3/10/2017
OUR SENSES
Sensory Connection to Trauma and
Treatment in Youth
Understanding the Senses and Their potential for Treatment
Aspire Clubhouse
Albany GA
April 30 or May 1, 2014
 Auditory
 Visual
 Olfactory
 Gustatory/Oral
G t t r /Or l Motor
M t r
Presentation by
Karen Moore, OTR/L
Angie Balzarini-Leonhart, OTR/L
 Tactile
 Vestibular
 Proprioception
 Introception
1
Make Your Own Toolbox
Sensory Integration
As the SCP workshop progresses, use this form to k
k f d
h
ll
keep track of ideas that will make sense to use in your clinical setting so that you can develop your own personalized tool box.
See Handout p. 3
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4
Who May Have Difficulty with Sensory Processing?
 Individuals who experience:
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Physical or sexual abuse
Emotional neglect
Traumatic Birth
Traumatic injury/Surgery
Chronic Pain
Multiple hospitalizations
Sensory deprivation
Torture / War
Institutionalization
Who May Have Difficulty with Sensory Processing?
 Diagnoses to consider:
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Autism
Asperger's
ADHD/ADD
PTSD
Reactive Attachment Disorder
Intermittent Explosive Disorder
Anxiety Disorders
OCD
Schizophrenia
Major Depression
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Sensory Strategies for:
Coping Through the Senses
 Stress coping through the senses
 identify leisure and self-care
techniques
 -deep abdominal breathing
Regulation sensory
 Emotional Regulationsnacks
 identify sensory input that helps
with calming or alerting
 Poor Reality Orientation provide strong deep pressure and
proprioceptive input
 Display environmental cues and
decrease clutter
Stress‐ “thoughts or feelings that tax or exceed our ability to respond effectively.” ‐Karen Moore, 2005
Severe Stress or Trauma
Research done by Robert Macy‐ 2007
 More Primitive Responses Prevail
 Communication
C
i i iis suppressed
d
 Brain Scans show increased activity in the
hypothalamus and decreased in the Broca
area (speech) is diminished
The Power of the Senses
 Focus is on the present
Using the Body to Calm the Mind
In crisis and critical illness there is “no wise mind.”
 Brings self-awareness and
environmental
i
l awareness
 Vacation from thoughts (and
problems)
Sensory input can be used to help calm the
system –
even when cognitive techniques fail!
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Sensory Qualities that Are Calming and Alerting
Alerting:
Calming:
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Fast paced
Irregular
Complex
Unexpected
Unpredictable
Intense
Strong
Irritating
 Negative Associations
Soft
Rhythmic
Familiar
Soothing
Simple
Mild
Predictable
Slow
Positive Associations
Just‐‐Right Balance
Just
Arousal - Finding the Right AlertAlert-Calm Balance to Match the Situation
sleep low arousal just‐right balance high arousal shutdown
Factors:
Cognitive
Emotional
Physical
Environment
Spiritual
Handouts page 3
What Input Do We Need? Calming Upset
Losing control
Agitated
Needing to relax
Anxious
Overwhelmed
In state of
shutdown
Alerting
Needs grounding
Needs reality orientation
Lacks attention
Unable to focus
Sleepy
Needs to be energized
Decisions ‐ Decisions
What kind of input does this fellow need?
CALMING OR ALERTING???
ALERTING
???
Handouts page 3
What Type of Stimulation Does She Need?
 Is she depressed?
 Is
I she
h h
hypersensitive
i i andd
over stimulated?
 Is she agitated?
Decisions ‐ Decisions
What type of stimulation does this child
need?
Is she sedentary and have poor environmental awareness?
Is she sensory sensitive and withdrawn to avoid
stimulation?
Is she highly over stimulated to the point of shutdown?
