Modulation is “the ability to self-organize and regulate reactions to sensory inputs in a graded and adaptive manner. The ability to self-organize inhibitory and excitatory sensory stimulation and adapt to environmental changes”
Tina Champagne, Med., OTR/L
Simply put…
It is our arousal level, but more than that, it is our ability to regulate information coming in AND encompasses how we respond to the sensory information in both intensity and duration.
We can get an image of this if we consider the lowest level of arousal being a sleep state and perhaps the highest level of arousal being jumping up and down, fist pumping and singing at the top of our lungs at a rock concert.
Throughout the day, we are asked to fit our arousal into appropriate levels. To grade and adapt to changes in place and time such that our behavior fits the task and to continually monitor and adjust that state based on whatever happens.
What does that mean?
Well, if I am sleeping and the fire alarm goes off and am suddenly awakened from a very low arousal state, I need to be able to identify what the blaring sound is, quickly motivate and direct my body to react and get to safety. My heart rate will likely elevate, my breathing will elevate, and my excitatory response will kick in. My arousal level will sharply intensify.
Another example: If I am at a rock concert it is appropriate to jump, fist pump, sing loud and be otherwise extremely excited. When the rock concert is over and the group that I am with wants to go get dinner, I need to be able to turn down the volume a bit. I will need to check in with my gut to find out if it needs to be refueled, check in with my bladder to determine if I need a trip to the bathroom before leaving the stadium and establish a calm, appropriate “inside voice” and de-escalate so that I can sit appropriately in a vehicle and in a restaurant to finish a meal.
Throughout our day, we are expected to function at various levels of arousal. We are modulating all the time. Each activity we participate in may require a different level of modulation.
Think about kids on a playground versus kids in a classroom. How does this look different?
The problem occurs when the level of arousal does not fit the task. We then say that the child is having difficulty with modulation. The best state for learning is
CALM-ALERT (neither too high or too low) If we take the words of Goldilocks, it is the “Just Right” state.
Children with a Modulation Disorder have difficulty with regulating their arousal level and are either:
A. Sensory Over Responsive (SOR)
B. Sensory Under Responsive (SUR)
C. Sensory Seeking/Cravers (SS)
A. SENSORY OVER RESPONSIVITY (SOR)
Sensory Over-Responsivity is characterized by responses to sensory stimuli that are faster, longer and more intense.
-Individuals may demonstrate over-responsivity to any type of sensory stimuli and behavioral responses in the face of adverse stimuli.
-Responses may include aggression, fear, avoidance, withdrawal, irritability, or moodiness.
We see them as:
-Sensory Avoiding or Sensory Sensitive (defensive)
-Responds too much, too frequently, or too long to sensory stimuli.
-Irritable, fussy, moody (hyper-alert emotions)
-Unsociable; avoids group activities, difficulty forming relationships (social scheme too overwhelming).
-Excessively cautions and afraid to try new things.
-Upset by transitions and unexpected changes.
-Hypersensitive to sensations (visual stimuli, sounds, touch, movement, tastes, and smells).
B. SENSORY UNDER RESPONSIVITY (SUR)
Sensory Under-Responsivity is characterized by neurons that fire very slowly, with low intensity and often for shorter duration.
This is what a child may look like who is under responsive:
-Child is less sensitive and less aware of sensory stimuli.
-These children often have a high pain threshold.
-It takes more intensity to get this child to respond.
-Usually prefers sedentary activities.
-Unaware of need to go to the bathroom.
-Passive, quiet, withdrawn.
-Difficult to engage in social interactions.
-Excessively slow to respond to directions.
-Lacks motivation or drive, initiating is a problem.
C. SENSORY SEEKING / CRAVING
Sensory seekers /cravers have neurons that fire too slow, with low intensity, and with short duration. l am UNDER-RESPONSIVE to the extreme.
