FAQ

Parents know their children the best. If you are concerned that your child is finding certain tasks or environments more challenging than what you would expect, it may be worth investigating it further.

The brain has capacity to develop and change. Neuroplasticity is greater when children are younger. Memories and connections are being made creating positive learning experiences at a young age supports learning development.

Sensory processing disorder (SPD) is the overall term for children who struggle to take in and respond to sensory information to the extent that it impairs their daily routines. It is based on the theory of sensory integration.

The theory of sensory integration hypothesizes that:

Normal sensory integration functioning enables children to learn. Sensations are the way that our nervous system receives information using our senses. This could be sensations of movement and information about the environment. We then process this sensory information to make sense of what is going on in our own bodies and the world around us.
Furthermore we have to organise and interpret this information and attach meaning to it before we can act on it. Sensory processing happens all the time in everyday tasks. For instance:  children learn how to write by knowing how it feels to sit upright, to be able to filter out background noise, knowing the shapes of letters, how it feels to hold a pencil and how to form the letters correctly.

Signs of sensory processing disorder may include:

• Difficulty being at the ‘’right level of alertness

• Spends much time being ‘under alert’ (dreamy/lethargic) or ‘over alert’ (anxious/excitable) rather than ‘calm and alert’

• Physical clumsiness

• Stooping posture, leaning on arms at the desk or leaning on others

• Difficulty learning new movements or skills

• Inability to filter out background noise, e.g. in a classroom, assembly or playgroup

• Awkward grasp on markers and scissors 

• Struggles to learn automatic movement patterns such as riding a bike or playing sports 

• Prefers playing on the computer, watching TV or controlling others to do tasks for them

• Activity level unusually high or low

• Poor awareness of own body in relation to others and furniture

• Extreme sensitivity to touch, movements, sights, sounds or tastes

• Seeking out sensation, touching and fidgeting, trouble sitting still

• Difficulty following instructions

Sensory processing disorder is divided into three areas:

Sensory modulation disorder

There are three subtypes:

• Over responsive
  This is when an individual over-responds to stimulation that is usually processed by most people, e.g. listening to the vacuum cleaner. Some children react impulsive or aggressive when placed in these situations and will try to avoid it,these sensations set off a proactive response usually a fight or flight nature. Sensory input often has a cumulative effect and sudden exaggerated responses may occur to a seeming trivial event due to the collective events of the day.

• Under responsive
  Some children don’t recognise sensations which would bother most children, for instance food around their mouth, or hurting themselves. These children can appear quite lethargic or show a lack of drive to explore their environment. They can seem inattentive and disinterested. These children are often seen as “easy children” when younger, but  they find it challeenging to keep up with school time tables and demands.

• Sensory seeking
  Some children crave intense and strong stimuli. They require loads of stimulation so often move, talk, touch, chew frequently. 

Sensory-based motor disorder

This is divided into two subtypes:

• Postural disorder 

  • These children have difficulty stabilising the body during movement or at rest. They usually struggle with balancing activities. 

• Dyspraxia 

  • The impaired ability to conceive, plan and execute new actions. People appear awkward and poorly co-ordinated.  (LINK DOES NOT WORK???)

Sensory discrimination disorder

This is when children struggle to discern between the fine detail of sensory information, e.g. the shape of a toy in their hand, or the teacher’s voice versus classmates. You need normal sensory discrimination to be aware of where your body is in space and how it is moving. We use seven senses to create this picture: touch, sight, hearing, smell, taste, movement detected in the inner ear (vestibular information) and movement detected in our muscles (proprioception).

