara is a 5-year-old girl diagnosed with cerebral palsy. She walks on her toes and has challenges with getting dressed. The Physical Therapist may give her orthotics to prevent toe walking, or work on muscle strengthening. The Occupational Therapist may provide her with aids such as adaptive zipper pulls that can help with her dressing challenges. 

How is an Occupational Therapist different from a Behaviour Consultant? 

Behaviour Consultants address complex behaviours by looking at a child across a variety of situations for patterns and the function of the child’s behaviour. This includes observing environmental factors including the relationships between the child and their caregivers.  

In contrast, Occupational Therapists will look at the barriers limiting the child’s ability to engage in or perform their occupations. Occupational Therapists also consider a child’s behaviour, as well as sensory challenges, environmental factors, and motor skills impacting occupational performance. 

For example: Jake is a 7-year-old boy with Autism Spectrum Disorder. He becomes stressed at unexpected, loud noises in his class at school. Also, when he gets frustrated with his tasks in school, he engages in screaming and throwing his pencils. The Occupational Therapist may provide him with large headphones to block out unsettling noise. Additionally, they may help him with emotional regulation skills for his frustration. The Behavioural Consultant will focus on establishing the cause and outcome of the child’s screaming and throwing of pencils. They will develop strategies to reduce or prevent this behaviour in all environments. 

Despite the differences between Occupational Therapy, Physical Therapy, and Behavioural Consultation, the three professions have a lot of overlap. The chart below compares the areas of overlap between the professions. 

ChallengesOccupational Therapists (OTs)Behaviour Consultants (BCs)Physical Therapists (PTs)
Sensory
Does the child avoid activities with certain textures, (gluing, finger-painting), have sensitivity to loud noises or smells, frequently pull, hit, seek touch (hugs, tight spaces), or avoid active games and slides?		✅ OTs will help children find strategies to manage their sensory challenges. For example, they may suggest headphones to block out loud noises, or help children become tolerable of different sensory stimuli.❌❌
Behaviour 
Does the child display repetitive behaviours, restrictive interests, low frustration tolerance, difficulty with transitions, or impulsive behaviour?		✅ OTs will assess aspects of the person, environment, or occupation to ultimately support the child’s ability to perform their occupations.✅ BCs can conduct assessments of the child and the environment to determine the triggers and responses to the challenging behaviours. They will develop strategies that will address the purpose of the behaviours by preventing future occurrences of challenging behaviours, teaching more appropriate behaviours to replace the problem behaviours, and responding to challenging behaviours in order to make them ineffective, inefficient, and irrelevant.  ❌
Gross Motor
Does the child have postural challenges, difficulty achieving motor milestones (walking, crawling, etc.), clumsiness, (often tripping and falling), difficulty with age-appropriate bicycle/tricycle riding, throwing a ball, kicking a ball, climbing stairs, or tire easily? 		✅ OTs can help with many of these areas with a focus on occupation. They may teach the steps required to ride a bike or throw a ball. They may suggest energy conservation strategies or provide strategies to increase coordination. The key is that they will focus on these challenges in relation to occupation. ❌✅ PTs frequently assist children with gross motor challenges, by providing specific exercises aimed at improving their physical abilities. 
Fine Motor 
Does the child have difficulty with age appropriate dressing, the use of eating utensils, handwriting, colouring, cutting, using both hands together, or manipulating toys?		✅ OTs will provide suggestions to develop and enhance fine motor skills or adaptive equipment such as a weighted spoon. ❌✅ PTs can help with improving physical strength and coordination for fine motor skills, especially handwriting. 
Equipment
Does the child have equipment needs including: prescribed equipment such as wheelchairs, walkers, standers?		✅ OTs can prescribe and fit children for adaptive equipment.❌✅ PTs can prescribe and fit children for adaptive equipment.
Oral Motor
Does the child have difficulty chewing, keeping food in their mouth, swallowing, drinking from a cup? Are they very slow eaters?		✅ OT’s will provide strategies for a child to learn to chew, swallow, and drink. The OT will first make sure that there are no medical or postural reasons for difficulty in eating and drinking.❌❌
Social 
Does the child have difficulty making and maintaining friends, making eye contact or using other non-verbal communication, playing with other children, or listening to and following instructions? 		✅ OT’s may conduct assessments to determine potential reasons for the social difficulties. OT’s will also assess how these difficulties are impacting the child’s occupations and will give strategies on how to include the child in play and help the child participate in activities. ✅ BCs can conduct assessments and observations to determine supports in programming to develop the child’s social skills and have appropriate interactions with others. BCs will focus on changing socially significant behaviours that will support the child’s inclusion in all their environments. ❌
Cognitive 
Does the child have memory impairments, attention deficits, difficulty with decision making or problem solving, or difficulty following multi-step directions?		✅ OT programming can also focus on cognitive skills to determine possible adaptive or remedial strategies for the challenges listed. ✅ BCs assess the child’s current cognitive abilities and break down complex skills into smaller steps for the child to learn. BCs design individualized strategies/ adaptations to support skill development. ❌

