Summer Tips from an Occupational Therapist

Ah, summer. A little more flexibility in the schedule, perhaps a little more travel, and definitely being off of the academic year routine (for many). Make the most of this season to support your child with sensory processing issues. These are some things that I have recommended (and have used with my own children over the years). 

After the initial decompression, late nights, sleeping in, general chill time, these are some suggestions that may help your child. 

  • Using a visual schedule, or calendar. This is especially helpful if your child is navigating multiple camps or different schedules. You can verbally review the day, write it in a central place (chalk board wall, fridge dry erase magnet, or even a robust app like Skyline). This can really help soothe anxiety for children so they know what to expect each day. Try it out–it might surprise you!
  • Outdoor time, fresh air, connection with peers. Look for splash pads, public pools, playground or park gatherings, hiking, camping, and simple picnics. 
  • Give your child some uninterrupted time, free from screens. Reading books together, tossing a ball, swimming, going for a bike ride, card games, board games, even just sitting together and talking.
  • Have accommodations, and “Plan B” on the ready. I recommend developing mental flexibility around outings and events. It’s OK to leave early when your child becomes overwhelmed. Keep a backpack or tote with backup clothing, extra sunscreen, wipes, and emergency snacks, and any other accommodations that support your child when in stress. 
  • Allow for extra sleep and provide healthy snack and meal choices. This is fairly basic, but important. Consider magnesium over melatonin for sleep issues, and shopping at places like Trader Joe’s and Aldi for treats and frozen meals (as they don’t contain artificial food dyes and the preservatives in the frozen foods are much lower than the big brands). 
Summer Through a Sensory Lens

I want to break down the sensory systems that we work with as occupational therapists, and spark some ideas of how to provide rich sensory input on the daily. Whether your child seeks out the sensory experiences, or avoids them (or both!), it is good to provide them with opportunities to get their needs met, or build tolerance, respectively. Many of these things overlap, and will be providing multi-sensory input. 

Vision

Our visual system is, for many, is compromised with excessive screen use and indoor time. It’s incredibly important to give our children opportunities to expand their visual systems–and outdoors is the best place to be!

  • Keep sunglasses on hand for kids who are visually sensitive
  • Scavenger hunts (in nature)
  • Water balloon games: tossing, aiming at target
  • Ball games and sports, frisbee
  • Crazy straws (binocular vision)
  • Blowing bubbles and catching them on the wand
  • Blowing dandelions that have gone to seed
  • Soapy slip and slide 
  • Being outdoors!

Touch/Tactile

This is a very important system with which we experience our world. It is strongly linked to emotional regulation. If your child experiences sensitivities to sand, clothing changes, wearing sunscreen, engage in a lot of the muscle/proprioception based activities below before and after the touch/tactile activities.

  • Sunscreen, bug lotion (use firm pressure if your child is sensitive, or let them help to rub it into their skin)
  • Body paint, face paint
  • Walking barefoot
  • Wearing rash guard shirts if sensitive about wearing less clothing 
  • Sandcastles, mud pies
  • Loofahs, silicone scrubbers in the bath
  • Homemade slime, play dough
  • Baking, cooking
  • Lakes, ocean, creeks, pools
  • Running through the sprinkler

Movement/Vestibular

This sense helps us with attention, focus, and balance. We tend to be far more sedentary than is good for us, so keeping active this summer is real medicine for your children. This sense can overstimulate some kids (especially with spinning) if they get too much, engage in the muscles proprioception activities below afterwards. 

  • Hammocks
  • Swings
  • Riding scooters, bikes
  • Wagon rides
  • Merry Go Round
  • Swimming
  • Amusement park rides
  • Practicing somersaults and cartwheels
  • Water slides, slip and slides
  • Trampoline, bouncy houses

Muscles/Body Awareness/Proprioception

This sense is unique; using the muscles and stimulating the joints of the body help the body get more information about itself (in regards to moving through space) for better coordination, and also can help to soothe and/or stimulate the nervous system to bring it into stasis. So, if you are tired, muscle activity can “bring you up” and if you are overwhelmed, muscle activity can “bring you down”. This is why this sense is so crucial, and it is hands down, the best thing to use with your child when in doubt. 

  • Rock climbing, scrambling
  • Tree climbing
  • Monkey bars
  • Riding a bike
  • Paddling/kyaking
  • Animal walks: bear, tiger, crab, snake, cat, etc. 
  • Yoga poses
  • Trampoline, jumparoo
  • Tug of War 
  • Potato sack races
  • Hippity Hop bouncing ball
  • Swimming
  • Running races
  • Hand clapping games like “Mary Mac”

Oral Input

If your child is a nail biter, puts pens, clothing or hair in their mouth, it’s good to encourage alternative outlets for this sensory need. The need to chew *can* be linked to retained primitive hand reflexes, so if you notice this need (or if they are moving their mouth a lot) when drawing or crafting, have resistive snacks or chewy toys available. 

  • Using crazy, silicone, eco, or stainless steel straws
  • Silicone chewy toys and necklaces 
  • Crunchy, chewy, resistive snacks (apple wedges, granola bars, bagels, carrot sticks)
  • Whistles, harmonicas, wind instruments

Sound/Auditory

This sense can really affect our level of regulation–so if your child needs accommodations such as headphones and ear plugs to participate, please allow them! Music can help to calm us down–especially organized classical music (Bach, Mozart), and binaural music, or rev up–depending on what we need at the moment. 

  • Listening to music
  • Having earplugs and headphones to reduce noise for sensitive kids, during fireworks, loud sports games, loud concerts
  • Whispering games like “Telephone”
  • Freeze dance
  • Simon Says
  • White noise, noise machines, or fans to help with sleep
  • Outdoor concerts and festivals where there is a lot of green space to move (bring those headphones!)

Smell + Taste/Olfactory + Gustatory

As many of us have learned during the pandemic, these senses are very linked. Some children are very smell sensitive, so much so that it can limit places that they can be in. Others love to smell things; toys, objects, etc. to understand them. 

