Sensory Processing Disorder & Sensation Avoidance

This post on Sensory Processing Disorder & Sensation Avoidance is the 2nd in the series of our journey with Sensory Integration Therapy and I hope it can help others in some way:
Sensory Processing Disorder & Our Boy With Down Syndrome
Sensory Processing Disorder: Sensation Seeking & ‘Antisocial Behaviour’
Please also see Potty Training A Child Who Has Zero Interest
The more I learn about sensory processing, the more I realise just how much we can do to help our kids that shy away from, or find certain sensations really hard to cope with.  The more we do, the more it can help!

This post, Sensory Processing Disorder & Sensation Avoidance follows on from my previous post ‘Sensory Processing Disorder & Our Boy With Down Syndrome, which to quickly recap on – we receive information via our five senses all day every day (sight, hearing, taste, smell & touch), which our brain processes and we then respond to, either appropriately or not…

One thing I thought might be useful to others, is to write a post about some of the sensation difficulties our boy with Down Syndrome used to have a lot of, he just didn’t like touching certain things: grass, snow, cold things in general, food, trees, leaves, wearing hats, ‘messy play stuff’, touching anything new….

So what did we do and did it work?  The answer is yes is really has worked and the problem seems to have gone (I shouldn’t have said that should I?).  I’m not saying  this will work for every child but I think it’s definitely worth a try….and it takes ages so be patient!

We broke everything down as much as we could into the tiniest of micro steps, looked at helping him to explore things through safe barriers, gave lots of positive reinforcement and then after any micro step we did something (however briefly) together.  (I also think bribery can be a wonderful thing…if you do this you can have one sweet (or whatever their currency is).  The idea is to create as many opportunities for praise and good experiences as possible.

By ‘safe barriers’ I mean using things he felt comfortable with between him and the scary item – gloves, touching our hands, being carried, being in the bath etc and make sure he was in a safe place before being asked to meet his fear.

Here’s what we did:

The fundamentals: 

• Got him to observing harmless interaction of others with the scary item (to normalise the visual input).
• Filled his world with exposure to the scary item until the problem was sorted.
• Took tiny micro steps to keep things as stress free as possible while giving opportunities for empowerment and pride.
• Lots of praise.

Approach 1

• We made sure he saw us touch ‘the scary things’ as much as possible in all sorts of situations until he no longer felt stressed by that.

• Then we put gloves on him (if your little one doesn’t tolerate gloves, can you think of anything else they may be happy to use as a barrier? A muslin, blanket, facecloth, hand inside a large envelope etc….) and put his hand on top of ours while WE touched the scary thing and then gave him lots of praise before going off to do something completely different together. By doing this, they’re watching how you don’t come to any harm by touching the item.  If your little one couldn’t manage this (i.e. cope with being close to the fearful item), then maybe try doing it with an item you know they’re fine to touch – by this you’re introducing them to the concept of barriers.  Do lots of this until they understand they just won’t get the sensory input from the actual item…..yet 😉

• We did this 3-5 times a day until he was 100% fine and then moved on to him touching it directly with his gloved hands (lots of praise, bribes, opportunities to show off….)

• Then we tried without gloves but back to putting his hand on ours while we touched it.

• Then finally we asked him to touch the item without the gloves.  Some items he would and others he wouldn’t.

For those he wouldn’t, I would put it on me e.g. a melting ice cube in the palm of my hand, a leaf on my knee, a piece of cooked pasta on my nose, I’d stand inside a bush and we would all laugh and sing and we’d all take take turns doing it except for him while he watched.  Strictly looking only!  Over time he became more comfortable and then we’d do things like roll a beloved ball (you could also use a favourite snack) to stop just in front of a bush (scary item), so he could get it without touching the bush but he had to be next to the bush.  Over time (weeks) the ball got closer and closer until it was underneath and he had to touch and manoeuvre the bush to get his ball out.  Now all he wants to do is sit in trees and push his way through shrubs!

Approach 2

The other approach we had was to mimic the sensation for him using ‘ourselves’ – for example, he didn’t like hats on his head, which is fine until you want them to be be able to be comfortable wearing a bike helmet so…

• I’d make up silly songs about things sitting on our heads and while I sang I’d put my two hands firmly on his head, add a bit of pressure and then moved my hands down over his ears and his face.

• Lots of head massage with my fingers while reading him a story.

• When helping him with his top, I’d pretend I couldn’t find him (you know the game) and hold his top so the neck of it was still around his head and then slowly slowly pull it down.

• Crawl underneath duvets.

• We’d balance books and cushions on his head, drape materials over his head and basically do as much ‘stuff on head’ fun as we could think of.

• When we got to the hat on head stage, we’d take turns and ‘allow’ him a very quick 0.5 second turn before taking it off and saying ‘no it’s my turn’ and then not letting him have it and running away, then he’d chase us – you know, the usual fun stuff.