Occupational Therapy and Paediatrics Part 1

What is Occupational Therapy? 

Occupational Therapists work with clients of all ages, with any challenge preventing them from performing their occupations. Occupational Therapists look at aspects of the person, environment, and occupation to discover the factors contributing to the barriers to the clients’ participation. They have specialized training and use a strengths-based approach to work with each client and tailor the therapy to their individual needs. 

Paediatric Occupational Therapists help children to perform and engage in their occupations of self-care, leisure, and productivity. These include activities individuals want to do, are expected to do, or need to do to (Canadian Association of Occupational Therapists, 2016): 

  1. Take care of themselves 
  2. Participate in a group setting 
  3. Have fun

Occupational Therapists work with children in various settings including home, early learning environments, schools, and medical facilities. The main occupation of children is play; as a result, Occupational Therapists incorporate play interests in their work with children.

Initial visit with an Occupational Therapist: The Occupational Therapist will ask questions to gain a better understanding of the child, their environment (home, family, playroom or school) and the task that they are having difficulty with. To support the collection of informal information, the Occupational Therapist may conduct specific, evidence-based assessments to understand the child’s challenges in more detail.

After the initial visit: Occupational Therapists use a number of different interventions. Each intervention is collaborative and focuses on improving occupational performance and engagement in tasks that you and the child determine are important.

The following are some examples of Occupational Therapy Interventions: 

  • If a child is having difficulty with the washroom routine, an Occupational Therapist may introduce a visual schedule that breaks down the steps of using the washroom for the child to follow. If a child’s washroom difficulties are sensory-based the Occupational Therapist may suggest the use of potty seats or a change of location of the potty.
  • If a child is having sensory challenges, the Occupational Therapist recommendations may include adjusting the task or environment for an individual’s needs, introducing movement breaks, using weighted products, headphones, organizing spaces or providing quiet times. 
  • If the environment is limiting the child’s occupational performance, the Occupational Therapist may suggest modifying spaces for accessibility by providing ramps, adaptive bathroom equipment such as toilet seat insert, or alternative lighting to reduce brightness.

Links 

  1. Visit the Canadian Association of Occupational Therapists to find an Occupational Therapist at https://www.caot.ca/site/pt/findanOT?nav=sidebar
  2. Definitions of Occupational Therapy Terms
  3. Occupational Therapy and Paediatrics Part 2
  4. To learn more about Occupational Therapy, visit the Canadian Association of Occupational Therapists, or the Ontario Society of Occupational Therapists at https://www.caot.ca and https://www.osot.on.ca 

References

Canadian Association of Occupational Therapists. (2016). What is Occupational Therapy?. Retrieved from https://caot.ca/site/aboutot/whatisot_test

Dunn., W. (2017). Strengths-based approach: what if even the ‘bad’ things are good things?. British Journal of Occupational Therapy. 80(7): 395-396. 

Creating a Calming Environment

Providing a calming and nurturing environment for children requires a safe and inviting space for both adults and children to explore together.  Calm and engaging environments offer predictability, stability and positivity for children. This is especially true when children have experienced challenging or stressful situations that upset their sense of security.