I actively seek ways to stimulate my system all day long because it is the only thing that is keeping me alert. I often get labeled as “bad”. I am often mis-diagnosed as ADHD/ADD. I often have a behavior plan at school. I get kicked out of school or daycare due to unsafe behaviors.
I look like this:
-Constantly on the move.
-Likes crashing, jumping, rough housing.
-Excessive spinning, swinging, rocking.
-Constantly touches objects or people.
-Seeks vibration.
-Can like to watch spinning objects.
-Constantly talking; trouble turn taking in conversation.
-Seems to need much more sensory stimuli than most people.
-Often break things.
Sensory Based Motor Disorder (SBMD) is defined as a motor challenge with an underlying sensory basis
There are 2 types of sensory based motor disorders:
1. Dyspraxia
2. Postural Disorders
DYSPRAXIA
Let’s first define PRAXIS: It is the process of planning, organizing, sequencing, and executing a task.
Dyspraxia: is a neurological disorder that causes trouble with processing the sensory information correctly and it results in problems with planning, organizing, sequencing, and executing motor actions/tasks.
They may have difficulty in forming a goal or idea, planning a sequence of actions or performing new motor tasks. These individuals are clumsy, awkward, and accident-prone. They may break toys, have poor skill in ball activities or other sports, or have trouble with fine motor and gross motor activities. They may prefer sedentary activities or try to hide their motor planning problem with verbalization or with fantasy play.
You may also see/hear the term:
Developmental Coordination Disorder
DSM-5 criteria for diagnosis of DCD:
1. Marked impairment in the ability to perform activities that require motor coordination and performance level is below that expected for a person’s age and intelligence.
2. The impairment significantly interferes with academic achievement or activities of daily living.
3.The impairment cannot be explained by another general medical condition (eg, cerebral palsy or muscular dystrophy) and the criteria are not met for Pervasive Developmental Disorder.
4.If general learning disability is present, the motor difficulties are in excess of those usually associated with it.
Dyspraxia can affect:
•Fine Motor Skills: handwriting, zippers, buttons, using scissors, stringing beads, using utensils. How we articulate using fine motor muscles of the mouth or move the mouth to chew food.
•Gross Motor Skills: balance, coordination, body awareness, physical strength and reaction time (catching a ball, riding a bicycle, dancing, use of playground equipment etc.) Negotiating space and strength, volume and rate for completing a task.
•Motor Planning: Executing a motor skill in the way that we want to. (Walking, jumping, grasping a pencil, tossing a ball to a partner, blowing (mouth set)
•Coordination: How we organize all of our body actions so that we are successful. Are the actions smooth, effortless, and balanced.
POSTURAL DISORDER
Postural Disorder is a challenge with operating muscles and moving the body successfully. Children with postural disorder usually have difficulty keeping their body on task while moving or keeping their body still at rest.
Other signs include:
-Often exhibit poor balance due to insufficient core strength and ability to coordinate co-contraction of muscles and poor endurance.
-Poorly responsive to gravity and may have very slow protective responses to fall.
-Tend to move inefficiently and have poor body awareness.
-Poor bilateral coordination.
-Challenges with ocular-motor abilities (visual tracking and peripheral vision difficulties)
-Behaviorally, you will notice slow, cautious movements or unwillingness to move with clear preference for sedentary activities.
-The decrease in stability and poor body control causes individuals to compensate by increasing their base of support. (Ex: W-Sitting or a wide gait)
Postural control is a type of motor control that stabilizes the body in space by integrating sensory inputs (visual, vestibular and proprioceptive) about the body’s position with motor outputs to coordinate the action of muscles and keep the body’s center of mass in proper alignment when standing or moving. It grows in parallel with the maturation of the nervous system (Brandt, 2003). In everyday life, attentional resources used to control posture are frequently shared so as to perform other tasks simultaneously; thus postural stability is naturally part of a dual-task (Woollacott and Shumway-Cook, 2002).