  • Dye and scent free laundry soaps for sensitive children
  • With picky eating, exposure to the foods is great–over forcing bites or for them to eat a certain amount–such as handling, washing, helping with prep
  • Family style meals with the food on the table versus being brought a plate
  • For smell “seekers”, try working with natural scents and tastes: fresh lemon or lime, orange wedges, pepper flakes, kraut, and complex flavor profiles 
  • Using essential oils versus synthetic fragrances (please note that you should treat essential oils like a medicine; keep them out of reach of your children, and if you are working with the oils, avoid undiluted direct skin contact)–nasal inhalers can work well for this!

 

Safety First

Children need to have a sense of safety before they can engage, explore, and connect with others across different environments. In the fast paced, on demand, high-expectation-of output kind of world that we are in, it’s an important angle to consider: “does my child feel safe?” and even a step before that, “do I feel safe?”. 

With a lack of perceived safety, we all can get stuck in a fear response: the very primitive reflexive responses of “freeze”, where one can’t act, respond, or engage to the demands presented (this is linked to the Fear Paralysis Reflex, or, FPR). We can get triggered into creating safety for ourselves with “fight” or “flight”; by attempting to fight and/or run away from the situation (this is linked to the Moro reflex). 

When in a state of fear, where lack of safety is perceived, we cannot access the higher brain centers that support learning and connections. When we do feel safe, we can better engage in exploration, socializing with peers, accessing our creativity, the willingness to make mistakes and try again, and even the ability to digest food (this could be a factor if your child brings home an uneaten lunch, even if its a favorite meal).

Maslow’s Hierarchy of Needs is a model that was presented in the mid 20th century as a way to acknowledge a heirarchy of collective societal needs. Physiological Needs sit at the bottom of the pyramid; with the most basic elements of biological survival: food, air, water, sleep, etc. The second level up is Safety: security, health, stability of environment, etc. All of these things create the foundation for the levels above: Love and Belonging, Esteem, and ultimately Self-Actualization. 

If we look at the ancient study of the energy systems in our body through Ayurveda and the chakra system, the base of the 7 chakras is the “root chakra”, also referred to as the first chakra. The root chakra is all about safety, feeling grounded, and connected to the Earth. The other chakras )ground up) include the sacral chakra (creativity, joy), solar plexus (independence, willpower, strength, individuation), heart chakra (emotions, love, compassion, bridge to higher chakras), throat chakra (our ability to speak our truth, advocate, express ourselves), third eye chakra (our perception of the unseen, intuition, knowing, seeing, mental capacity), and finally the crown chakra (our connection to things outside of ourselves, engagement with higher realms, collective consciousness, higher self). 

As someone who has worked in both the medical and energetic arenas, I cannot emphasize enough the importance of safety, having our needs met, and feeling grounded. If we consider Maslow’s Heirarchy of Needs, it is possible to skip the “developmental” steps, but ultimately, without a stable or connected base or sense of safety, life may feel more challenging, more cumbersome. We might feel sabotaged, not have the mental or emotional bandwidth to engage, need frequent breaks, and more. 

So, how then, can we create a sense of safety for our children so that they can feel confident to explore the world?

First, start with yourself. Check your own energy before supporting your child. Are your needs met? Do you need to take some deep breaths, move your body, shake it out, drink some water, or have a  snack? Pay attention to your regulation needs before helping or connecting with your child. They pick up on all of your energy. Many sensitive, “sensory” children are adept at reading their environments and the people within them to scan for safety, especially if there is a history of trauma. 

  • Having basic needs met. Access to food, water, sleep.
    • This can be tricky for children with ARFID who resist foods; try supplementation, taking baby steps with trying and engaging with food. Work with a dietician. 
    • Children who have sleep issues; try limiting screens a couple of hours before bed, using magnesium (discuss with your pediatrician), salt baths, and getting plenty of physical outlets during the day. 
  • Having access to physical contact, emotional support, and engagement with loved ones. This is so important.
    • If your child has separation anxiety, take time to comfort them versus forcing them to separate. If you travel, make time for video calls, leave little notes, and spend time with your children when you are home.
    • If your child is a teen or resists contact or gets into heated arguments with you, offer a family communication journal to communicate back and forth with. This simple task can remove the emotional intensity that face to face interactions can spark.
    • Offer tactile input through hugs, massage, and other forms of touch that are tolerated. A weighted blanket and body socks can also provide input if they don’t prefer touch. 
    • Be mindful of sensory needs. Maybe your child releases through talking, or playing, or moving their bodies. Try to tune in to what they need. You can always ask them what they need; they might surprise you!
  • Make time for uninterrupted connection. No phones, no tablets. Playing, building forts, reading or telling stories, creating, walking or hiking. With everyone’s busy and packed schedules, even 15 minutes of uninterrupted connection time can be incredibly supportive. 
  • Rhythmic body tapping: this can be done intuitively. This is deeply settling for the nervous system. If your child is actively in OT at AboutPlay, you can ask your child’s therapist to show you a technique. 
  • Eating grounding foods like protein and root vegetables.

So, the next time you are at school drop off, or a party, and your child is having a hard time entering or engaging, set them up for success. Get them to a playground to allow for some body movement before the activities, walk or bike to school if possible. Make sure that they have access to food and water. Tell them that they are safe, and that you believe in them. Make a plan to bail early if they are going to an event (such as a party, play date, sports arena game or a live show).

Creating strategies and support, including having a “plan B” helps the body to feel calm, and promotes a sense of safety. This goes a long way for a path to independence, self esteem, and eventually expression and actualization. 

Celebrating Occupational Therapy This April for National OT Month

Occupational therapy was founded in 1917 by individuals who sought the humane treatment of people in mental health wards. This happened in a little town in upstate NY, Clifton Springs. George Edward Barton, Eleanor Clarke Slagle, William Rush Dunton, Jr., Susan Cox Johnson, Thomas Bessell Kidner, and Isabel Gladwin Newton Barton pioneered what is now known as occupational therapy. 