Educators and families can set the stage for a calming environment through three key approaches; 1) positive relationships, 2) organizing the environment, and 3) consistent routines.  When the environment is predictable, supportive, and consistent, children feel safe to explore and learn, which in turn promotes the development of self-esteem and resilience.

Building a Positive Relationship

Consider the following when building supportive relationships and a welcoming environment. 

  • Greeting your child by name will strengthen your relationship with them and help you understand and respond to how your child may be feeling that day. 
  • Have appropriate expectations for your child – When setting your expectations, take into consideration your child’s likes, dislikes, interests, skills and learning style. 
  • Follow your child’s lead – Plan activities that capture your child’s interests and abilities. 
  • Provide opportunities for your child to have individual attention from a responsive adult. Even a few minutes of quality interaction using listening and eye contact will show your child that they are heard, they are special and that you are happy to be with them.
  • Comfort and reassure your child quickly when they are distressed. It is important to recognize and label your child’s feelings.
  • Include family and cultural practices throughout the day, ones that will help your child find a way to ground themselves within their identity.

Organizing the Environment

A well-designed environment promotes independence and fosters a sense of calmness. Consider the following when planning the play space.

  • Create defined play areas – if possible, break up the room into areas using shelves, tables and other furniture.
  • Create space to sit and relax where your child can take a break from loud sounds.
  • Keep the room tidy, clearing away unnecessary clutter may reduce visual stimulation and help your child find what they need more easily.
  • Reduce the number of toys available at the same time. 
  • Rotate play materials as necessary to continue to keep your child interested and engaged.
  • Adjust the sensory input in the environment to support well-being.  Can lighting or the noise level of the room be adjusted?
  • Incorporate opportunities for movement and music into the daily routine.

Consistent Routines

The more consistent your daily routine, the easier it is for your child to anticipate what will happen next and make sense of the day. This predictability may help them cope with stressors. Consider the following.

  • Use a visual schedule, showing pictures of the daily routine and step-by-step mini-schedules for parts of the day that are more stressful. This will increase predictability of the routine and help your child understand what is happening next.  Model using the visual schedule and make it a fun experience with your child. Let them point out what is happening next.
  • If your child has a high interest in technology, such as computers or tablets, structure their time for using technology by including this in the scheduled routine.
  • Prior to transitions, give warnings that the transition is coming.  Get down at their level and make sure they have heard you and are aware that the transition is coming.

Remember

Creating a safe, secure environment where your child can form meaningful and supportive relationships is critical to their social and emotional development. Providing consistent environments, relationships and routines can help your child feel safe to explore the world around them. 

References

Burnett, Christie. (2020). Managing Big Emotions Through Movement:  Yoga for Kids.  Retrieved from https://childhood101.com/yoga-for-kids/.

Coping Skills for Kids. (2019). Deep Breathing Exercises for Kids!  Retrieved from https://copingskillsforkids.com/deep-breathing-exercises-for-kids.

Kostelyk, Sharla. (2020). 175 Sensory Activity Ideas for Kids.  Retrieved from https://www.thechaosandtheclutter.com/archives/175-sensory-activity-ideas-kids/.

Minero, E. & Fleming, N. (2020). DIY Ways to Meet a Child’s Sensory Needs at Home.  Retrieved from https://www.edutopia.org/article/diy-ways-meet-childs-sensory-needs-home.

COVID-19 Mental Health Resources

Trauma is the lasting emotional response that can result from living through an event that undermines a person’s sense of physical or emotional safety.  Long after the traumatic event occurs, people who have experienced trauma can continue to feel the effects which can impact their ability to function day to day.

COVID-19 has had an effect on everyone’s sense of physical and emotional safety.  For individuals who live with a developmental disability and their caregivers, adjusting to life in isolation and significant changes to routine has been particularly difficult.   