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External Senses
Always start with calming techniques
 Smell (grounding, aromatherapy, hygiene products)
“Emotional
dysregulation can result in two
paradoxical responses
p
p
that are flip
p sides of
the same coin.”- Karen Moore, 2005
 Taste (exploration, grounding, comfort foods) “When it comes to chocolate,
resistance is futile”- unknown
 Vision (art, bubble lamps, fiber optics)
 Hearing (music, therapeutic listening, white noise)
 Light Touch (fidgets, tactile input)
THE SENSE OF SMELL
The Sense of Hearing
Protective and informative
Primitive, Protective & Powerful
Feeds directly into limbic system
Good for grounding
We form associations (pleasant memories or
flashbacks and dissociation)
Connected to vestibular system (ear ache
causes dizziness)
Sounds can be soothing or activating
depending on beat, volume, and personal
taste.
Loud noises can be upsetting and some
people have trouble recovering.
recovering.
The Sense of Vision
The Sense of Taste
Smell
 Unifying Sense/Protective
 Linked to Vestibular sense
 Provides environmental awareness
Responses to visual stimulation
are not universal.
and taste are linked
Strong
tastes can be used for
grounding
Oral
Motor Input
People
turn to “comfort foods” when
they are upset.
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Oral Motor Sense
The Sense of Touch
 Skin is the largest sense organ
 Montague 1968
 Oral Motor Sense is a combination of flavor, texture, temperature, and movements of lips, jaw, and facial muscles
temperature and movements of lips jaw and facial muscles
 Touch has p
powerful effects on emotions
 Influences limbic system
 Pound for pound the jaws are the biggest proprioceptors in the body
 People seek oral motor stimulation to help with comfort, attention, and overall attention, and overall organization
organization
 Basis of body image/boundaries
 With proprioception
 Input activates the vagal system through the cranial nerves and supports social engagement system
Handout for Hand Massage p. 8
Interoception
 Events that occur in the body
 Activated by internal stimuli
within
i hi the
h b
body
d or visceral
i
l
sensation
 Visceral sensations reach our self
awareness and impact mood and
our sense of well-being.
Vestibular Stimulation Ideas for Clinics, Play Areas and Classrooms
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Rocking Chairs/Gliders
Swings
Therapy Balls/Chair balls
Exercise Band Rowing
Head Rolls
Movement Activities
Walking/Pacing
The Vestibular Sense

Keeps the body erect. Drives
equilibrium responses.
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Gives awareness of body position and
movement in space (Ayres, 1979).
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Receptors are located in the ears and
there are strong ocular connections.
(Hence dizziness with earaches and
carsickness)
Proprioception
Deep Pressure & Movement Sense
 Activated by movement or
compressing or stretching a joint
 Tells where body parts are in space
and in relation to one another
 Increases endorphins if input is
strong and sustained (runners high)
 Rarely overloading to sensory system
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Sensory Powerhouses‐Organizing Input
Vestibular Proprioception Deep Pressure Touch
Kids Need Physical Outlets
 When the heart is pumping the endorphins are flowing!
 Endorphins help our body fight stress!
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Power Systems
Activities
Preferences are Personal
 Glider Rocker/Swing
 Therapy Ball
 Yoga, Tai Chi & Qi Gong DVDs
 Candy/Gum  Deep Breathing
 Full back massager
 Hand held vibrator
 Weighted blankets
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Weighted collars/lap pads
Thera‐Band Exercises
pp
Deep pressure vests
Bean Bag tapping
Yoga Mat
Exercise Machines
Massage with scented lotion Always give choices!!
~ Heller, S. (2002)
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Discovering Sensory Preferences
 Take some time to explore the sensory activities. y
y
Mark in your tool kit the ideas that you could use in your clinical setting.
 Think about the input that you enjoy and compare it to the experiences of others – what you enjoy others may find aversive.
Lack of Training Can Lead to Negative Experiences
 Understand calming versus alerting stimuli
 Know when to back off
 Honor preferences (sensory treatment is very personal)
 Is this sensory or behavioral?