“Developmental dyspraxia is an impairment or immaturity of the organisation of movement. It is an immaturity in the way that the brain processes information, which results in messages not being properly or fully transmitted. The term dyspraxia comes from the word praxis, which means ‘doing, acting’. Dyspraxia affects the planning of what to do and how to do it. It is associated with problems of perception, language and thought.” www.dyspraxiafoundation.org.uk 

Children with dyspraxia may demonstrate some of these types of behaviour:

• Difficulty planning how to do a new task

• Reduced co-ordination and may constantly bump into objects

• Often falls over

• Difficulty with pedalling a tricycle or bike

• Lack of any sense of danger (jumping from heights etc)

• Continued messy eating and difficulty handling cutlery

• Frequently spills their drinks

• Avoids constructional toys, such as jigsaws or building blocks

• Poor fine motor skills

• Difficulty in holding a pencil or using scissors 

• Drawings may appear immature

• Children may prefer adult company

• Laterality (left- or right-handedness) still not established

• Difficulty following instructions

• Limited concentration and tasks are often left unfinished

• Difficulty adapting to a structured school routine

• Difficulties in Physical Education lessons

• Slow at dressing and unable to tie shoe laces

• Barely legible handwriting

• Immature drawing and copying skills

• Low self-esteem

Children with dyspraxia often have other challenges. “Dyspraxia and dyslexia overlap and often co-exist in the same person. Dyspraxia is an impairment of the organisation of movement that is often accompanied by problems with language, perception and thought. Dyslexia is primarily a difficulty with learning to read, write and spell and is often accompanied by other problems such as poor organisational skills. The pattern of difficulties experienced by a person with dyspraxia may vary widely as with dyslexia.”  www.dyspraxiafoundation.org.uk 

Children with dyspraxia often also have sensory processing disorder. Dyspraxia falls under the medically diagnosed term developmental co-ordination disorder (DCD). 

“Developmental coordination disorder (DCD) is a motor skills disorder that affects five to six percent of all school-aged children. DCD occurs when, a delay in the development of motor skills or difficulty coordinating movements, results in a child being unable to perform common, everyday tasks. By definition, children with DCD do not have an identifiable medical or neurological condition that explains their coordination problems.

Children with DCD have difficulty mastering simple motor activities, such as tying shoes or going down stairs, and are unable to perform age-appropriate academic and self-care tasks. Some children may experience difficulties in a variety of areas while others may have problems only with specific activities. Children with DCD usually have normal or above average intellectual abilities. However, their motor coordination difficulties may impact their academic progress, social integration and emotional development. 

DCD is commonly associated with other developmental conditions, including attention deficit/hyperactivity disorder (ADHD), learning disabilities (LD), speech-language delays and emotional and behavioural problems.” http://dcd.canchild.ca/en/AboutDCD/overview.as

DCD can be caused by dyspraxia, poor posture or other motor skill difficulties such as benign hypermobility syndrome.

Further information on DCD is available on www.dcd.canchild.ca

 As children’s Autism usually have sensory differences, OT’s are key in supporting children and families through some of the related struggles. Sensory preferences impact on use of toilet or food choices and ability to cope with a stimulating environment. OT’s help children and families in the areas they identify as challenging/ emotional regulation.

They frequently have difficulty filtering out unimportant auditory information and find it hard to focus on the teacher’s voice. They might also find it hard to find the “just right” level for learning. They can often be over responsive in a classroom situation and find it hard to sit still, and possibly seek different types of sensory activities to calm themselves, these could include making noises or repetitive movements. Therapists who have sensory integration training can help your child to process sensory information in a more organised way. This will help him/her integrate better with their environment. 

• Therapists use a variety of approaches to support children such as the Alert programme, or cognitive strategies with older children. Occupational therapists can also help children develop a wider range of play skills by introducing engaging activities, sometimes involving a second person. The DIR floor time principles support children to regulate, engage and take turns in an appropriate way.

• Children with ASD often require extra support to cope in their environment. Occupational therapists can assist in setting up suitable support to help children transition better between tasks. They can also structure the environment to enable the child to cope better with the challenges in the environment. These could include helping to set up a visual timetable to assist him/her to the sequence of events, and feel more in control. 

