Hands On Activities for Children with Autism & Sensory Disorders

This chapter describes in detail a systematic approach for working (and playing) with children with sensory processing disorder, including SMD. This includes most children with autism and some with ADHD. This chapter is based on the work of leading sensory researchers who named 10 core elements for providing effective sensory interventions for children (Parnham, 2007).

Practices have evolved in the ensuing years since the researchers identified these core elements, but these guiding principles remain a good foundation for practice. This chapter includes “best practices” for a clinic setting that can be used, as well, in school settings and at home. Guidance for parent and classroom involvement has been woven into these recommendations to assist parents and teachers who are working on their own with children.

1. Create opportunities for the child to gain sensory (or executive function or social or emotional) experiences.

These elements form a set of guidelines for those who wish to incorporate sensory practices into their work with children. This next section explains each of the elements and gives advice on how to make use of them in practice.

The goal is to provide children various experiences in the areas of sensory processing, executive function, social growth and emotional awareness. Let’s begin with sensory activities. The following two statements are true: 1) sensory interventions do not need to be done as a stand-alone activity, and 2) any activity can become a sensory activity. Now replace the word sensory with the other types of activities: executive function, social growth and emotional awareness, and read the two statements again. They remain true. If you can find ways to add sensory (or executive function, social growth and emotional awareness) into the day’s planned activities, you can add value (i.e., achieve sensory goals) with just a little extra work.

Most of the activities in this book are focused on sensory and sensory-motor, and they are typically performed with children with sensory needs. So let’s dig down deeper and discuss ways we can create opportunities for sensory interventions.

Although parents and educators can perform a sensory-only activity such as having a child smell a vial of scent or listen to calming music, the mixing of sensory into normal day-to-day activities saves time and supports overall growth and development. In therapy, combining sensory with another intervention makes for a richer, potentially more powerful intervention. The challenge is to create a sensory mindset. You can incorporate sensory with other activities in the following ways:

• Approach each task with the question: what can I add to this activity to make it more pleasant or more challenging?

• Play your strong suit. Find the easiest way for you to work with the child: arts and crafts, motor activities, games, stories, puppets, academic work, play activities, cooking, housework or something else. Start with one activity and add a single extra sensory component. For example, use scented crayons with a coloring-book activity. Add punching pillows (proprioceptive input) to the task of making the bed. Add singing songs to performing chores or to playing with puppets. Take shoes off for a little while when taking a walk.

When we combine sensory input with the other things we are doing, integration of the senses with the brain and body takes place.

Have these on hand:

1. Natural scents to sniff or to add to activity materials (3-4 of these):

a. Jars of orange peel, lemon peel, dried mint, fennel seed or anise seed (licorice);

b. A bottle of real vanilla;

c. Diluted essential oils: a few drops of real fruit or flower scents in a small jar of water (check for allergens before using flowers).

2. Music player, calming music, speakers and headphones.

3. Visual:

a. Coloring materials (design coloring books for older children);

b. A kaleidoscope;

c. Colorful magazines.

4. Fidgets (get a few of these):

a. Two feet (2/3 m.) of Thera-Tube or Thera-Band (OT or PT will have these);

b. A personal container of Thera-Putty for each child;

c. Velcro with adhesive backing to put on bottom edge of a table (for rubbing finger tips on);

d. 2 sandbags covered with colorful material– to fit into the hand;

e. Soft materials, toys for feeling and squeezing.

5. Regulating items (1 or more of these):

a. Weighted balls: 1-2 pounds (.5-1 kilo) for 2-year-olds. 5 pounds (2 kilos) for 8-year-olds, 8-12 pounds (4-5 kilos) for older children;

b. A body sock or stretchy fabric tubing for deep pressure play (find these online);

c. A rocking chair;

d. Sugarless gum, mints, sour candies.

6. Vibration:

a. Pillow or stuffed animal;

b. Electric toothbrush (at home).

Collaboration with an older child on plans and activities for a session, as well as child-directed play with a younger child, is a win-win for all. The child feels respected and gets a sense of control and ownership in the interventions. For the therapist, teacher or parent, the interactive sessions can be fun as well as effective.