World Health Organization, ICD-10 defines Dyslexia is a neurobiological disorder characterized by “a specific and significant impairment in the development of reading skills that is not solely accounted for by mental age, visual acuity problems, or inadequate schooling” Different theories have been suggested for explaining the origins of dyslexia. This lack of certainty about the origin of dyslexia obviously causes difficulties in the care of dyslexic children.
As early as 1973, Frank and Levinson (1973) were the first to make the subjective hypothesis of neurological signs of cerebellar-vestibular deficiency in a dyslexic population thanks to a positive Romberg test. Romberg test is used for testing neurological function: the patient is asked to remove his shoes and stand with his two feet together. The arms are held next to the body; a positive Romberg test is when a swaying and even toppling over occurs.
Frank and Levinson (1973) also observed difficulty in tandem walking, articulatory speech disorders, hypotonia, and several dys-metric deficits. Indeed, they reported that 97% of 115 children with dyslexia examined, presented signs in agreement with such hypothesis.
The cerebellar deficit hypothesis was confirmed by Nicolson and Fawcett (1999) who noted balance and motor coordination deficits in a population of dyslexic children; as their postural stability was affected by a secondary task, shifting attention away from the primary postural one. These authors suggested that dyslexics needed to invest more attentional resources than non-dyslexics to control their balance when two tasks were performed simultaneously. (In many of the journal articles that I looked over they called these “dual task”)
Sensory Discrimination describes our ability to detect and understand the information received, label and organize it as relevant and whether it requires additional action or not. It helps us create a database that correlate with previous experiences. Every sensory system has a discriminative ability. This helps us become social beings and active learners.
Have you have seen a child in this state? (look at the picture to the right)
Now consider what a child with sensory discrimination difficulties is going through when they are unable to filter the sensory information that is not relevant to a task. The stimulation is bombarding the central nervous system and eventually they can no longer deal with it.
Why are children so desperate for their technology?
Technology is familiar, it offers them some control of what they must deal with. Usually you will see movement stop, they sit still, they visually focus on the screen, hands and eyes are occupied and they are no longer being yelled at to "sit still". It helps them gain some control over themselves and to some extent the focus of their attention.
Why is it such a profound need?
CONTROL - Controlling the input, gaining control over their bodies, gaining something to focus attention on, and gaining control over not participating in something that is more difficult task/activity. Think of all the challenges they get to miss when their face is in a screen. They aren't asked questions, don't have to move, and there is no need to respond. It is comfortable because they can isolate. It is also satisfying to the because it is familiar. They want to watch the same things over and over.
Is this a sensory issue or a behavioral issue?
KEY CONCEPT: “Atypical behaviors are often both behavioral and sensory. Excusing difficult behavior because it has a sensory foundation is a mistake. When dealing with sensory issues, we must make sure the underlying problem is not being overlooked (sensory) what may be a quick fix (behavioral intervention). “
Behavior
Learned rather than willful. Once a child has repeated a behavior it is learned. Behavior followed by success or reward is reinforced. Behavior is a concern when it interferes with the child’s ability to learn or function or is harmful.
Sensory
Input from the environment is interacting with and affecting the child’s neurology (internal state) to cause an emotional output. Their internal sensory state becomes either over-responsive or under-responsive.
Information we receive through sound and vibration within the ear.
INPUT is described as
OVER-RESPONSIVITY TO AUDITORY INUT
Can be so profound, that the child will begin to cry when seeing the item that causes the of
Information we receive through sound and vibration within the ear.
INPUT is described as
OVER-RESPONSIVITY TO AUDITORY INUT
Can be so profound, that the child will begin to cry when seeing the item that causes the offending noise. Behaviors that you will see when a child is over responsive includes:
Usually, the behavior lasts a while because the neuro response is intense and long lasting.
UNDER RESPONDERS TO AUDITORY INPUT
Neurons are firing slowly and it takes a lot more time for me to respond.