Patients with mental health issues were released from restraints and encouraged to participate in tasks to “occupy” their hands and minds, instead of being left in chairs, or beds with little to no purposeful interaction or meaning, other than to be fed, medicated, and placated. These patients were suddenly now engaged with arts and crafts (basket weaving, knitting, jewelry making, rug weaving), vocational activities (sewing gardening, print making), recreational arts (music therapy, painting), and Instrumental Activities of Daily Living, or “IADLs” (laundry, cleaning, gardening). This was to give their lives more purpose, meaning, and would eventually be geared towards their independence.

Since these beginnings in the mental health arena, there have been many areas where occupational therapists have added value to people’s lives; the core uniting theme being to help them engage in meaningful and purposeful activities. Whether this is a return to independent living after a physical injury such as a stroke, spinal cord injury, or any other injury, helping children improve sensory processing and integration, visual-motor and fine motor skills for children and adults, working with assistive technology, learning to drive, trauma informed approaches in the holistic realm, pelvic floor therapy, return to participating in arts, crafts, and other leisure activities, yoga practices, and even using Reiki–the focus is person-centered and supports meaningful independence. All of this is addressed while honoring the cultural, spiritual/religious beliefs and values of the individuals that we support. 

There is really no limit the creativity we can bring into any setting as occupational therapists. I value the initial instincts that drove the founders to create the field of occupational therapy: providing humane treatment to people that had been “written off” by most of society. I also love seeing how many diverse areas our field is branching into. We continue, at AboutPlay, to stay updated with new information relevant to our scope of practice, and how to apply it in meaningful and creative ways to support our children and families. Thank you for being a part of it all with us–it truly is an honor for us to serve our community. 

Why We Favor the DIR/Floortime Approach (and Other Play Based Approaches)

At AboutPlay, we favor the DIR/Floortime (Developmental, Individual-differences, Relationship-based) approach over other (more widely available) behavioral models. We have a number of reasons for this. I first want to describe Floortime a bit more, for context. 

The Floortime approach was created by the late Dr. Stanley Greenspan. He felt that a key to connect with and reach children therapeutically, was literally to get down to their level and engage with them on their terms. To play and engage with their preferred activities and as they become comfortable, to help to challenge them to connect more. This model sees communication in many forms (not only language based communication), and encourages “circles” of communication. This is such an effective method, especially for non-speaking children. The communication may be gestural, and the goal is to continue to stay engaged. 

The Floortime model dovetails so well with the Ayres’ Sensory Integration model that we also use at AboutPlay. Floortime acknowledges the sensory systems and sensory processing, nervous system regulation, connection, and play. We understand that play is the highest form of learning. When a child is engaged with playing with certain materials, or has interest with, they will play with it for a while, may move away from it to integrate the learning, and come back to engage with the play, expanding on their explorations; trying new things out. This type of learning is far more effective and meaningful than the punishment/reward based learning that happens daily in other forms of behavioral therapy (and schools) which many times use the play and sensory experiences as the reward or break–whereas we see play and exploration through the senses and nervous system AS the therapy. 

So why do so many people still prefer to use behavioral methods? Because for the provider, it’s easier to have a plan. Because it has been what’s been done for so long, and people are reluctant to do something which requires constant engagement. There is no “dialing it in” as a therapist working with Floortime and Sensory Integration–it requires a constant engagement and assessment of whether or not the child is engaging and responding, and to be able to shift moment to moment based on what is happening in real time. 

When I was a young therapist in the 90s, the first conference on autism that I attended had incredible speakers. One of my favorite panels was with adults on the spectrum, who were talking about their experiences in childhood with ABA (then known as LoVoss), and with more sensory based approaches in OT. I remember one woman stating that the behavioral methods traumatized her, while some of the sensory based interventions from OT were much more in line with what she needed in childhood (she specifically mentioned swinging and playing). I will never forget that panel; as it has shaped the way that I have chosen to work with children. 

I stand by this approach now, despite what gets reimbursed, and what is widely practiced by others. I have seen firsthand the benefits of the DIR/Floortime and Ayres’ Sensory Integration play based approaches for decades. What can appear to be a quick fix with the behavioral methods can have lasting and even harmful effects on the nervous system. The behavioral methods also often encourage “splinter skills” to develop: when a skill is learned or taught without the foundational aspects of the skill. For example, we can teach children to perform a task, say, handwriting (which is a highly complex neurological skill), without addressing the foundational aspects of handwriting, handwriting may improve, but the other areas are still lacking. 

Conversely, when we do address the issues (sensory processing, sensorimotor, motor, dexterity, social-emotional) from the bottom up, the higher level skills (such as academic learning, handwriting, social skills) all seem to improve in concert (versus creating the splinter skill). So many families over the years have come to us with a very specific concern (behavior, handwriting, poor sleep), and have been pleasantly surprised to see many things improve, instead of just one thing. In this sense, in my opinion and experience, the payoff with the play based models is much higher, and is in alignment with our overall philosophy of building healthy brains and experiences through sensory rich connections. 

You can learn more about the DIR/Floortime approach here.

You can learn more about the Ayres’ Sensory Integration approach here. 

As always, if your child is actively being seen by one of our team members, we encourage you to connect with them with any questions that you might have about this approach. 

 

How a “Sensory Diet” Helps Children

The term sensory diet can be confusing; mainly because it is not all about our diet (it can be a part of it, though). This term was originally coined by Patricia and Julia Wilbarger: mother and daughter occupational therapists who created the Deep Pressure Proprioceptive Technique in the early 1990s (also called “DPPT”, “brushing” or “Wilbarger Brushing Protocol”). 

The idea of the sensory diet was originally connected to therapy brushing, and the activities accompanying the brushing. I have used this method over the course of many years; the frequency of the brushing was originally to happen every 90 minutes (often rounded by therapists to every 2 hours) that the child is awake, and supplemented by proprioceptive, or, “heavy work” activities.

The purpose of doing this was to give a very high amount of tactile and proprioceptive input to children who have sensory modulation issues (including sensitivities to any/all of the 8 senses we look at as OTs–visual, auditory, tactile, smell, taste, balance, body position, and interoception), issues with transitions, and/or children with a high frequency/duration of meltdowns. This high dose of input and activity was done to help the child feel what it is like to have a more typically functioning nervous system. 