In some situations therapists are able to help parents and teachers change the environment to make it inclusive.

Children with ADHD often have difficulties with fine motor skills and co-ordination tasks. Occupational therapists can help them to improve in these areas, such as ball skills, balance and handwriting.

Some children with ADHD also have sensory processing disorders. See Q2 and benefit much from sensory integration therapy. This can greatly improve attention in class. ’

Some children with dyslexia have difficulty with visual perceptual skills and reversals. Occupational therapists can help children improve their visual perceptual skills and can help children understand shapes better and therefore improve their understanding of letters.

Children with dyslexia often have dyspraxia, which in turn affects their handwriting skills. This can improve with therapy.

There are usually three types of assessments 

1) More general and functional assessments drawing on understanding child development, the occupations children need to fulfil within a certain context and motor/sensory/cognitive skills impacting on their participation. A full assessment usually has three steps:

1. Classroom observation: we observe how well your child performs key actions compared to other children in a busy classroom environment. For example, looking at their handwriting, concentration and how they express what they have learnt. 

2. Individual assessment: Using standardised tests we are able to determine the underlying causes of any difficulties your child may have. For example, if your child struggles with handwriting, it could be because they lack hand strength or because they find visual symbols confusing. The treatments for these causes are very different.

3. Report: we provide you a report outlining my findings and can discuss it with you in a feedback appointment.

2) A sensory assessment usually takes place at home or school, particularly the environment that is more taxing for your child. We analyse Sensory processing scores and interview parents before the observation. After or during the observation, do we engage with your child in a range of appropriate activities to build rapport and gain further clarity on their processing. We try to get to observe your child through transitions e.g. in PE and on carpet time, or changing from playing to participating in an adult-led task. We use questionnaires from home and school or nursery to build an overall picture of times and environments that are more taxing. 

3) In depth Sensory Integration Assessments either using the EASI, a marvellous Sensory Integration assessment that indicates and quantifies praxis challenges.  Alternatively drawing on a range of sensory activities and standardised tests to indicate sensory motor profiles. 

If the assessment leads us to conclude that your child will benefit from treatment, we can discuss and agree how many sessions will be required.

It is generally recommended that a treatment block should cover 8-12 weeks of individual sessions. This allows your child to build a relationship of trust with the therapist. However, some treatment blocks are shorter or longer. 

Each child’s needs are different and therapy will be tailored according to the goals set with your child. All activities will also be tailored to your child’s interests and abilities:

1. Warm-up: We usually start with gross motor activities that could address issues such as levels of alertness, posture or balance. Fun imaginary games are incorporated to strengthen muscles and aid co-ordination.

2. Gross motor skills: We work on various motor skills such as shoulder strength, ball skills or co-ordinating movements on the two sides of the body. This treatment usually involves the use of large equipment such as therapy balls, scooter boards, hoops and ropes. 

3. Fine motor skills: We end with fine motor tasks such as developing a good pincer grasp. This often includes handwriting activities relevant to your child’s school work.

Group work follows a similar format.

In practice this varies significantly. It depends on numerous factors such as how clear-cut your child’s difficulties are and whether they do the exercises at home and school. However, positive results can often be seen in six to eight weeks.

In more complex cases children will benefit from therapy over a longer period of time. You will be kept up to date with your child’s progress on a regular basis.

Treatment is most effective when it takes place not only during therapy sessions, but also in the classroom and at home. This requires a partnership between the child, the therapist, the school and the parents. Therapy is usually accompanied by recommended exercises for you to carry out with your child at in your own home. I would also give advice to the school about exercises that can be done in the classroom.

• • Increased confidence in writing

  • Increased confidence in general

  • Improved pencil grasp

  • Improved letter formation and legibility

  • Better dressing skills and eating skills

  • Better problem-solving

  • Greater self-awareness of their skills

  • Greater willingness to persevere 

  • Improved posture when seated

  • Improved alertness for learning