SEEKERS / CRAVERS OF AUDITORY INPUT
These children are under-responsive to the extreme.
Information we get from the tongue or in/around the mouth.
INPUT is described as
80% of developmentally delayed children present with some sort of feeding disorder. That means that chances are pretty high that you are seeing a child with
Information we get from the tongue or in/around the mouth.
INPUT is described as
80% of developmentally delayed children present with some sort of feeding disorder. That means that chances are pretty high that you are seeing a child with avoidant food intake disorders, restrictive food intake disorders, and chewing or swallowing disorders.
OVER RESPONDERS TO ORAL INPUT
Neurons respond very quickly and with intensity. Responses can be any of the following:
UNDER RESPONDERS TO ORAL INPUT
Neurons respond very slowly and with less intensity. This is why these children:
CRAVERS/SEEKERS TO ORAL INPUT
I am an under-responder to the extreme:
Information we receive through our eyes.
INPUT is described as
80% of learning occurs through vision.
VISION HAS MOTOR AND SENSORY COMPONENTS
1.Visual Field & Visual Acuity
2.Visual Motor Ability
3.Visual-Perception
**It is possible
Information we receive through our eyes.
INPUT is described as
80% of learning occurs through vision.
VISION HAS MOTOR AND SENSORY COMPONENTS
1.Visual Field & Visual Acuity
2.Visual Motor Ability
3.Visual-Perception
**It is possible to have vision and not see (perceive or make sense of the information coming into the eyes).
OVER-RESPONDER TO VISUAL INPUT
Neurons respond quickly and with intensity.
UNDER RESPONDER TO VISUAL INPUT
Neurons respond too slowly.
CRAVER / SEEKER TO VISUAL INPUT
These children are under-responders to the extreme.
Information coming in from the nose as odors.
INPUT is described as:
Smell is one of the first senses to develop in utero. It has immediate access to the amygdala (limbic system) and is intricately linked with the emotion and memory systems of the brain.
OVER
Information coming in from the nose as odors.
INPUT is described as:
Smell is one of the first senses to develop in utero. It has immediate access to the amygdala (limbic system) and is intricately linked with the emotion and memory systems of the brain.
OVER RESPONSIVE TO SMELL
Neurons respond too quickly and with intensity.
UNDER RESPONSIVE TO SMELL
Neurons respond slowly or with low intensity.
CRAVER / SEEKER TO SMELL
These children are under-responsive to the extreme.
INPUT is described as:
TEXTURE
TEMPERATURE
PRESSURE
VIBRATION
Our tactile receptors constantly monitor the surface of the skin and internal state of the body. We have the m
INPUT is described as:
TEXTURE
TEMPERATURE
PRESSURE
VIBRATION
Our tactile receptors constantly monitor the surface of the skin and internal state of the body. We have the most connections in our hands/face/lips.
Triggers a significant spike in norepinephrine levels when stimulated.
OVER RESPONSIVE TO TOUCH
Neurons fire too quickly or with too much intensity.
UNDER RESPONSIVE TO TOUCH
Neurons fire slowly and with less intensity.
CRAVER / SEEKER TO TOUCH
These children are under-responsive to the extreme.
Information we get about the position of the head relative to gravity. THIS IS THE BUILDING BLOCK OF THE SENSORY SYSTEM.
INPUT is described as:
It directly influences speech motor patterns because it impacts p
Information we get about the position of the head relative to gravity. THIS IS THE BUILDING BLOCK OF THE SENSORY SYSTEM.
INPUT is described as:
It directly influences speech motor patterns because it impacts postural control, muscle tone, motor coordination, and motor planning. They are connected because they are both processed in the receptors of the ear.
OVER RESPONSIVE TO VESTIBULAR INPUT
Neurons fire too quickly or with too much intensity.
UNDER RESPONSIVE TO VESTIBULAR INPUT
Neurons fire slowly and with less intensity.