The issue for most folks over the years is the frequency (every 2 hours is not sustainable for most families, even in the short term), and the resistance that some children put up to the process. Sometimes, I will still use this (depending on the child and family) with modifications in place to make it achievable. We are much busier (and keeping our kids much busier) than when I started using this technique in the 90s. 

Sensory diets are still talked about and used today, mostly without the brushing. Today, we as OTs talk more about sensory diets as specific activities to do with children that are in scheduled intervals to help improve our level of arousal, or, ability to focus, learn, and handle things that come our way. The benefit of bringing sensory input into your child’s life (and your life!) in this way is as a preventative measure. In other words, if your child’s sensory threshold is being met daily, then the chance of meltdowns decreases–in some cases, dramatically. 

If your child’s sensory threshold is not being met (too much sitting at school, too much screen time, not enough variety of food from pickiness/preference), the chance for dysregulation is higher. I know for myself, if I don’t get enough movement in my day, it can dramatically affect my mood. I might feel cranky, more sedentary (ironically), and have more “short fuse” moments. Additionally, if you try to introduce calming activities to a child whose sensory threshold has not been met fully, it can really backfire, and simply not work.

So, what sorts of things make up a sensory diet? Here are just a few examples of what sorts of activities can be supportive for children. 

  • Movement: running, bicycle or scooter riding, balance challenges, swimming, swinging, walking, dancing, tumbling, sports 
  • Muscle Work, or “Heavy Work”: climbing, jumping, tumbling, crashing into bean bag cushions, pushing a sibling’s stroller, carrying groceries, pulling a wagon, digging in dirt
  • Touch, or “Tactile” Input: slime, foam, body or face paint, dry bean/corn/rice bins, play dough, finger paints, cooked/cooled/oiled pasta
  • Visual Input: go outside–this has positive effects on visual skills such as convergence, as well as nervous system benefits, limit screens, View Finders, kaleidoscopes
  • Auditory Input: humming, singing, making silly noises, playing musical instruments, listening to music (classical, binaural beats), wearing earplugs/headphones for sensitivity
  • Taste and Smell Input: smelling and/or tasting fresh citrus, spicy foods, complex flavors in Asian, Mexican, and Indian cuisines, smelling essential oils in a nasal inhaler

If your child is working with an occupational therapist, have them help you create or update their sensory diet. If not, it may be helpful to identify the most challenging time of your child’s day, and then begin to try to work in some of the above suggestions. It’s especially important to work in the muscle work/heavy work activities throughout the day, as a preventative measure. If your child is getting enough of this, it can really help to even out meltdowns and improve overall regulation.

If you have tried some sensory strategies that are not working (and you will know, if they are bored or overwhelmed, become silly and/or unregulated), use heavy work/muscle work, as this sense is very grounding and regulates us if we are tired/sleepy AND if we are overwhelmed or overstimulated. Another good time to use heavy work is just before bedtime. 

A note on “play wrestling”. Although this is heavy work, it can quickly overwhelm a child. If you notice that your child is seeking this out, but becomes overwhelmed and even aggressive, pull back. They may be working though the Moro primitive reflex (fight or flight). Opt for things like using a punching ball or bag (with gloves), burpees for older kids, cartwheels, animal walks (like crab or bear) or wheelbarrow walking. 

Know that there is always a bit of trial and error when coming up with these activities. What works one day, may not work another day. While children do like routine and predictability, variation and novelty is also good for the brain as well, paradoxically. Try to stay flexible and give your kids 2-3 limited choices of something in each area when exploring what might work for them. Another idea is to have a visual chart with some of the ideas posted in plain view so that they can make a choice. 

And try to take as much opportunity to play with your kids. Truly play. No phone, no computer or tablet. Enjoy even a small amount of time to connect with them each day. This is another ingredient to helping your child meet their threshold; often times they are looking for connection and co-regulation with YOU. And if you are finding that you need some adult sensory strategies, check out my blog post for The Energetic Heart this month. Take care, and be well!

 

Autistic Burnout: What it Looks Like and How to Support It

There is a lot of talk about autistic burnout in the neurodivergent communities right now. This can happen for both children and adults on the spectrum. If someone is not diagnosed with autism, this may look like dissociation, shut down, and/or depression. As we learn more and more about the autistic brain and how it functions, we can begin to see the crossover with mental health issues. 

A person can get autistic burnout from being in environments that have excessive demands that put a lot of pressure on a nervous system that is wired differently. If there is a constant push for a child to fit into a particular mold (often seen in school situations, especially public school), or if there is a lot of chaos in the home situation with siblings and/or parents, or an otherwise high level of demand to perform or behave a certain way from a parent may be exhausting to someone with autism. Also, simply having to constantly navigate unclear social expectations and change in routine can be exhausting and overwhelming for a person on the autism spectrum. 

Autistic burnout can have many characteristics. An intensification in any of these things that is beyond what is usual:

  • Sensory overwhelm: this can include heightened sensitivity to sounds, visual stimulation, clothing textures, foods (leaning into strong food preferences), smells, or movement. 
  • Increase in rigid behaviors: inflexibility with changes in routine, wearing specific clothing, eating specific foods, attempts to control social behaviors (like dominating rules of games, need to win, dictating what happens between friends in social circles, rejection of siblings)
  • Intensification of behaviors: this may include social withdrawal, stimming behaviors (flapping, spinning, lunging, rocking, etc), increase in intensity. or duration of meltdowns, moving into only one room and isolating
  • Emotional changes: highly volatile, reactive, anxious, depressed, loss of interest in things that are normally enjoyable.
  • Exhaustion: unable or unwilling to get out of bed, little to no willingness to participate in activities of daily living (such as bathing, eating, brushing teeth, changing clothes)

If your child is experiencing any of this and has sensory challenges or is on the autism spectrum, you can take certain steps to help them. 