 Is the patient ready to assess sensory needs?
 Plan sensory spaces carefully
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Symptoms of Distress
Abdominal Breathing
STOP! These are signs that the
person is not tolerating the activity.
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Anxiety
Excuses
Confusion
Irritability
Resistance to activity
Defensive behaviors
Paranoia
Take a deep breath, it calms the mind
Light headedness
Increased sweating
Flushing
Shortness of breath
Over arousal
Nausea
Fearful expression
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Handout for Deep Breathing p. 5
Handout p. 4
Incorporating Sensory Snacks Incorporating Sensory Snacks in the in the Day
Day.
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Often used as the first strategy for calming
Keep it simple: 4 deep breaths
Practice together
Stress Management Strategies
 Make environment comfortable
Eliminate Bothersome input
Add pleasurable input
Swinging bike ride,
Swinging,
ride rocking chair
Soft or heavy blanket
Fidget, coloring, puzzles
Scented lotion and quick hand massage
Massage of shoulders or “hand hugs” up the arm
Lifesaver's, chewy, crunchy food
Water bottle
Music
 Plan daily doses of strong sensory input
Walk, stretching, yoga, work out activities
heavy back-pack, dancing, bicycling
 Plan relaxation “rituals”
Deep breathing, meditation
Luxurious bath, fragrant candle and music
Read by the fireplace
Good for “sleep hygiene”
What is a Comfort Space or Room?
Sensory Cart
 Soothing wall paint colors
 Calming pictures, Picture books
or Murals
 Comfortable seating
 Weighted Collars and Lap pads
 Relaxing Music and Sound
Machines
 Visual Relaxation Videos, Dim
Lighting and Lava Lamps
 Aromatherapy
 A sensory cart is one way to provide accessible sensory
equipment.
 Ideally it should be out on the unit where clients can
access it readily.
 Handout with items and a brief description of items
should be laminated and attached to the cart.
 All staff should be trained on how to support clients in
the use of the items.
SCP Curriculum has directions and
handouts for a Sensory Cart
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Individualized Comfort
“Safe” Space
Sensory or Comfort Rooms
They provide a laboratory to learn selfself-regulation coping
skills!!
skills
 Dedicated space/room or corner of a room
 Comfortable chair
 Items chosen byy the individual for nurturingg
and self-regulation
 Items might include CD or music, art or
picture books, “Heavy Duty” animal, blanket,
weighted lap pad, manipulatives, tasty treats,
grounding supplies, scented lotions.
Wish list for comfort space p. 27; worksheet p. 34 – 35.
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Sensory Room Thoughts
Sensory Rooms:
Coping, Calming and Comfort 
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Must reflect:
Purpose
Developmental Age
Safety Issues
Make sure it is a POSITIVE place (never use of “time outs)
Use pro-actively (never wait for a meltdown)
Allow time limited opportunities
pp
to use it “when needed”
Provide a timer
Good for downtime
If needed – make it a regular part of the day
Be careful not to support “escape” behaviors
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Chauncy Hall
Innovative Ideas
Sensory Connection to Trauma and Treatment
in Youth
Understanding the Senses and Their potential for Treatment
Workshop II
Aspire Clubhouse
Albany GA
April 30 or May 1, 2014
Presentation by Karen Moore, OTR/L
Angie Balzarini‐Leonhart, OTR/L
Calming and Alerting Tags
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Chill Room
Chauncy Hall
Chauncy Hall
Sensory Room
Recipe for a Self‐help Space
Recipe for a Self
help Space
Take an empty room next to the classroom
Add a rug, a beanbag chair and a video rocker
Add a few simple sensory tools
Allow kids to use it when needed to chill out
Voila! You have a simple “sensory room”
And then there’s pets……….