CRAVER / SEEKER TO VESTIBULAR INPUT
These children are under-responsive to the extreme.
Information that we receive from our muscles and joints about our body’s position in space relative to people and things. THIS IS THE MOST IMACTFUL - WHEN IN DOUBT, START HERE!!
INPUT is described as:
OVER RESPONDER TO PROPRIOCEPTIVE INPUT
Neurons r
Information that we receive from our muscles and joints about our body’s position in space relative to people and things. THIS IS THE MOST IMACTFUL - WHEN IN DOUBT, START HERE!!
INPUT is described as:
OVER RESPONDER TO PROPRIOCEPTIVE INPUT
Neurons respond too quickly or with too much intensity.
UNDER RESPONDER TO PROPRIOCEPTIVE INPUT
Neurons respond too slowly.
CRAVING / SEEKING TO PROPRIOCEPTIVE INPUT
These children are under-responsive to the extreme.
Information from inner body systems that alert us to internal bodily signals.
INPUT is described as:
OVER -RESPONDERS
Neurons respond very quickly and w
Information from inner body systems that alert us to internal bodily signals.
INPUT is described as:
OVER -RESPONDERS
Neurons respond very quickly and with intensity.
UNDER RESPONDERS
Neurons respond too slowly.
SEEKER / CRAVER
These children are under-responders to the extreme.
Researchers are discovering new things every day.
"Multisensory neurons are actually common, having been identified in the parietal, temporal, and frontal lobes as well as in various brain stem areas...The location of sound with respect to the head, the location of sound with respect to the eyes or both of these factors were predictive of how cells would respond....The study suggests eye position influences the responses of at least a subset of auditory neurons in the lateral intraparietal region of the posterior parietal cortex (LIP)".
The Nervous System has 2 basic components:
The Peripheral Nervous System is subdivided into the Autonomic and Somatic.
Somatic controls the external actions of skin and muscles.
Autonomic controls the internal activities of organs and glands.
They are charged with producing the neurochemicals that affect calming and arousing.
The sympathetic system is an arousing system and the parasympathetic is a calming system. The 2 systems must work in synchrony with each other to regulate / modulate appropriate behavioral responses.
Since I am not a neuroscientist and my description of how these two systems works would be intrinsically boring. Below are videos of the 2 system that I know you will find more interesting that I could ever be.
Dr. Stephen Porges' Polyvagal Theory is the science of feeling safe. "Dr. Delahooke's presentation at the 2019 SSP Gathering in Atlantic Beach, Florida. The Polyvagal theory and the concept of neuroception of Dr. Stephen Porges shows us why relational safety should form the foundation for all approaches in treating children with emotional, behavioral and developmental challenges.
Children oscillate between seeking and avoiding in order to modulate. Their neurological systems are not experienced enough to handle self-regulation in a mature way. Some of the behaviors you may see to support this include:
Children oscillate between seeking and avoiding in order to modulate. Their neurological systems are not experienced enough to handle self-regulation in a mature way. Some of the behaviors you may see to support this include:
Knowing when the behavior needs to be addressed is as simple as answering the following question:
"Is the behavior causing limitations in functional activities, communicating /interacting or learning, and/or harming himself, or others?"
If the answer is NO, then there is nothing to do.
If the answer is YES, then keep the following key concept in mind:
If you STOP the child from engaging in the behavior that is meeting a sensory/emotional regulation need and give nothing to replace it, then another and potentially more challenging behavior may manifest.
Self-regulation is the ability to controlling one's behavior, emotions, and thoughts in order to manage disruptive behaviors and impulses.
Self-Regulation is the ability to controlling one's behavior, emotions, and thoughts in order to manage disruptive behavio
Self-regulation is the ability to controlling one's behavior, emotions, and thoughts in order to manage disruptive behaviors and impulses.
Self-Regulation is the ability to controlling one's behavior, emotions, and thoughts in order to manage disruptive behaviors and impulses.