Immediate supports for the acute phase:

  • Reduction of demands: allow for rest, give space
  • Encouraging journaling or art to express and release heavy emotions
  • Using essential oils or natural scents to create a quick shift of mood
  • Using an ice cube on the bridge of the nose or face as a reset
  • Quick, short burst of exercise/activity; outside is best such as walking a pet, walking to the park or playground
  • Nourishing foods as much as possible, and mood boosting supplements like B and D vitamins, magnesium, 5HTP, vitamin C, probiotics, omega 3s

Long term supports to help keep burnouts from happening:

  • Therapeutic support: occupational therapy and psychotherapy can help over the long run
  • Healing foods, supplements + medications 
  • Prioritizing intermittent breaks, rest, and self care 
  • Setting up accommodations in school through an IEP or 504 
  • Setting up regular outlets for movement, focusing on muscle work such as climbing, riding a bike, hiking, and jumping on a trampoline

Autistic burnout is real. If your child is acutely experiencing this, please try the suggestions for acute management. If your child is not experiencing burnout, start applying some of the long term suggestions and get ahead of it. Most importantly, know the signs of burnout so that you can more quickly identify it and start applying some of these suggestions. 

 

 

Helping Sensory Children In Colder Weather

We have all felt the desire to hunker down, rest, and cozy up as the colder weather arrives. And this is a necessary moment for us; to gather ourselves near the proverbial hearth, to eat the foods that we have harvested in the warmer months, and allow for rest and re-set. 

Many children with sensory processing differences struggle with time and seasonal changes; the temperature changes, as well as the diminished sunlight and outdoor time. Especially those that need more movement who are in school environments who restrict outdoor time in colder months. Here are some ideas to make the most of the shorter and colder days with your sensory children. 

  • Get in your daily dose of movement. We know that children benefit from movement; especially sensory children. Find ways to stay active in the winter when the days are shorter (as they are in the northern hemisphere). Make sure that your kids have gear to play in lots of kinds of weather; cold, wet, snowy. Walk to school (even part way), get to the playground, walk a pet, or play on the trampoline. Being outdoors is one of the best and most effective types of experiences, and it’s free. 
  • Family outdoor time. Maybe it’s a hike, a brisk walk, or even walking the neighborhoods to see the holiday lights after dinner. Doing a nature scavenger hunt can also be fun–looking for pinecones and acorns.
  • Have some indoor movement alternatives. You don’t need to have a full on sensory gym in your home; you can use what you have around the house to construct mini obstacle courses: pillow cushions, broom sticks to jump over, step stools for height variation, and/or using rolled up socks or beaning babies to toss items into a bucket or laundry basket are a few ideas for ways that you can use what you have. (See below for an some at-home obstacle course tips)
  • Build cozy forts for nesting. You can use pop up tents, blankets, pillows, Flashlights may be fun for reading while in a fort. 
  • Nutrition and vitamins for health. This is a great time of year to up vitamin C intake for the natural “sunshine”: think oranges, citrus fruits, elderberry. If you have a very picky eater, you may try gummy supplements of vitamin C or elderberry.
  • Epsom salt baths (for ages 4 years +). These warming baths can combat the colder weather and also help to soothe the nervous system with the magnesium. They are especially helpful after a cranky day.
  • Making homemade holiday cards. Go ahead and get messy! Work with a variety of mediums such as paints, crayons, cotton balls, glue and stickers. Incorporating sensory play into fine motor activities (such as crafting) is very stimulating for the brain. 
  • Using tight fitting long underwear under clothing may help with the seasonal clothing changes. Many children have issues with the tactile nature of clothing when moving from wearing short sleeves to long sleeves or shorts to pants, or even tolerating wearing coats, hats or gloves. 
  • Massages after bath with lotion or oil. Use the warmth of your hands to help massage lotion or oil into your child’s skin after bath time. This firm pressure touch is deeply healing and soothing for the nervous system. If your child is sensitive to your touch, you can have them rub it into their skin by themselves. This may also improve the toleration for various foods if your child is a picky eater.
  • Create a natural aromatic experience on the stovetop. You can warm apple cider or a milk product with cinnamon, orange peel, and star anise. Then you can add honey to sweeten (for milk based brew), sip on it and enjoy it. If your child is sensitive to smells, try using natural scents such as citrus and peppermint (essential oils should be handled by adults only, or used in a diffuser).

And, here are some tips for creating obstacle courses at home:

  • Find objects at home, such as cushions, pop up tunnels, step stools, broom sticks, empty laundry baskets, beanie babies, balloons, squishy toys, etc. 
  • Allow your child to engage in the planning. This can be written or drawn, if you’d like to add some fine motor elements. If they have trouble planning (this may be indicative of issues with ideation–the ability to plan out an unfamiliar task), offer some ideas, and help them. The skill of ideation really improves with repeated practice of doing unfamiliar, or novel, tasks. 
  • Novelty is key! If they have completed a course successfully a few times, ask if there is any way that they can change the set up to mix up the challenge. This is supportive for brain executive functions. 
  • Bring in balance components such as walking on stools, and walking on a rolled up blanket–the long, thin way.  
  • Bring in visual-motor components: have them place squishy toys, beanie babies or even rolled up socks around the course to pick up and throw into a laundry basket or bucket. This is highly impactful for the nervous system. 

I hope that some of these tips are helpful for you to navigate the shorter days and colder weather. Sensory-rich play is so effective in helping children’s development. Make sure to put down your devices, and play with your kids this season! Adults need more play….

 

Sensory Seekers + Avoiders

Most people who know about sensory processing are familiar with the terms sensory seekers and sensory avoiders. These labels can be helpful to define seeking and avoiding behaviors, as can knowing that they are not mutually exclusive; one can be a seeker and an avoider, even within the same sensory system. 