We are now adjusting to a “new normal” where we will continue to practice physical distancing in most environments and those of us who are able to will wear masks and other personal protective equipment as needed.  Things are changing every day as we learn more about COVID-19 and while it is important to stay well informed it is just as important to be aware of how we and those we care for are being impacted.  

ConnectABILITY.ca has compiled a list of resources so that individuals with developmental disabilities and their families can find the support and information that they need.  You are not alone and help is available. 

Please note: if you are experiencing a mental health crisis please contact 911 immediately or present to your nearest emergency department. 

Resources for Children and Youth

  1. Jack.org has created an online hub of COVID-19 youth-focused mental health resources to help students take care of themselves and their peers.
  2. School Mental Health Ontario provides students with resources and guidance around self-care, reaching out for help and maintaining a positive outlook.
  3. Woodview Mental Health and & Autism Services is offering virtual ‘walk-in’ mental health counselling during COVID-19. See the attached flyer for more information.
  4. Kids Help Phone is a 24/7 national support service that provides free professional counselling services to young people through phone, text and live-chat.
  5. Bounce Back is a free, evidence-based cognitive behavioural therapy (CBT) program providing guided mental health self-help supports for adults and youth over the age of 15.
  6. AIDE Canada has developed resources and toolkits to support children and youth with autism and intellectual disability deal with stress during this difficult time. 
  7. What’s Up Walk-In provides free virtual mental health counselling to children, youth, young adults and families. 

Resources for Adults, Parents and Families

  1. Health Care Access Research and Developmental Disabilities (HCARDD) offers a variety of free information sheets, webinars, videos and tools to help individuals with an intellectual disability better understand COVID-19 and manage feelings of worry and stress.
  2. Canadian Association for Community Living (CACL) has developed a robust COVID-19 resource page to provide individuals with developmental disabilities and their families with reliable information and resources, including a section on mental health supports.
  3. Autism Ontario has put together a list of mental health resources to help people with autism and their caregivers get through this global pandemic.
  4. Safehaven has developed a Self-Help Corner with resources for staff, parents and families, including fun at-home activities that can help promote positivity and well-being.
  5. Community Living Ontario’s Staying Connected page offers suggested resources to boost health and wellness such as mindfulness apps, fitness videos and a downloadable guide to educate individuals about normal versus excessive worrying.
  6. The Council for Intellectual Disability provides videos, easy read guides, and information sheets to help individuals with an intellectual disability look after their mental health.
  7. Surrey Place has compiled a list of online tools that provide accessible and up-to-date information for individuals with a developmental disability, including tips on reducing anxiety and stress.
  8. Check out Anxiety Canada’s articles, CARD handouts, mobile app and My Anxiety Plan online courses to effectively manage and deal with anxiety as a result of COVID-19.
  9. The Ontario Caregiver Organization offers caregiver tip sheets, multilingual resources and an online peer support group for individuals in a care-giving role.
  10. CAMH provides a variety of mental health resources to help individuals cope with the effects of COVID-19 such as feelings of isolation, stress and anxiety, loss and grief, and stigma and prejudice.
  11. The Candian Mental Health Association has put together some resources and suggestions to help support mental health at this time of uncertainty.
    1. Additionally, CMHA branches are open but offering alternative service delivery, for more information, click here.
    2. To enroll in a free virtual mental health course, click here.
  12. Wellness Together Canada provides free mental health and substance use supports including modules for addressing low mood, worry, substance use, social isolation and relationship issues.
  13. The Mental Health Commission of Canada has developed tip sheets to help individuals cope with COVID-19, including strategies to manage ‘return anxiety’ as the lockdown lifts.

Resources for Seniors

  1. Chatting to Wellness offers free 1-1 chatting sessions over the phone to all seniors, across Canada to help isolated seniors feel connected and reduce stress.
  2. Bob Rumball has developed a series of Mental Health and Wellness videos for deaf seniors with ASL interpretations. 
  3. The Canadian Coalition for Seniors’ Mental Health shares physical distancing activities, virtual visits toolkits, tips for battling anxiety and mental health support lines for Seniors in Canada.

Sotos Syndrome

Fact Sheet

What is Sotos Syndrome?