Let me shine some light on this...all children struggle with self-regulation. The population we work with often has limited communication skills such that "how they behave" is the way they communicate their needs. Teaching caregivers how to handle the challenging behaviors in a positive, mindful, and responsive and consistent manner is where therapists fit into this triad.
The idea is to begin teaching the child about how their bodies “feel” and what their behavior is emitting. Checking in with yourself and identifying if/when you need to take a sensory break. Asking for the break before you become part of the problem.
Children make noises for different reasons.
Here are some reasons children make extra noise:
Children can also be so fearfu
Children make noises for different reasons.
Here are some reasons children make extra noise:
Children can also be so fearful of noise that just the sight of the offending item brings them fear.
Again, we ask ourselves the questions:
"Is the behavior causing limitations in functional activities, communicating /interacting or learning, and/or harming himself, or others?"
If the answer is NO, then there is nothing to do.
If the answer is YES, then keep the following key concept in mind:
If you STOP the child from engaging in the behavior that is meeting a sensory/emotional regulation need and give nothing to replace it, then another and potentially more challenging behavior may manifest.
Children fidget for diferent reasons. It is natural for a child to explore and this should be encouraged, but can be problematic when it becomes a health/safety concern or is harmful to self.
Children fidget for diferent reasons. It is natural for a child to explore and this should be encouraged, but can be problematic when it becomes a health/safety concern or is harmful to self.
Trichotillomania is an obsessive-compulsive disorder of hair pulling and sometimes pulling and eating of the hair.
Excoriation is an obsessive-compulsive disorder of skin picking.
Dysregulation of internal state can manifest in children who are unable to read body signals of sleep / hunger / thirst/ excretion, etc. Challenging behaviors can manifest as:
TAKE AWAY
If the behavior works, it is serving a purpose and will be maintained. Taking away a behavior without giving a satisfactory replacement will likely cause another (potentially less desirable) behavior to emerge.
These children are not bad, their neurology is different, and they interpret the world around them in a clearly unique
TAKE AWAY
If the behavior works, it is serving a purpose and will be maintained. Taking away a behavior without giving a satisfactory replacement will likely cause another (potentially less desirable) behavior to emerge.
These children are not bad, their neurology is different, and they interpret the world around them in a clearly unique way.
Be kind, be patient, be aware!
Know thy self in order to know thy child.
Remember that behavior is the result of a feeling… and often the only way that a child has to communicate with you about that feeling.
A child's desire to exerting independence over what he will and will not wear is normal. Toddlers go through a stage of exploring their autonomy and personal control. Additionally, they often like being naked. Clothing can be more restrictive. I say, pick your battles. It is not worth fighting over their desire to wear a princess dress to
A child's desire to exerting independence over what he will and will not wear is normal. Toddlers go through a stage of exploring their autonomy and personal control. Additionally, they often like being naked. Clothing can be more restrictive. I say, pick your battles. It is not worth fighting over their desire to wear a princess dress to go grocery shopping or to walk around in a diaper only in the privacy of your living room. However, extreme reactions to clothing that makes keeping clothes on or prolonged battles over clothes is something entirely different and warrants a closer look. Things that may set them off include:
These challenges can cause children to meltdown on a daily basis when they need to get dressed or wear clothes and are usually a sure sign that it is a sensory processing difference.
“Atypical behaviors that are sensory in nature are often both behavioral and sensory. Excusing difficult behavior because it has a sensory foundation is a mistake.”
Neurons respond too quickly or with too much intensity. My cup seems to always be "overflowing".
Neurons respond too slowly. My cup is always needing "just a little more".
Neurons respond extremely slow and because of this, my cup "never fills up" no matter how much I try.
Oral Over-Responders have neurons that respond very quickly and with intensity.