Adolescent Unit – Westborough MA
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Chauncy Hall “What Helps?” Board
Animals and Autism
Advance (2011) 27, (17)
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Full time therapy dog at Chauncy Hall in Westboro
MA
Suggestions for Residential Treatment
 On going education on sensory approaches
 Staff roles models use of strategies
 Provide personal sensory kits
 Provide daily opportunities for sports or exercise
 Develop a chill/calming room
 Teach relaxation or mindfulness techniques
Case Study‐ Robbie
 Robbie is a 19 year old African American male
 Primary Diagnosis: Autism, Mental Retardation, Explosive
Personality Disorder, Intermittent Explosive Disorder
 Secondary Diagnosis: Adult Neglect/Abandonment- Biological
Mother perpetrator of maltreatment and neglect
 Family members report patient is demonstrating increasing
destruction of property and violence toward family members.
 Patient was placed in seclusion and restraint upon arrival on the MH
inpatient unit for impulsive and unpredictable behaviors.
Handouts p. 17
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Symptoms and Triggers
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Symptoms:
Unprovoked agitation
Out of control
Impulsive
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Triggers:
patient becomes vocal and will holler
patient places his arm near an item or person
patient runs to room and slams door
at his school program he is triggered by noise and light
School Based Interventions
Sensory Interventions:
aromatherapy (orange) soft fabric, fidgets, toy maze Deep Pressure Vest Weighted Blanket
Glider rocker Comfort Room
massage chair CD player (R&B, harp, 50's classic pop rock)
Sensory Diet: The above interventions offered and encouraged in a predictable schedule using communication cards and picture schedule.
How Sensory Friendly is Your School?
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Is there clutter?
Is the lighting comfortable?
Is it noisy?
Are there places kids can go for quiet time?
Do you have rocking chairs or chair balls?
Are there attractive elements – art work, soothing sounds, sensory activities available?
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Making “Quiet Space”
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Control Noise 60
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Hydration
Provide Exercise
“Having a water bottle at one’s desk is probably one of the most effective sensory‐related interventions that could benefit a child with sensory disturbances.
Moyes 2010
 Oral motor input
 Fidget widget
 Hydration
 Alerting input – helps focus
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Plan for Quiet Times for Re‐charging
Provide Strong Sensory Input Breaks
People with special needs are often easily overwhelmed and they are working harder just to keep up.
Remember the rule:
Children can focus for 1 minute per year of their life. Expect a six year old to sit for six minutes without a break.
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Provide Sensory Snacks
Using Games and Movement for Teaching
Classroom‐based physical activity (using active games and movement) improves classroom behavior reduces fidgeting classroom behavior, reduces fidgeting, improves concentration, increases time on task and also results in lower BMI rates and obesity.
Donnelly, J.E., Lambourne, K. (2011) Classroom‐based physical activity, cognition, and academic achievement. Preventative Medicine 52, S36‐S42
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Humming/singing
Slap Clap
Self‐Hug
Figure Eights
Full Body Joint Compression
Koosh Toss
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Sensory Tool Box or Basket
Tool Time!!!
 Step 1: Identify Problematic Situations
 Step 2: Engage in Sensory Exploration
 Step 3: Create Toolbox
 Step 4: Make Connections
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Tool Time!!!
 See the Tool Time Protocol in your handout package.
 This process helps to identify tools for problematic situations and to teach children when and how to use them.
 Eventually the teacher will be able to give the simple cue and the child will respond by going to their toolbox and choosing an appropriate tool.
 The Tool Box Handout provides suggestions for mouth, hearing, hand, eye and “Doing Tools.”
Handout pages 10 ‐
11
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Sensory Exploration
 Must be Guided at First
 May need to be supervised
 Keep track of helpful modalities
Handout pages 10‐11
Guiding Choices Activity
If a person  is sleepy and needs to be more alert……
suggest exercise band rowing  is in heightened alertness after a gym class…
suggest sitting in a beanbag chair with a heavy duty dog on the lap.