Child-directed play is not a free-for-all with the child now running amok. Instead, the therapist suggests activities and observes the child as she plays, looking for opportunities to incorporate lessons and introduce challenges. The therapist ensures that the child is keeping pace with the work and that the child is engaged by adjusting the level of stimulation (through lighting and sound). The therapist also grades the emotional intensity and other factors by introducing calming or alerting activities.

Every therapist, teacher or parent brings their own personality and style to collaboration. One person might collaborate using a matter-of-fact negotiation technique. Another might be quite playful, but have a solid plan in mind. Let’s look at two scenarios.

Scenario 1: Roger is a matter-of-fact sort of therapist. Prior to seeing a child, he creates a plan with goals. On the day of the session, he puts together engaging activities, sets out interesting materials and asks the child to do the work. On a good day, the child comes in, looks to see what Roger has in store for him and does his work. Another day, the child may enter and complain about the activity. Roger listens, collaborates, negotiates and works with the child. If they can compromise, the child happily completes the work. However, the child may have his own agenda that day. In that case, Roger can elect to take it easy, gently incorporating elements that will accomplish his (Roger’s) goals. If the child is resistant on a regular basis, Roger can use behavioral methods to rein him in.

Scenario 2: Fiona is seeing a small child with autism, and she uses a picture schedule to help him track activities. Although she knows what she wants to do before he arrives, she waits for him before setting up the schedule. After he arrives she enlists his help in selecting the activities by showing him three cards and asking, “Which of these should we do?” Next, she gets his input in choosing the order in which they’ll be done by asking, “This first, or this first?” In giving the child control over small decisions, Fiona gets better compliance.

Perhaps the best known of the ten core elements is “Give the child the just-right challenge.” How can we tell how much input a child needs? This can be tricky. While we want to provide a child with challenge, we need to keep challenges appropriate to her intellect, sensory systems, attention skills, emotional system and physical body. The best way to do so is to tune in to the child as you work with her. Sense her calm-alert state, her frustration level, her attention-to-task and her capacity for enjoyment. Later, get feedback from the child, as well as from caregivers and teachers on how well she was able to handle the remainder of the day.

• In terms of sensory stimulation, the child’s environment should have just the right amount of sensory stimulus. The sensory-sensitive child and the child with autism might show subtle reactions to loud noises, bright lights and to being touched. You need to address these environmental factors. The undersensitive child may need stronger sensory input such as lively music or physical exercise to wake up sleepy circuits in the brain. The child who craves input such as touch or enjoys visual “stimming” may need a specific amount of that input from time to time to satisfy the craving and allow self-regulation. Giving that child a two-minute break to receive the sensory input he craves will help him to attend.

• The child with ADHD may have a limited supply of brain glucose, the substance that provides energy to brain self-regulation circuits (in the prefrontal cortex). He may be able to perform, for example, the attention-to-task activities that you give him, but doing so depletes his store of brain glucose. That will limit his ability to self-regulate once he leaves you, and he might act out with impulsivity or other behaviors immediately afterwards. The just-right challenge will consider his capacity to switch gears and stay regulated after your session. It might include hard work with a rest period and protein snack (such as a glucose shake) immediately afterward. (Glucose shakes are available over the counter at pharmacies. Check with parents and the child’s doctor beforehand.)

Many interventions with children with autism, ADHD and sensory disorders include an education component. Children getting sensory interventions learn (in a hands-on method) about the level of sensory input their brain needs and can tolerate. A child with ADHD will learn tricks to pay better attention and to monitor his own level of impulsivity and hyperactivity. The child with autism also learns these things, plus how to express and read emotions, how to communicate with others, and how to use simple organization techniques such as a visual schedule. When we teach children through role-play or other forms of live simulation, we have the opportunity to include some self-reflection. Using a cognitive approach, we can interject open questions such as, “How did that feel?” and “What would you do in this situation?” and “How do you know when you’ve reached your limit?” We can also ask leading questions throughout the intervention that will help him to understand the process, for instance, “What should we do next?” “Is this a good idea or a bad idea?” “What will happen if we . . .?”