ORAL OVER RESPONDERS
Behaviors that you will see when a child is over responsive includes:
Many times, these children look pleasantly plump because they are getting full of high calorie laden liquids (milk/juice) and lots of crunchy carbs. When you consider health and nutrition, we need to also be concerned about food variety and micronutrients contained in the foods we are consuming, and this is why I am so adamant that a nutritionist and the physician be an integral part of the feeding team.
Try these strategies:
1. Environmental issues that may be hampering mealtime:
** Surprise** Sometimes it is not the food at all. It is everything else going on that the child just cannot overcome. The noise level in the home, the smell coming from the garbage you haven’t’ taken out for 3 weeks, the clutter in the home or on his tray or the table that is visually distracting, the toys that are sitting on the table that he cannot eat without, the fact that he is bound to a chair and cannot get up and no one is there – he /she is left alone. Children will act out in these types of situations.
2. Establish A Mealtime Routine:
1. Time of day.
2. Place in the home and possibly a specific place at the table.
3. Pre meal “heavy work activities” of the body and the mouth (see Proprioceptive Input Handout in previous section).
4. Handwashing pre and post meal.
5. Establish responsibilities (bring utensils and paper towel to the table)
6. Sit with the child to eat.
3. Autonomy and Control:
1. Have the child help you make a weekly meal schedule and do the shopping together.
2. Allow the child to participate in as many aspects of cooking as possible.
3. Allow the child to have control over his food and worry about the mess after the meal. STOP wiping face!! When you are constantly wiping a child’s face, it is very disorganizing. No one reaches in and wipes your face while you are eating. Don’t do it to the child. Let it be!
4. Let the child decide if he wants to wear a bib or not. Sometimes it is how the bib feels or sounds that is disruptive at a mealtime.
5. Give the child permission to spit. Just because it goes in the mouth doesn’t mean the food MUST swallow. Spitting is ok as long as we teach them to do it in the right way. This is a social skill that can be taught (napkins are best).
4. Use his FASCINATIONS:
If he likes dinosaurs, then get dinosaur cookie cutters and make his sandwiches in the shape of a dinosaur. Truth be told: One of the things I have not wholly embraced is “playing with food”. I just can’t buy into building mashed potato castles, but I do think it is fun to let kids make things with their food such as using chocolate chips to decorate a pancake or to stick carrot sticks out of each side of the corner of the mouth to look like a walrus. Mealtimes can be fun too.
5. Texture Play outside of mealtimes.
The concept here is that a child will not eat a texture if he is unable to tolerate touching it from a sensory perspective. Below is a hierarchy of textures to progress through:
a. Dry textures that don't leave residue (dry rice bins, dry bean bins, dry noodle bins, pom-pom balls, texture cloths/fabrics.
b. Dry textures that DO leave residue (sand, cornmeal, chalk, compost/dirt).
c. Damp textures that mostly fall away (slightly damp sand, silly string, PlayDoh)
d. Wet textures that are familiar and don't leave residue (water play, ice cubes)
e. Wet moving into sticky that leave residue (wet sand, mud, finger paint)
f. Sticky textures (shaving cream, glue, stickers, slime)
g. Foods that are dry (crushed cookies or graham crackers, Cheetos, Doritos, Powdered donuts, granular sugar, the list is long)
h. Foods that are wet (cooked noodles, cooked rice, icing, yogurt, pudding, oranges, apples, avocado, ketchup or other condiment, the list is long)
i. Foods that are sticky (melted chocolate, ice cream, jelly, sucker that is getting all over the hands)
6. WHO IS RESPONSIBLE FOR WHAT at a mealtime.
***Adult Caregivers job is to decide what the child eats, where the child eats and when the child eats.
***The child’s responsibilities are to decide IF and how much they will eat.
Nina Ayd Johanson, MA, MS, CCC-SLP, CLC presented the RESPONSIBILITIES notion in her AEIOU course. Responsive Feeding: The Baby Cued Method. I have used this with teaching the very foundation of my feeding strategies with families ever since. Parent and Child have responsibilities related to the meal. The parent cannot do the child’s job and the child cannot do the parent’s job. If we keep this basic premise in mind, we can navigate some of the difficult problems that arise with feeding and mealtime management.