Before we break all of this down, let’s also discuss the 8 sensory systems that we are measuring, as OTs (and an additional “sense” that I look at):

  • Touch/Tactile: anything that touches the skin such as playing with messy materials, clothing preference, touch from others, textured foods
  • Vision: involves processing the visual environment, clutter, being attracted to bold colors vs. neutrals, lighting, navigating “busy” visual environments
  • Hearing/Auditory: includes navigating environmental situations with background noise, listening to music (preference for volume), being able to filter pertinent sounds/communication
  • Movement + Balance/Vestibular: includes being able to navigate heights, experiences with feet off of the ground (swings, etc), challenges with sitting still
  • Position/Proprioception: includes awareness of the body, intense experiences that stimulate the joints and muscles such as climbing, running, jumping, pulling, pushing
  • Taste/Gustatory: linked with smell/olfactory, includes textures, temperatures (both also linked with touch/tactile system), spicy, bland, sweet, sour flavors
  • Smell/Olfactory: linked to taste/gustatory, aversion to strong odors, can smell things others can’t, seeks smelling objects and/or food
  • Internal State/Interoception: includes a link to the homeostatic functions of the body organs such as thirst, hunger, heart rate, toileting needs, temperature, breath capacity, and also emotional state
  • Intuition*: involves being in tune with subtle aspects of self and environment, in tune with motives and emotions of others, being in tune with internal world (interoception) to decipher internal “signals” such as the gut instinct, being able to read others’ emotions/feelings 

It’s also important to note that many of these senses work together. For example, as many of us who have had COVID have learned, smell and taste are absolutely connected. The movement/vestibular, auditory, and visual systems are also closely connected. The position/proprioception and vestibular senses are also connected. There are many other connections; these are just a few examples. It’s also important to note that the internal state/interocpetion and intuition are challenging to label into seeking and avoiding categories, but are important to be aware of as they play important roles in our lived experiences. 

A sensory “seeker” is someone who seeks out different sensations, while a sensory “avoider” is someone who avoids different sensations. Here are some examples of sensory seeking and avoiding behaviors:

  • Loves textures, loves getting messy, playing with things like slime, putty, finger paints, and even playing with foods—->avoids textures, avoids getting hands messy, resists bathing/grooming, strong preference to soft clothing, loose waistbands
  • Wiggles, fidgets, can’t sit still, loves movement—–>fear of heights/swings, limited play on the playground, prefers running to climbing, tentative, watches others first
  • Likes busy, bright environments, OK with noise, likes to be loud—->prefers quiet environments, small groups, wears headphones to block noises, covers ears with loud sounds.  
  • Likes exploring with spices, adventurous eater, places non food objects into mouth, PICA       ——> Picky eater, likes a certain color, texture, or temperature of food, limited food choices, brand preferences (may be related to preservatives), ARFID.

To address the fact that a person can be a seeker AND an avoider, even within the same system, let’s consider an example. A person who is sensitive to loud, unexpected sounds (the auditory system) may also be noisy on purpose. This is a way for them to desensitize themselves to loud noise, while getting the benefit of the proprioceptive system (stimulation of the muscles around the lungs and intercostals to produce loud sounds, which also stimulates the Vagus nerve that elicits a relaxation response). It’s sort of like removing a bandage: it’s much easier to remove it yourself than to have someone remove it for you. 

There can also be conditional issues that influence seeking and avoiding. If someone is stressed out, has had little sleep, has had insufficient food/nutrition, or is in a challenging situation, they may not be as able to tolerate things that they typically tolerate. Just as this is true for us, it is true for our children. 

Another nuanced detail to this is that the founder of Sensory Integration therapy, Dr. A. Jean Ayres, noted that children tend to seek out the input that they need. I’ll add that they may not always seek it out appropriately (such as biting toys/clothes, or hitting others for the proprioceptive input to calm the nervous system). We also do see children seek out things to an extent that it ends up dysregulating them, and also those who avoid experiences that could actually benefit their nervous system. These are all factors that skilled OTs take into consideration when working with children. 

Furthermore, this is why, as occupational therapists, we use detailed questionnaires, and look at behavior over a period of time, versus one time. We rely on the report or presentation of the child, as well as gathering information from teachers and caregivers to get a fuller picture of how to support children with sensory processing issues across a variety of environments. Based on these sensory “profiles” and how a child is presenting at any given moment, we can adjust our OT sessions depending on where the child is at in that moment, and knowing what might support them best. 

This is one reason why planned interventions can be less effective than responding to the child’s needs in any given moment. Many parents of children with sensory processing issues understand that more “traditional” approaches, including discipline, simply don’t work as effectively with children with sensory processing issues. This is because we are basing our qualifications of “good behavior” on neurotypical individuals. 

If you have a child who is a sensory seeker, it is important to give your child opportunities to safely get what they need. If you have a child who is a sensory avoider, it is important to try and introduce these experiences in a safe and non threatening way, and consider baby steps to be a big deal. If your child’s responses to sensory experiences are getting in the way of their home, school, or social life, it is recommended to seek help form an OT skilled in sensory integration, preferably Ayres’ Sensory Integration (ASI). 

*I have added intuition as a sense; its not traditionally recognized as such 

Are “Sensory” and Neurodiverse Children Empathic?

This is currently a question that people are getting more and more curious about. What if sensory sensitivities are also linked to empathic abilities? Let’s first define the word empath. Oxford Languages defines it as “a person with the ability to perceive the mental or emotional state of another individual.” As a highly sensitive (including sensory sensitive) person, I have experienced this first hand. But it is important to note that, for most of my life, I thought that was I was feeling was entirely my own. This could range from physical symptoms, to moods that suddenly appeared. 

After becoming a mother, my empathic and intuitive abilities became very strong (I believe that this is more common than most would know), after having “turned them off” for over a decade to complete studies, and begin my career. When this occurred, I had been working with children for about 8 years as a therapist. I suddenly became curious about the sensory sensitive children I was working with. Could they too, be empathic like I am?

It is not secret that part of the presentation of neurodiversity–especially ADHD–comes with a lot of emotional dysregulation. These children (and adults) are deep feeling individuals. I have witnessed many children with sensory sensitivities have powerful emotional outbursts, sometimes referred to as “meltdowns”, that can be high in frequency, duration, or both. Sometimes these sensitive children even seem to become the “emoters” of–and for–the family: when the adults or older siblings are avoiding or otherwise unable to process their own emotions, for any number of reasons.