Sotos syndrome is a rare multisystemic genetic disorder characterized by a typical facial appearance, overgrowth of the body in early life with macrocephaly, and mild to severe intellectual disability.

Sotos Syndrome is an autosomal dominant condition which means that if either one of the parents has Sotos, there is a fifty percent chance that each of their children will inherit the condition. 

In around 90% of children with Sotos Syndrome the cause is a mutation in the NSD1 gene. This gene provides instructions for making a protein that is involved in normal growth and development. The protein affected cannot then function properly and normal growth is disrupted. It is not currently clear how the disruption causes the overgrowth and other complications and research is ongoing.

How is it Manifested?

The following characteristics are present in Sotos Syndrome:

  • A long narrow face with a high forehead
  • Flushed (reddened) cheeks
  • A small pointed chin – large mandible
  • Corners of the eyes point downwards with an abnormal increase between the eyes
  • Large feet/hands- clumsiness and awkward gait
  • Intellectual disability (Autism Spectrum Disorder, Mild Intellectual Disability)
  • Behavioural issues (can include Attention Deficit Hyperactivity Disorder, phobias, tantrums, obsessions/compulsions, social development delays)
  • Delays in speech/language – monotone voice, stutter, problems with sound production
  • Delays in motor skill development – weak muscle tone (hypotonia)

Additional characteristics may include:

  • Curvature of the spine (scoliosis)
  • Seizures
  • Heart or kidney defects
  • Hearing loss
  • Problems with vision
  • Some infants with this disorder experience jaundice and poor feeding
  • A small percentage may develop cancer in childhood

Who is affected?

Sotos Syndrome is reported to occur in 1 in 10,000 to 14,000 newborns.

Diagnosis

A clinical diagnosis of Sotos Syndrome may be gained by the presentation of the typical symptoms:

  • Characteristic facial appearance
  • Learning disability
  • Childhood overgrowth
  • Increased head circumference

This suspected diagnosis can be confirmed through a genetic test to check changes in the NSD1 gene.

Treatment

There is no specific course of treatment for Sotos Syndrome. Treatment is usually based on symptoms which have been identified.  Sotos Syndrome is not a life-threatening disorder and individuals may have a normal life expectancy.

Resources

Sotos Syndrome Support Association of Canada

The Sotos Syndrome Support Association of Canada helps to support families by providing them with information by way of handbooks, pamphlets, Internet, public lectures, and discussions, and with emotional support by facilitating discussions with other parents who have been through similar experiences.

1944 Dumfries, Montreal, Quebec, H3P 2R9 Canada
Email: info@sssac.com
Website: http://www.sssac.com

National Organization for Rare Disorders

NORD, along with its more than 300 patient organization members, is committed to the identification, treatment, and cure of rare disorders through programs of education, advocacy, research, and patient services.

https://rarediseases.org/rare-diseases/sotos-syndrome/

Anxiety in Childhood

All children experience some form of anxiety; this is to be expected and can be a response to something positive or negative happening in a child’s life. Feeling anxious can be associated with changes in routines, family dynamics, new experiences or exposure to a traumatic event. Any indication of a child experiencing anxiety requires a supportive and empathetic response to help them manage worries and learn a variety of coping skills.

Working Through Anxiety Together

It is important to identify your child’s feelings and responses to a variety of situations.  Work together with your child to practice new skills when they are calm and during general routines so that they can use those skills when feeling anxious.