We just kept at it – lots of tiny bursts that we built up over time.  Now he’ll wear anything on his head.

He absolutely hated having his nails cut, so we put nail clippers all around the house and would just do one clip on one finger or toe once to twice a day.  We started off having to hold him down first and the more we did it the more he got used to it and now he just tells us which one he wants cut first.

We also did lots of modelling through play and asking him to do the dreaded action to a toy, to a sibling, to us…

I know other children have trouble with things like having sun-cream put on them and having showers & haircuts.  I’m not sure what you’ve tried or what you haven’t but these would be my initial thoughts and ideas of what might be worth a try based on the same principles:

Suncream

• Squirt some cheap allergenic body lotion (there’s going to be a lot of wastage) into a bowl and put it in the garden with some sticks, stones or long paper twists next to it for them to ‘discover’. 

• Hide a couple of drops of olive oil in their bath so they get used to their skin feeling slightly oily / slippery (careful they don’t slip in the bath though!).

• Spend time rubbing / touching their skin with as many different textures as you can lay your hands on including wet, cold and warm ones.

• Get them to put cream on you / dinosaurs / dolls / bananas / the table / the window (lovely art work!) using the tip of one finger.

Then….

• Put a tiny bit of cream on your hands or ask them to squeeze some on to your hand for you, rub it in until it’s vanished and then get them to touch where it was / see if their detective work is up to scratch and if they can work out the exact spot where it was!

• Put a little bit of cream in the palm of your hand, rub your hands together until it vanishes and then put it on them but start with one toe.  It’s in effect not really going on them and they should really just feel your touch more or less as normal.  Then go off and do something completely different together – always end with a lovely one to one time, however short.

• Then come back to it a couple of hours later, rub some more between your palms and put some on one elbow etc etc

• Over time they will tolerate more coverage and more cream.  They never need enough cream to feel sticky afterwards, so don’t feel you have to lather it on for it to be effective.

• When you reach that stage, don’t put cream on where their clothes will go though – even I can’t stand that sensation!

Haircuts

• The first thing I’d be tempted to do is buy lots of cheap barbies or styling heads from eBay – and sit them down with a pair of scissors and play hairdressers.  So they can see for themselves that it’s only the hair that’s being cut, not the head or face.
• Pop into as many friendly (primed) hairdressers as you can ‘just to give a note to the owner’ as often as you can (several times in a week) – so they get used to seeing people have their haircut and see that no-ones’ crying with pain.

• Move on to ‘please can they have a go in the fun chair very quickly before you go?’.

• If they don’t like hairdryers, use one at home as often as you can and let them blow tiny balls of tin foil along the table with one, blow it at their feet after a bath (from 1 second to as long as you like) and so on.

• Play games where they have to close their eyes and see if they can guess what noise you’re making in their ear e.g. a bang, scissors snipping, drinking etc – if they’re non verbal, then use signs and pictures to facilitate communication. They get lots of praise when they guess it right.

• Borrow a book about hairdressers from the library and read it as often as possible!

• Buy a ‘hair’ magazine and help them cut the pictures out and make a collage picture.

• If they’re head shy then maybe try some of the ideas I listed above first?

• Fill your world with as many hair experiences as you can fit in!

Showers / getting wet out of context

• Watering can with a sprinkler attachment, hot day, bare legs and feet! OR use the shower attachment in the bath if you have one.

• Ask them if they’d like to help water something terribly important (weeds can be very thirsty things).  Let them water whatever it is and then it’s your turn.  Except you water your feet.

• And then it’s their turn, let them water the garden AND your feet (and theirs if they’re happy to).  Lots of laughing and then let them poke at your wet feet.  Go off and do something else quite different together.  Repeat and then move on to watering their feet…

• If you just know they won’t like their feet being watered then wet their feet using warm water and a cloth first.  Make sure the water in the watering can is warm before watering just one toe / one thumb….just break it all right down.  Put socks on them if needs be so they can see their feet being watered but they won’t get the same sensory sensation as if they had bare feet.

• Slowly build up to watering them higher up their legs and body etc

• It’s also important to let them watch you shower as much as you can and ask them to pass random things in to you (so they get their hands wet)…this will help to reduce any visual or audio (sound) scary components and help to normalise showering as a concept for them.

I hope you’ve found this post on Sensory Processing Disorder & Sensation Avoidance useful and I’m sorry it’s so long.  Once I got writing, I found I had more and more to say! Please do share it with anyone who you think may be interested in having a read through and please do leave any tips of how you’ve managed to resolve any sensation difficulties your children may have had or ask any questions that someone may know the answer to.

A fabulous book to read on Sensory Processing Disorder is The Out Of Sync Child by Carol Stock Kranowitz

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