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Individual Sensory Kits
 Developing kits teaches sensory coping strategies in a concrete way.
 Taking home a kit helps with carryover of skills.
 Scool tool kit can be kept in the classroom and can cotain larger items such as a weighted lap pad or theraband for desk leg.
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Brainstorming Kit Ideas
What will the kit be used for?
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Paying attention at work or school
P
i tt ti t k h l
Staying awake in the car
Relaxing before bedtime
Dealing with anxiety
Helping with sobriety
Grounding
What items will be helpful?
Sensory Kit for Clinical Outreach in the Community
 Oral Motor Items
 Fidget Widgets
 Focused Activity
 Strong Sensory Input
 Grounding Items
Page 12
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Meltdowns and Catastrophe
Anger Management
Feeling Overwhelmed
D
Demands
d are T
Too High
Hi h
Sensory Overload
 Angry feelings are normal and can be managed.
 Anger sets of “fight or flight” response – become aware of physiological responses.
 Identify triggers.
Identify triggers
 Start with physiological coping skills (deep breathing, relaxation, counting activities).
 Discuss and practice prosocial ways to deal with anger.
Feeling scared
Person is trying to preserve “inner self”
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Anger management
Anger Management Magnet Creative Therapy Associates, Inc.
Kellner, M., & Bry, B. (1999) The effects of anger management groups in a day school for emotionally disturbed adolescents. Adolescence, 34 (136), 645‐651.
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Sensory Approaches to Anger Management
Anger Management and self‐regulation group helps children identify symptoms of anger and strategies for anger management. Maas, Mason & Chandler (2008)
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Alert Program and Atwood’s Exploring Feelings Program
Anger Management
 Angry feelings are normal and can be managed.
 Anger sets of “fight or flight” response – become aware of physiological responses.
 Identify triggers.
Identify triggers
 Start with physiological coping skills (deep breathing, relaxation, counting activities).
 Discuss and practice prosocial ways to deal with anger.
An 8‐week‐long use of the Alert Program® within the classroom setting for 7 children with emotional disturbances demonstrated improvement on all measures as compared to the control group.
Barnes, K. J., Vogel, K. A., Beck, A. J., Schoenfeld, H. B. & Owen, S. V. (2008). Self‐
regulation strategies of children with emotional disturbance, Kellner, M., & Bry, B. (1999) The effects of anger management groups
in a day school for emotionally disturbed adolescents. Adolescence, 34
(136), 645-651.
Williams, M. Shellenberger S. (1996) How does your engine run?:Leaders guide to the Alert Program for self‐regulation
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HOW ANGRY ARE YOU?
Cause or Event
Rage
Internal Feeling or
Body Response
Extreme
Emotion
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Scale of 8‐10
Angry
Very Upset
Scale of 5‐7
Irritated
Upset
Scale of 2‐6
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Sensory Driven Behaviors and y
Sensitivities
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Handouts p. 9
Sensory Driven Behaviors
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What Could It Mean?
 Sometimes behaviors have a sensory Sometimes behaviors have a sensory component.
component.
S
Sensory seeking and sensory avoidant behaviors ki g d id t b h i can be misleading.
 Many sensory behaviors are seen in autistic Many sensory behaviors are seen in autistic spectrum disorders.
spectrum disorders.
 Young man continuously throwing himself down on the floor.
fl
 Adolescent insisting on lying on the floor during groups and sometimes discussions
 Young man with PDD refusing to change clothes and shower
 Child acting out when going to lunch
 ADHD ADHD has sensory has sensory implications.
implications.
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Be a Sleuth
Start considering sensory possibilities
 When behaviors seem in explainable
 When an outburst “comes out of the blue”
 When tried and true interventions don’t seem to work
Identifying Sensory Sensitivities Handout p. 36.
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SENSORY DEFENSIVENESS
Abnormal reactions to things most people wouldn’t notice.