  • Watch and learn how your child reacts under stress. Their reaction will tell you what they need.
  • Help your child recognize and label emotions in themselves and others. 
  • Provide space and an opportunity for your child to express emotions without shame.
  • Offer comfort and reassurance quickly when your child is showing anxiousness. Let them know you are there for them and stay close to offer comfort if they choose.
  • Understand your own response to stressful situations. What strategies are you modeling?
  • Find ways to regulate your own emotions to avoid inconsistent responses to situations.
  • It’s important to include family and cultural practices throughout the day, ones that will help your child find a way to ground themselves within their identity.
  • Visit new settings in advance to introduce your child to an upcoming change (e.g., if your child is starting school or a new child care program, visit the physical setting, talk about the changes in advance and on multiple occasions).
  • Warmly welcome and say goodbye to your child when coming or going. Make eye contact, smile and reassure them.
  • Provide engaging, interesting and challenging activities for your child to shift their attention to when feeling anxious.  Ask yourself, “What do they like to do?”
  • Offer a favourite toy or activity to help comfort your child when they are anxious. Spend some time with them at that activity.
  • Slow down and allow flexibility in your routine.  When possible, let your child lead the routine and allow time to complete tasks. If your child is upset, slow the routine down to give them extra time to regulate their feelings. Model calming techniques, such as taking deep breaths, thinking of a quiet place, counting to ten. Practice these activities with your child during calm periods.
  • Prepare your child for transitions using visuals, such as pictures or verbal reminders to give them time to prepare (e.g., “In five minutes we are going to tidy up and get ready to go outside”).
  • Prepare your child before any upcoming changes. You can use tools such as calendars, books or personalized stories to help them understand the change.
  • Use a visual schedule, showing pictures of the daily routine and step-by-step mini-schedules for parts of the day that are more stressful. This will increase predictability of the routine and help your child understand what is happening next.  Model using the visual schedule and make it a fun experience with your child, let them point out what is happening next.
  • Use a visual timeline, such as a calendar to count down the days until the start of an upcoming change.

Additional Tips for School-aged Children

  • Talk about what is happening, plan and brainstorm solutions together.  Be sure to practice this plan during moments of calmness and revisit later, after a stressful situation, to adjust the plan as needed.  
  • Help your child adapt to stressful situations through short exposure and practice. Completely avoiding triggers of anxiety does not allow your child the opportunity to build a toolbox of coping strategies.  With practice, your child can learn to work through their fears and worries.
  • Help your child ‘reframe’ their anxious thoughts. Here is a script that can help:
    • “Name a worry floating around in your mind right now.”
    • “What is the worry telling you?”  What is a fact about this worry? 
    • “Let’s break it down and tell me more about how you feel.” 
    • “How can we take that worry and change it to a positive thought?”
  • Help your child list strategies to use in a moment of anxiety.  Write them down or use pictures to represent the strategies. Here are some examples:
  • deep breathing
  • progressive muscle relaxation – tense a group of muscles and then relax them, moving up from the toes to the top of the body
  • squeeze a stress ball
  • journal ways to identify worries and reframe thoughts
  • talk about worries with a trusted adult

Remember…

Children, like adults, need time to adjust to new people, situations and experiences. Thoughtful and supportive responses on the part of the adults in a child’s life can help them learn how to approach fears and manage their anxiety.

Helping your child respond positively to new and potentially stressful situations supports healthy emotional development. All children are unique and have different ways of managing. What is tolerable to other children may not be for your child. It’s important to understand the cause of the anxiety and the ways to support them. Caregivers, family members and early learning educators share a role in making children feel safe and secure.

If your child has a sudden change in behaviour such as limited appetite, disruptive sleep patterns or is no longer interested in favourite activities, contact your child’s family doctor for additional resources and support.

References

Beidel, D. C., & Turner, S.M. (2005). Childhood anxiety disorders: A guide and treatment. New York: Routledge.

Cooper, H. (2020, March 05). Helping Children and Teens Cope with Anxiety About COVID-19. Retrieved June 11, 2020.

Dym Bartlett, J., Griffin, J., & Thomson, D. (2020, March 19). Resources for Supporting Children’s Emotional Well-being during the COVID-19 Pandemic. Retrieved June 11, 2020.

Hurley, K. (2018). Helping Kids with Anxiety: Strategies to Help Anxious Children. Retrieved June 11, 2020.

Illinois Early Learning Project, (2005).  Please don’t go: Separation Anxiety and Children. Retrieved June 11, 2020

Mount Pleasant Family Centre Society. (2020, April 22). Early Childhood Development  in a Time of Pandemic. Retrieved June 11, 2020.

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