In the same way, we can interject questions such as, “Which goes first?” or “What do we do next?” Other questions can walk the child through decision-making, organization and planning out an activity.

Not all worthwhile activities call for a calm-alert state, yet it is the best state for learning and participating. There are a number of ways to calm a child and to increase her level of alertness.

Physical activities help provide a calm-alert state. They include heavy work, chores, exercises, aerobics, sports, swimming and so on. On-the-spot calming from excitement can be achieved with a 4-minute workout (see chapter 10). Gentle movement, rocking, and swaying are calming. Fast movement and dancing are alerting. Some children become overactive with movement and need a calming exercise afterwards. Playing toss with a heavy ball can calm an excited child within a minute or two.

Sensory activities include adjustment of lighting and sound – up for alerting, down for calming. Cold, tangy, minty or spicy foods and drinks are alerting. Warm foods and drinks, as well as mushy foods, are calming. Root vegetables (potatoes, beets, yams, carrots) and mushrooms are thought to be calming. Turkey is known for its sopophoric effect. Bright, fast music is alerting; soft slow music is calming. The sound and activity of a group will be alerting and may decrease a child’s ability to be calm. Working solo may decrease alertness but is calmer.

We can adjust a child’s calm and alert states by the activities we choose. Calming activities are generally slower and rhythmic and may involve slow breathing or singing. Alerting activities can include physical movement, singing or reciting. We can grade the activity level (the intensity of the activity) to match the needs of the child. Citrus or vanilla scent in small quantities can also help provide a calm-alert state (see chapter 7: scent immersion).

When working with a new child with autism, ADHD or sensory disorders, it’s important to build the start of a relationship by doing fun or interesting activities for a few minutes. Have the child do a few minutes of movement prior to asking him to sit and work. Movement helps get wiggles out of the body and increases focus for work.

Movement gives you a chance to tune-in to his energy level, personality and various cues or signals concerning his state of mind and emotions. Look also for other signals, such as eyes that squint at bright light (demonstrating light sensitivity), a body that becomes stiff in a noisy environment, darting eyes showing inattention, silly behaviors that reveal underlying emotions, and so on.

Prior to a difficult activity such as feeding therapy, socialization or sensory desensitization, have the child do 15 to 20 minutes of strenuous play or work. This helps ground the child and makes him less resistant to the task. Activities that make use of the upper body and that get the child breathing hard help to relax the shoulder and neck muscles that easily become tense with anxiety. Such activities include climbing, hanging from a trapeze or monkey bars, or doing wall push-ups, floor push-ups or chair push-ups.

A child ready to have a meltdown will reveal cues through body language. You might see rounded shoulders, a sad demeanor and eyes that look at the floor. Or you might see an arched back and arms and legs spread open and ready to flail.
A therapist, teacher or parent who disregards subtle (or not-so-subtle) signs of discontent in a child with autism, ADHD or sensory disorders may have to deal with a volatile situation. The child’s mood has not been acknowledged, and now he might act-out in frustration to gain attention. A simple statement such as, “You look upset,” can help to avoid undesirable behaviors. If the child is verbal, a small discussion is appropriate if he is willing to talk. Otherwise, setting him up in a quiet environment with quiet activities can help him transition to a better mood.

A child who is having a meltdown benefits from being in a low-lit, quiet room. Soft, soothing speech from you, along with slow movement in a rocking chair, swing or swaying in your arms, can be helpful. Some children accept hugs, others do not. Take things slowly if you do not know the child well. It takes a bit of time to recover from a strong mood or an emotional outburst, and modification of the child’s activities and our expectations of her may be needed.
In other cases, a few minutes of quiet activity is enough for the child to calm. If we gradually increase the pace of activity, along with the beat of background music and the brightness of the room, the child can be transitioned to normal activities.