 Hypersensitive Hypersensitive –– low threshold
 Abnormal experiences of sensory experiences
 Increased startle reflex
 Avoidance and control issues
 Some input can feel painful
 Self
Self‐‐injurious injurious behaviors common
behaviors common
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Sensory Sensitivities
What Can We Do?
Making Connections
Where do We Begin?
Eliminate it
Avoid it Get used to it – slowlyy
Work around it
Use a sensory tool
Change the time
Prepare yourself
Relax after
Tell someone – ask for help
 Work with your partner of group to come up with p
gg
some possible suggestions for some varied situations.
 Remember that what you choose may not be the preference of the client so you will almost always be offering choices.
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Diagnostic Concerns and Sensory Issues
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Dissociative Disorder and Borderline Personality Disorder
 Chronic hypervigilance
g
 Constant struggle with feeling unsafe
 Dissociation – state of non‐feeling
 Distorted pain experiences
 Hypersensitivities
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Overly Quiet/Withdrawn
Depression
Always start with Calming!!!!!
 Easy to overlook
“Just hold my hand.”
 Person may be shut down or overwhelmed
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 Storm may still be raging inside
 Just being with the person might help
 After comforting try engaging in Koosh Ball toss
In acute stages person may be in shut‐down
Use calming input to start
Move on to mildly alerting input
Comforting input is essential – teach self‐soothing
Encourage movement and exercise
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Upset/Agitated
Disorientation/Dissociation
Flashbacks/Suicidality
Try calming input and
strong organizing sensory input.
 Deep breathing
 Walking or pacing
 Stress ball/Toss Koosh
 Theraband rowing
 Listen to calming music
 Rocking
 Weighted blanket
Use Alerting Input or Strong Organizing Sensory Input
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Person is not connected to reality
Person may be scared or even traumatized
Use Grounding Strategies
Use Heavy Work or Exercise or Weighted Modalities
Strong input to the body helps bring the person to the present
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Psychosis
Be careful
May have to wait until meds kick in
Sensations may feed psychosis
Give them some space –
Gi h avoid surprises
id i
Try walking (pacing) with person
Provide grounding
Increase strong sensory input
Provide reassurance
Anxiety
 Often arises from feeling unsafe
 Bring person to quiet place, make a connection, lower voice, humm together, do deep breathing, toss ball together, pace or walk together.
 Help person find environmental or auditory “Safe Space.”
 Make a cue card
Peter is safe!
Peter has friends!
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Self‐Stim Behaviors
ADHD and SENSORY PROCESSING DISORDERS
People use self‐stim behaviors to keep regulated.
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Easily over stimulated
Anxious
Inordinate effort to perform tasks
Poor body awareness and stability
Perceive things differently from other people
Kinnealey (2007)
www.sinetwork.org/aboutspd/response.html
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Rocking
W ll d it ti
!
We all do it sometimes!
Smacking lips
Hand flapping
Is it working for the person?
Humming/self talk
Putting objects in the mouth
Hair twirling
Leg wiggling
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Finding Alternatives to Self‐Stim Behaviors
 The behavior is a clue as to what is working for the person
y
g
y
y
 Don’t take anything away “cold turkey”
 Wean away slowly by substituting something similar and rewarding use of new technique.
 Look at the reason behind the self‐stim
Do they need some down time?
Do they need to rev up with exercise?
Are the demands too hard?
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Why Self‐Harm?
