Thinking Zebras
Pediatric Occupational Therapy
Sensory regulation is the ability to bring ourselves back to a calm and composed self. The exercise above shows a child counting and rhythmically bouncing on a therapy ball to get ready before starting his homework routine.
What is Sensory Regulation?
The ability to adjust one's sensory preferences to meet the demands of the outside environment, filter distractions, and successfully focus on the task at hand is known as sensory regulation.
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Our brain constantly processes sensory information from our five senses: vision, hearing, touch, smell, and taste. Within our central nervous system, there are mechanisms to receive, process, filter, adapt , and act on all incoming sensory information—a truly impressive process. Additionally, our bodies utilize two more senses to gather information from the environment: the vestibular sense (which contributes to our sense of balance) and proprioception (which helps us perceive our body's position in space). Our brain relies on information from all seven sensory systems to function and guide —a complex neurological process that operates subconsciously - and is called sensory processing. In recent times a sense of interoception has been incorporated in occupational therapy practice. Interoception is the ability of the body to read its internal body signals.
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As the name suggests, here we will discuss how to support children who struggle with sensory challenges. These challenges vary widely, from milder symptoms that can be effectively managed to more severe difficulties that significantly affect a child’s daily activities.
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If these challenges are profound and regularly disrupt a child’s routine, they may be diagnosed as sensory processing disorder (SPD). Research indicates that SPD is more prevalent among children with neurodevelopmental conditions such as developmental delays, ADHD, autism, and anxiety etc. compared to the general population. It's important to note that children can experience sensory processing challenges or disorders independently, without accompanying diagnoses.
Why is Sensory Regulation Important?
Common Signs of Sensory Dysregulation
Depending on their neurology some children may seek specific sensory input, others may avoid certain kinds, and some may seek and avoid different inputs at different times. On the other hand, some children may struggle to register incoming sensations. Sensory processing is a deeply personal experience with no definitive right or wrong. In therapy, the goal is not to correct these sensations but to validate the child's experiences and to support them.
In school, children with sensory processing challenges may find the classroom, cafeteria, or recess too noisy. At home, trips to busy parks, museums, or restaurants may be too stimulating. Their clothing may feel itchy, they may not want to wear socks in winters, they may be picky about the texture of food they like to eat, they may often bump into things and fall, they may be scared to go on the roller coaster or they may love climbing high and so on.
How Can Occupational Therapy Help?
Sensory processing is another common area for which children are referred for OT services. Sometimes it's straightforward, but other times it can be challenging to identify underlying sensory challenges because a child may have a host of other issues that could cause them to behave in a certain way, which may resemble sensory dysfunction but not necessarily be so. For instance a child who is struggling to read, may wiggle and present themselves as restless in the classroom. Outwardly his behavior may present as movement seeking, but in fact it is the child's coping mechanism to deal with their anxiety of inability to read. So OTs take a wholistic look at every facet of child's performance
Your OT will conduct a thorough investigation which will include standardized assessment, interview with the teachers and the parents to understand child's work demands and coping mechanisms both at home and at school. This will enable the therapist to construct the child’s sensory profile. Based on which the OT can help create a plan of activities that a child can do throughout their school day (or at home) to stay regulated and engaged.
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In creating these activities, the OTs apply principles of sensory integration The principles of sensory integration are rooted in neuroplasticity—the brain’s ability to form new neural connections in response to "just the right" challenge. When children engage actively and purposefully in these activities, they generate what is known as an adaptive response, which indicates neural change, or neuroplasticity. These newly formed neural pathways enhance a child's ability and capacity to further learn skills they might otherwise struggle with.
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Sensory Processing Assessments
Ideas For Home Activities
According to the sensory integration Framework of treatment there are 3 sensory systems that play a key role in treating sensory processing differences;
Touch, proprioception, and vestibular.The movements used in therapy aim to stimulate receptors in all the three systems.
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​Below are some common activities used as part of sensory integration approach.
Rocking on Therapy Ball Activity
Activity Targets: Proprioceptive and Vestibular systems. This is a great calming activity.
Items Needed: A therapy ball. (right sized for your child but a slightly bigger ball is ok too).
How To Do: Help your child lay on the ball and find their balance as they rock back and forth, touching the ground with their hands and feet. Count slowly to generate the rhythm.
Rhythmic Bouncing On Ball Activity
Activity Targets: This can be used both as a calming & alerting activity .
Items Needed: Therapy ball (right size ball for your child, with their feet touching the ground comfortably when they are seated on it).
How To Do: Count rhythmically as the child bounces. Invite the child to count after you set the rhythm.
Calming Roll On The Ball Activity
Activity Targets: Creating a calming space for your child to go to when they are overwhelmed.
Items Needed: Tent in a quiet corner, pillows, cushions, your child’s favorite soft toys, activities and books. If you don't have a tent, you can create one with chairs and drape a bed sheet.
How To Do: Explain to your child the purpose of this space. Encourage them to use this space when you notice that they are overwhelmed. Do not use this space as time out space. This is a safe space for them to collect themselves when they are overwhelmed or agitated.
Body Sock Fun
Activity Targets: Calming activity to reduce anxiety during challenging task of memorizing math fact (in the example here- multiplication).
Items Needed: Paper with multiplication facts, and playdough.
How To Do: Place playdough under each fact and ask the child to squeeze the playdough as they say the fact. Repeat as many times. Repeat with different colors of playdough. To children seeking more, replace playdough with theraputty, which is more resistant.
Activity Targets: Calming activity .
Items Needed: Therapy ball.
How To Do: Have the child lay on their tummy, and gently roll the ball on their back as you apply gentle pressure on the ball. Count or sing their favorite rhyme. You can dim the lights of the room to add more quiet & calming effect.
Calming Corner
Activity Targets: Alerting while providing deep pressure.
Items Needed: Body Sock (get the appropriate size for your child).
How To Do: Help the child step into it and pull it up. Some children may be hesitant to pull it up all the way up to cover their heads. So initially, it may be a good idea to just bring the body sock up to their shoulders. And once they are comfortable in it, you can ask them to pull it over their heads, which provides additional deep pressure to the whole body as they stretch. Once the child is wearing the body sock - they can stretch their arms and press against the fabric, which provides deep pressure. Or they can dance in it. Or roll in it on the carpet. Please be around to supervise your child , as it may be hard for them to coordinate and balance their movements while they are in the body sock.
Learning Multiplication With Playdough
Accommodations To Support Engagement & Learning
Shown here are some common accommodations used in the classroom. Your child’s OT can guide you in implementing these strategies effectively. Once you learn how to use these strategies you can implement them at home as well.
Noise reducing headphones
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Weighted lap pad
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Weighted compression vest
Visual schedule
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