I often think of people with sensory sensitivities and  neurodiversity (especially ADHD) as having huge antennae, that connect them to others, events, and more. I have seen these children seem to intuit/name/feel deeply what a peer is thinking, what they are feeling. I have witnessed children becoming overly concerned with how peers are feeling, especially if they are having a hard time–both in classrooms and in the therapy gym. This can, of course, extend to the home environment, with this playing out with family members as well. In my experience as a neurodiverse person, having biological neurodiverse children, and working with neurodiversity since 1997 is that many of these sensitive children seem to have heightened empathic ability. . 

So, how can we help support our sensitive children who are empathic?

  1. Provide plenty of opportunities to release stored emotion. This can include physical outlets, (such as sports and free play–especially play that engage a lot of muscle work), talking about feelings, journaling or creating art to release the emotions. 
  2. Ask: “Does this feeling belong to you, or someone else?” Your child might surprise you with an answer. If they don’t know, it’s OK. You can invite them to “Let any feeling that does not belong to you, leave your body.” (As an adult, I use “Return to sender with consciousness.”)
  3. Create cozy corners, and safe spaces at home. I recommend creating a safe space in the main part of the house, as sometimes children want to be close to family when they are having a hard time. A safe space is NOT a time out. It’s a place to go to have some space to process intense feelings. 
  4. Time in nature. Getting outdoor play, going to the parks, hiking, etc. Nature is a great way for our children to ground their energy, release stored emotions, and be soothed. The natural elements are extremely healing, and supportive to our nervous system. 
  5. Clean water, clean food, sleep. This can be tricky for sensitive children. If your child has food avoidance or ARFID, you can try supplements to enhance their nutritional content. If they have sleep issues, limit screens, get a lot of physical input in the day, and consult with your therapist to help you create strategies and learn techniques for improved sleep and help with picky eating. 

Things are intense for our deep feelers, our sensitive and neurodiverse children, our empaths. The sooner that you can identify and support your children, the better. Sometimes, when a parent/caregiver opens up about the possibility of their child being empathic, the children will just begin to share their experiences, unprompted. I have experienced this multiple times. Get curious, and see what happens. 

 

The Power of Reframing Experiences for Your Child

As a parent, I completely understand (and have experienced, multiple times) just how challenging it is to witness your child struggling. Whether it is academically or socially, parenting a child going through hardship can trigger our own wounds, and, even with the best intentions, can send us into a reflexive response (fight, flight, freeze, or fawn) even in finding a “solution”. 

We may want to go immediately into fix it mode. We may feel angry and want to address it with another parent or educator involved. We may want to bury our head and let our partner deal with it, possibly because it’s triggering our own wounds that have not fully healed. 

Having my own children experience life (especially the painful parts) certainly brought up my old wounds as I witnessed them experiencing similar things that I did, that were really difficult. I think, even in the very early realization of what’s going on with our kids, it’s good to look at ourselves and our own responses as well as our children’s. While listening and supporting our children, it is very important to take the opportunity to get support to feel through our own pain and get any necessary support. 

There is a lot of chaos in the world right now. When things in the external feel chaotic, is tends to trigger our own unhealed wounds. We may be more reactive, sensitive, or self-punishing. Our sensitive kids are certainly feeling this; even when we keep news to a minimum, and do our best to shield them of the harshness of reality. It’s just sort of, “in the background”. 

It is so helpful to first listen to our children. You will likely hear a self sabotaging, or negative voice emerge about it. If this happens, it is a great opportunity for a reframe. But first, it’s important to listen and reflect back to them what they are saying (in a neutral voice). Validate their feelings, and then offer a different lens to view the situation through. This reframing can help stop the negative self talk, and unnecessary thought loops that can arise from challenging situations. It can be incredibly empowering for your child. 

Here are some step by step things to try when your child is experiencing a challenging situation:

  1. Notice your reaction to their experience. Are you going into fight, flight, freeze or fawn? Slow down. Have them repeat some details. Breathe. Breathe again. Take these moments to ground your own energy and calm your system.
  2. Change the scenery. Ideally, go for a walk, or get outside into the garden. Move to another room. This simple action is incredibly effective for getting a new perspective. These actions help shift the visual system and also the body (if moving or going for a walk) which can immediately have a positive neurological impact.
  3. Listen–without offering a fix. Embody the role of a reporter; repeat back the details. 
  4. Validate any associated emotions. This is simple, but often skipped. 
  5. Encourage a growth mindset. Instead of “I can’t”, encourage “I’ll try”. 
  6. Get curious by asking if there is anything that your child could have done differently. It is OK if they cannot think of anything. 
  7. Offer your own perspectives and stories to help provide examples. Children usually love to hear these stories; of how we also struggled, and shifted perspectives. This is a great tool also if your child is stuck. It will often help them to understand and be able to shift their own perspective.
  8. Role paying can be helpful to fully map out how to handle challenging situations. This is especially effective for children who have any motor planning/praxis challenges. Literally, get up, move around, and play a part. Real time practice can really help–it’s like theatrical blocking (when actors memorize lines when moving around the stage or set) and helps lock in the memory.

In summary, tend to any wounds that you experience when your child is going through something challenging. It’s an opportunity for us to reframe our own painful experiences. Pause, and notice any inclinations to go into “fix it” mode. Breathe. Listen and validate your child. Meet the situation with curiosity. Offer your own stories and how you handled it. Reframing can develop the ability to take on various perspectives, and also the ability to move into more of a growth mindset. 

The Paradox of Routines: Why They Are Important, and Why They Are Important to Break (From Time to Time)

I think that many people collectively agree that routines are important. They help us stay organized, and for many children (especially neurodiverse children, anxious children, and children who struggle with executive functions), they can help us to stay regulated. Experts suggest that creating routines into habits takes about a month, and to establish a healthy habit, it is recommended that it is practiced consistently for 30 days. 