 It can be a mal
It can be a mal‐adaptive calming technique
adaptive calming technique
 It can be stress related
 It can be a medical condition (toothaches, headaches, urinary infection, earaches)
 It can be frustration with inability to communicate (try a picture communication board)
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Sensory Connection to SELF‐INJURY
Soldiers in war who were the most wounded needed the least morphine
With repeated experiences of pain – body resets pain level –
faulty adjustment
People often report they do not feel pain
People report that after self‐harm they feel calmer
Self‐injury is hard to stop because IT WORKS
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Look Beyond the Behavior –
Look Beyond the Behavior – and Tina Champagne
Ask Why! People seek what they l
k h h
need –
need – adaptively or maladaptively
(Dunn, 1997; Hanschu, 1995)
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Sensory Connection to Trauma and Treatment
in Youth
Understanding the Senses and Their potential for Treatment
Workshop III
Aspire Clubhouse
Albany GA
April 30 or May 1, 2014
Presentation by Karen Moore, OTR/L
Angie Balzarini‐Leonhart, OTR/L
Games Teach Social Skills
 In a survey of children and adolescents with severe emotional disturbances 84% of 39 educators identified problems with play and leisure (Grisham, Cook & Crews, 2004)
 Skills include cooperation, assertion responsibility, empathy, and self‐control
 According to the poly‐vagal theory of Stephen Porges, games stimulate neural circuits related to social engagement Not video games!
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Pushing Game
Tailgate Games
What’s going on here? What would Porges say?
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Who Could You Go To?
Game for Supports
 Who could you go to if you are feeling upset?
 What could they say?
 How could they help?
Ho co ld the help?
When visiting
At a party
On an outing
At school
Who Has the Ball of Responsibility?
 Staff has it
 We share it
Responsibility
 You have it!
In the community
When with friends
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On the unit
Good self-control is having the ball in your court!
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Crisis Intervention
Basics of Success Follow the research……
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Develop a Crisis Intervention Plan
Intervene early
Identify Signs and Triggers
y g
gg
Identify Helpful Strategies
Have a Plan Contract for action “When I am upset I will………….…….”
 Post the plan where children and care providers can see and use it! See Handouts p. 22 ‐ 25
 Be proactive
Teach skills early
Introduce sensory room and sensory items
 Know your patient
Trauma history??
History of aggression??
 Respect preferences
LeBel et al, 2010; Huchshorn, 2004;
 Create safety zone
Sutton & Nicholson 2011; Scanlan, 2010;
MacDaniel et al, 2009; Porges, 2011
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Non‐Tool Based
Sensory Strategies
Core Strategies
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Deep Breaths
Vigorous Exercise
Wrap in a Warm Blanket
Weighted Blanket
Rocking/Swinging
Grounding Strategies (Smell box, Hot Balls)
See Handouts p. 20
Pause – Connect – Engage
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Chair pushups
Foot‐flexes
Jumping jacks (highly activating)
Pacing/walking
Upper body joint compression Full body joint compression Kneel‐stands Stamp feet or loudly clap hands
Rhythmic slap/clap activity Page 16 Can be used as a game. More ideas on 112 Free Activities
SCP website –
Pause  Something’s wrong. Step back. Take a moment to think.
 Was there a trigger?
gg
(bullying, humiliation, boredom, restrictions, frustration)  Was there a sign?
(agitation, threats, yelling, withdrawal, self‐injury)
Page 18 and 37
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What Are the Signs?
What Are the Triggers?
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Feeling scared
Confusion
Humiliation
H miliation
Boredom
Disappointment
Frustration
Teasing from Peers
Teasing from Peers
Being over tired
Someone being mean
Wanting to Wanting to go home
go home
Changes in Changes in staff
staff
Changes in routine
Changes in routine
Yelling
Noise
Trouble at home
Being left alone
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Handouts p. 23
 Connecting with the right person shuts off the “fight or flight” mode
 Who would you go to….. At home? At school?
Who Could You Go To? Game Engage
Do something positive
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Use a stress ball
Do deep breathing
Pace or walk
Rock in a chair
Do a puzzle or activity
Exercise
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Pause
Pause – Connect – Engage
for staff
Self Injury
Self Injury
Temper tantrums
Temper tantrums
Withdrawal
Emotional lability
Emotional lability
Being mean
Threats
Upset stomach
Laughing or giggling
Handouts p. 22
Connect
 Reach out to someone you trust!