And, from Kaye Toomey's SOS Approach to feeding, the concept that a child should be offered at least 1 food that he WILL eat at each meal and as much of it as he/she needs while working toward gaining new foods.
7. Proprioceptive "Heavy Work" for the mouth and other Sensory Input.
a. SAFE CHEWING TOYS:
Find things in the toybox that are safe for the child to chew. If the parent wants the child to stop chewing holes in their blanket or the soft plush toy animals that is great!, but we need to offer them another object they like to chew on and sometimes that can be the biggest challenge. Finding the right thing. There are so many products out there these days for safe chewing and one of my go to places in ARK Therapeutics. The items are soft rubber that are specifically made for chewing. Many infant oral stimulators will fill this need from Sophie the Girraff to any of a number of silicone teethers. Simply do an amazon search to find a variety of items.
**If the child is chewing so veraciously that the items are being broken, then find something firmer. The ARK items can be ordered in different densities.
Also, you may want to consider oral motor toys/activities with vibratory input.
b. VIBRATION can be found in:
kids' toothbrushes, Z-vibe (oral stimulation from ARK Therapeutics), Infant oral teethers with vibration, handheld massagers that can be placed on the head/face, vibrating spoon attachments to the z-vibe.
c. TEMPERATURE is another good way to intensify the input:
Try icy cold water, put teethers in the freezer, wet a towel and put it in the freezer to have a cold rag to chew on.
-Smoothies and popsicles
d. PROPRIOCEPTIVE INPUT OR “HEAVY WORK” FOR THE MOUTH:
Proprioception offers the mouth input from the muscles and joints. It allows us to make sense of location in space, pressure, and grading of input.
> Chewing:
Aside from chewing on a chewy tube or plastic toy, our kiddos that are under-responsive may really enjoy chewing on foods that are chewy. This includes, beef jerky, taffy, fruit leather, fruit roll ups, gummy worms, nuts, raw carrot or celery sticks, and yes…GUM.
Under responders need more impact!! They will probably do better with tastes that are more powerful too (spicy, sour, bitter, pungent)
If you are afraid the child will choke on the food, then consider a fabric bolus.
> Blowing:
Believe it or not, blowing is a motor skill. Knowing how to inhale to fill the lungs and exhale to let it out takes a bit of practice, not to mention the lip rounding and awareness of your proximity of lips to the bubble wand. Add to that the fact you are doing proprioceptive work for the mouth and new awareness of how it supports stimulation of the Vagus N. and it is a fabulous activity IF THE CHILD IS DOING IT!! It doesn’t count if you are the one blowing the bubbles.
> Sucking:
Sucking becomes heavy work when it is more difficult. You can grade suck strength by: Changing the viscosity of the liquid being offered (milk v/s milkshake). Changing the amount in the cup. Changing the length of the straw. Changing the diameter of the straw.
> Licking:
I consider the ability to lick an ADL. I like that if I am eating a hamburger, I can lick the mayonnaise off the corner of my mouth. It is personal hygiene. I also like that when I am offered an ice-cream cone, I can lick the cold ice cream – that is self-feeding. Without being able to extend, retract and laterally shift the tongue we cannot perform these basic things. I have started carrying a plastic mirror in my bag and when we are doing feeding activities, I bring it in. I do not clean faces, I let them see the problem and address it either by licking or wiping it off.
> Mouth Noises:
Kids really love when they can imitate fun noises you are making. To make it even more interesting, you can set a metronome at different intervals /speeds to try to keep the tempo or try to click to the beat of a favorite song.
> Bite and Hold Exercises:
Work toward getting the child to bite down on something and sustain the contraction for longer periods of time. This can be done fairly easily by playing tug of war with a dog toy or even a hand towel.
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