Routines can help children feel safe, and manage anxiety, as they can better predict the flow of daily-weekly-monthly happenings. If your child is struggling with anxiety, a visual schedule is highly encouraged with younger children to establish the predictability. This can be done with pictures, simple drawing, or words. Some children do better knowing in advance, so a weekly family visual planner is recommended. For others, it is enough to know what is happening on the day, in which case a daily visual chart will be helpful. Going over the routine verbally for the day during breakfast, or while driving to school can also be helpful to reinforce the awareness. 

Tech wise, this can be super simple and low tech (such as written or drawn visual lists that are in plain view), sticky notes, and lists that you can cross off. For kids that struggle with the change of routines (summer to school), or are having an acutely stressful time, visual planners for regular routines (nighttime routine or morning routing) with checklists are very helpful. As children get older, a handwritten planner is ideal (as handwritten notes stimulate different areas of the brain, and physically checking of items on a to-do list gives us a dopamine boost), and also familiarization with planning apps on tablets or laptops such as Monday, Click Up, and Smartsheet (which all have good reviews). 

So, now that we’ve discussed some of the simple reasons on why routines help children, let’s consider why it is also important to break routines for optimal health.

  1. Improves neuroplasticity. Shifts in routine, especially with travel, can significantly enhance neuroplasticity, which is the brain’s capacity to make new connections. Visiting a place where different languages are spoken, exposure to different cultures, different foods, opens up the awareness of different cultures. 
  2. Introduces novelty. Novelty helps our brain break rigid patterns. When we get too stuck on rigid routines, it can negatively impact us. Novelty keeps us alert, on our toes, and can broaden our perspective. 
  3. Challenges the brain. The brain does like routine, but too much routine is very limiting for us. The brain is challenged with new routines, and forces us to adapt, break from familiarity, and when we do this, we grow new synaptic responses and connections. 
  4. Improves cognitive flexibility. When we are exposed to new situations and things, we can adapt to challenges that come up within our normal routines with greater ease. We learn to get curious about different perspectives, and we are more able to identify or move out of being “stuck in a loop”. We can be more creative with problem solving in real time. 
  5. Boosts mood and creativity. Exposure to novelty is very stimulating for our own creativity. Seeing and experiencing new things is eye opening and can lead to greater creative pursuits. It can inspire us to modify the way we view things, or how we do things. 

For many children, change in routine can feel scary. Some children are very rigid about types of foods that they tolerate, change in restaurants, or any other change in routine; especially if they are sensory sensitive, have trauma, or have anxiety. The best way to support children who struggle with this is to discuss things with them, show them pictures, and offer some ideas on the need for support or to take a break when experiencing the novelty. Build a lot of physical breaks into vacations, or trips, and scale back the overscheduling or overbooking of events, offering opportunities for down time a the pool, in the hotel or rental home, and getting outdoor time. Try to have a plan B for your sensitive child. If you are eating at a new restaurant, it’s OK if you need to bring an emergency snack or food; the combination of the new environment AND new, unfamiliar food may be too much. Baby steps are helpful for these kids. 

So, there are clearly benefits to having routines, and to breaking them. And even though this article is discussing children, we must also remember that it is equally as good for us adults. Mix it up now and again! A change in routine can help to change your outlook on life, to boost your mood, and even to grow new neuronal connections for you, as well as for your child. 

 

The Importance of Emotional Outlets for Children

 

As a parent, it can be really challenging to watch your child experience distress. We tend to rush to help, to fix it really quickly, and sometimes negate the child’s feelings– intentionally or unintentionally. Watching another in distress, especially when you have a low threshold for discomfort, are empathic (feel others’ feelings) or are feeling taxed or overwhelmed yourself, is painful. 

But these feelings that your child is having need to be felt. Allowing some space around the emotions, though uncomfortable, can be transformative. If we are always in “fix it mode” with our kids, we may be missing an opportunity to let the feeling be to be fully processed. And unprocessed emotions will always come back to haunt us; whether they wear us down emotionally mentally, or cause physical symptoms to appear (stomach ache, headache, tension in muscles, fascia restriction). 

Even in the occupational therapy world, we can place emphasis on being in the “green zone”, or staying regulated, when that is simply not sustainable all the time– for anyone. Another implication is that being in the green zone is better than being in the red zone (dysregulation). While it feels more comfortable to be in the green zone, sometimes processing our emotions brings us into the red zone. I say all of this while knowing that spending *more* time in the green zone IS positive for our health and our emotional regulation. This is simply an invitation to realize that all feelings (and Zones of Regulation) are valid, and modeling this for our children is so important. 

So, how can you integrate this into your family in a way that normalizes all feelings?

  1. First of all, make sure that you are regulated, or, calm. When your child is having a dysregulated moment, focus on yourself first so that you can help them most effectively without getting entangled in their emotions. 
  2. Listen to your child talk about their feelings, without offering solutions. Simply reflect back to them, like a reporter, what they have said to you–summarizing their experience. Pause, breathe. 
  3. Ask them if what would make their body feel good in the moment. If they are unable to answer (since they are likely distressed), offer suggestions. It may be a good idea to create a list of suggestions and have it in a visible place–but make sure to do this in a time of calm to prepare for the heavier moments. Muscle work is regulating, as well as a salt bath, washing face or hands, listening to music, going to a calm space, etc. 
  4. Change the scenery. It could be as simple as moving to another room or stepping outside. 
  5. Ask about the “roses and thorns” of each day during a shared meal time. This normalizes the challenging as well as the joyful experiences. 
  6. Instead of rushing to fix it for them, you can ask your child what they think a solution should be (if a solution is appropriate–remember, there may not be anything to fix other than validating the feelings). This can enhance problem solving, and shows that you trust in them. 
  7. Have your child create art, or write about their feelings. If feelings are too intense to address in the moment face to face, consider this as an alternative or a supplement to the processing. Sometimes older children can have a family journal to vent about feelings to parents so that a productive back and forth can occur. 

Taking the time to do this for your child will help them begin to truly self-regulate their emotions. And just remember that this is a process, and it may take time. Begin to practice as a family now; it is a lifelong skill that will serve them as they grow.