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Kicking/hitting things
Pacing
Signs of Anger
Yelling or swearing
Uncooperativeness
Extreme Anxiety
Argumentative
Clenched fist
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What Helps?
When I am angry?
When I’m in a bad mood?
When I’m scared?
Signal person to think
Connect
Bring to a safe place
Make a connection (eye contact, smile)
Assure Safety
Engage
Ask what might help
Use common strategy (deep breaths, pace)
Page 18 and 37
 Activity is designed to help identify and communicate helpful strategies.
 Individualized poster is made using pictures of sensory activities and coping strategies.
 Poster is made available in the classroom or sent home to communicate helpful strategies to others.
What Helps? Game on SCP Website
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Case Study Lab
Fanny Packer
 Fanny Packs or Sensory Kits can be developed in school or at home
 Review situations that might need calming or alerting for individuall
 Practice using different tools and identify the most helpful activities
 Make kits at school or provide suggestions for home.
This is a good way to involve families!
 Read the study for Marty or Casey
 Using Handouts Identify What Helps?
 Using the Handouts Identify tools for a sensory kit or back pack (pages 10 ‐ 12)
 Fanny Packer Handout (page 13)
Page 13
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Self‐Regulation Workbook
“I Tried It” Activity
 Keep an “I Tried It” list of possible activities in the Sensory  I Tried It Activity
Room.
 Safety Zone Tool
 Each time a child tries a new activity have them check it off  Comfort Space Plan
C f t S
Pl
and perhaps put a star beside favorite activities.
 Sensory Sensitivities Discovery
 Give a reward when all the activities have been tried (stress  Paus Connect Engage Worksheet
ball or sensory tool)
 Circuit Breaker for Crisis Intervention
Page 29 Find this tool on the SCP Website
Handouts p. 28 ‐ 39
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MA DMH Safety Zone Tools
MA DMH Safety Zone Tools
Triggers Tool
Warning Signs Tool
What makes you feel upset
(Circle all that make you feel sad, mad, scared or other feelings)
Being touched
Too many
people
Loud noises
Yelling
Being alone
Available on-line http://www.mass.gov/eohhs/gov/departments/dmh/restraintsecl
usion-reduction-initiative.html
What happens to my body when I am angry, scared or upset
(Circle all that apply)
Loud voice
Upset Stomach
Being Hyper
Crying
Being mean
Available on-line http://www.mass.gov/eohhs/gov/departments/dmh/restraintsecl
usion-reduction-initiative.html
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MA DMH Safety Zone Tools
What helps you feel better? (Circle all that apply)
fidgets
games
Weighted
animal
reading
sports
Available on-line http://www.mass.gov/eohhs/gov/departments/dmh/restraintsecl
usion-reduction-initiative.html
Comfort Space Plan
 Dedicated space/room or corner of a room
 Comfortable chair  Items chosen by the individual for nurturing and self‐
regulation
 Items might include CD or music, art or poetry books, “Heavy Duty” animal, blanket, weighted lap pad, manipulatives, tasty treats, grounding supplies, scented lotions. Page 34- 35
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Comfort Space Plan
Bothersome Sensory Input
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Work with parents
Use Comfort Space Plan worksheet
Find a location
Make suggestions for items child seems to enjoy Decide how the space will be used
10 minutes morning, afternoon & evening
before or after school or work
before of after appointment or stressful event
before bed
Pages 33- 34
S
S iti iti Di
W k h t
 Sensory Sensitivities Discovery Worksheet
 What Can You Do?
Page 36 - 37
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Pause – Connect – Engage
Worksheet
Self‐‐Control
Self
Pause (for warning signs or triggers)
Connect (seek/accept help)
Take control and you help that day
that day.
Engage (do something positive)
Teach control and your help lasts a lifetime.
Page 38
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Try it Try it –
– You will like it!
Sensory approaches make sense!
Sensory activities are fun!
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