Look for ways to turn mundane tasks into creative learning experiences that engage the child. There are many ways of accomplishing tasks. For example, a child can be taught multiplication tables by writing them out on paper four times each, or she could recite them while clapping and stamping her feet in rhythm to a beat, or she could sing them very softly to a gentle tune. The goal has been met each time, but the means are completely different – and some of the means are fun. Which do we choose? If they appear to be equally effective, why not choose the fun option.

It goes without saying that we need to modify or grade activities that are too challenging for a child. Think about the child’s physical, sensory, mental, self-regulatory, emotional and social limitations. If we ask a child with ADHD to sit quietly for a long period and perform work she does not want to do, we risk her chances for success. Likewise, asking a boy with high functioning autism to participate in a noisy group activity with interactive discussion might cause him to be anxious and to act out. We can make both these scenarios work if we grade the level of challenge. In the first case, modifying the length of the task or using a more interesting activity (or both) will increase her ability to succeed. In the second, we can modify the goal such that he is expected to tolerate a group function for all or part of its duration, but he is not (yet) expected to participate in the discussion.

We can increase the child’s chances for success in other ways as well by following the advice of Dr. Lucy Miller, head of the STAR Center in Denver. Families travel to the center for a month-long intensive therapy treatment for their child with sensory processing disorder (with or without autism). The child receives several therapy sessions each day during the month. This intensive schedule increases the child’s skills dramatically in a short amount of time. Parents are included in the sessions. This allows parents to “share in the success,” as well as to learn new ways to be with their child and to help him maintain his new-found skills when they return home.

Based on this model, consider including others (teachers, parents, aides and other therapists) in your treatments, so that the child receives successful therapy that can be carried over to other environments by those who participated in it.

Safety is always an important concern, and adults are generally aware of safety hazards such as small or sharp items, trip hazards, and safety issues associated with play equipment. Additional concerns are involved in working with children with autism, ADHD and sensory processing disorders. A few of the common safety risks are listed below.

• Children who crave sensory input might take unwarranted risks by chewing on unsafe items, jumping from high places, listening to loud music over headphones, touching things and people at random, and so on.

• A child who is undersensitive to temperature or pain might scald himself while running water or a bath, or hurt himself without realizing it.

• Children who are undersensitive to their body movement (vestibular and proprioceptive senses), as well as children with ADHD, are at higher risk than others for injury and accidents during play. Such a child might also underestimate his strength as he plays with another child.

• A child who is oversensitive to touch or sound or is poorly regulated overall might lash out at others and cause them harm.

It is also important, of course, to keep the child emotionally safe. When you know your client or student well, you understand what types of things might trigger a strong emotional reaction. Common triggers include loud sounds, touching, removal of a favorite object, separation anxiety from parents, frustration in not being able to perform a task, lack of control, and so on.

Setting up the work and play space is key to a good intervention. The space needs to be simple enough that the child is not overwhelmed by the choices of play. Yet it needs to suggest that play opportunities are available. In one version of an ideal setting, two games might be sitting on a table, a swing is available, a drum is sitting in a corner and, in a clinic, a trampoline is set up. These props guide children in activity, giving them choices of equally suited activities or suggesting rewards for non-preferred work.

You can modify the sensory elements of the environment using the standard elements of light (soft for quiet, bright for alert), music (soft or loud, fast or slow), and even put natural scent in the room to increase a sense of comfort. These elements support the child’s sensory systems and, in turn, his emotional state and may prevent a downward or upward spiral.

Create a rapport with the child that will motivate her to accept challenges and to work hard during interventions. Every therapist, educator or parent has their own style for being and working with children. Some are playful, some are more directive. It’s best to try to include aspects of both playfulness and no-nonsense structure in your interactions with children. A pleasant demeanor and a playful attitude can go a long way toward getting the child to bond with you. Establishing rules and setting boundaries help to ensure that activities do not get out of control and create friction. Shared activities like games, role playing, puppets, and races can be shared fun that help the child to engage and bond. Finally, remember that you are asking the child to work hard, so make sure that you reward her for her efforts with preferred or fun activities.