Saturday, March 14, 2009

sensory diets 101

First of all, I am NOT an occupational therapist. You should consult one, and probably a speech- language pathologist, before you start a sensory diet. This information is drawn from my experience, and your child's needs may differ from Punkin's. Much of this was learned along the way; doing it a second time would be much easier. Also, Punkin's teacher is a rock star and did a lot of work to get this going. (THANKS!!!)

A sensory diet has little to do with food. Basically, it is a schedule of sensory breaks given throughout the day to regulate a person's state of arousal. This is something that most of us can do naturally -- we drink coffee, tap our fingers on the table, take a walk around the office, ect -- but people with FXS can't. And their needs are generally intensified compared to ours. I think of it as an inability to filter out unimportant stimuli from important stimuli, making the world feel like one giant attack on the five senses.

Some of these breaks may be activating while some are calming, depending on your child's needs. Punkin's are all focused on calming EXCEPT when food enters in. More on that later.

First, PRAY. Because, well, the hardest part is getting everyone to cooperate and agree -- not to mention actually DO it. I am of the belief that only an act of God can make this possible.

1. Learn as much as possible about hyperarousal and sensory diets as you can. The National Fragile X Foundation has their Foundation Quarterlies available online, and the articles by Mouse and Tracy are always approachable and realistic. Also, the series Braden on Behavior is quite good. The more you know, the easier it will be to convince your child's teacher that this is worth investing time and energy in.

2. Ask your child's teacher what times of day are the worst. If she doesn't know, ask her to make notes for a week or two and get back to you. Do this at home, too. Make notes of how your child reacts to specific situations -- try to be specific about which behaviors you want to eliminate. (ie: hitting, hiding under the table, stuffing food, screaming) The reason for this is to determine what time sensory breaks need to be given. A sensory break or sensory diet is meant to be proactive, not reactive. So if your child has trouble at 9:30 every day, you would schedule a sensory break at 8:30 or 9:00 in order to prevent a meltdown later. Also, your child will probably be more cooperative if you aren't catching him in the middle of a meltdown.

3. Request an evaluation by an occupational therapist. She can do a sensory profile on your child to determine his strengths and weaknesses. This is a really important step because it can help everyone understand what environmental and physical challenges trigger undesirable behavior. It will also help when coming up with ideas for what kind of input your child needs.

4. Talk to any other service providers, especially speech-language pathologists, as they often need to work closely with an occupational therapist -- or at the very least are often sharing the same concerns about oral-motor development and may have ideas about oral-motor interventions.

5. Schedule a meeting for all of the people involved just to talk. Hash out all the information you've been given and come to a consensus on what behavior(s) you want changed or eliminated. Also, brainstorm ideas on how to intervene (ie: deep pressure brushing, sensory balls, weighted vests, computer or TV time, swings, snacks, trampolines, chew tubes). In Iowa, if these items are written into the IFSP (Individualized Family Service Plan -- for children birth to three) or IEP (Individualized Education Plan -- for children three to twenty-one) then the state MUST provide them and use them. You, as a parent, aren't required to purchase anything. Of course, this means that the equipment stays at school, so you may need to purchase some items to keep at home for your own use. Rememer that the sensory breaks need to be as fast, easy, and cheap as possible. This increases the likelihood that the teacher and service providers will follow through. Because, let's face it, none of us wants this to be difficult or time-consuming.

6. The diet should be presented later by the OT at a second meeting. If needed, you may ammend the child's IEP to include the sensory diet.

7. Do your part and follow through at home. Also, consider buying your child's teacher some chocolate.

Punkin's Diet (general version):

He is given a break about every 90 minutes. The majority of this is Deep Pressure
Brushing (
incorrectly!) followed by heavy work. The brushing activates his joints and
nerve endings, and then the joint compressions calm them. This is followed by
heavy work (lifting, pushing, tug-of-war, chewing on a chewy tube) to further
calm and give the joints lots of input.

At other times, she (and I) may "squish" him under a pillow or bean bag to give him lots of deep pressure input at once. He LOVES this.

His teacher also has him lay on his back on an therapy/excercise ball to
give him some upside-down time. They also have sour candy, popcorn, and chewy
tubes to give him intense oral input that wakes up (sour) or works/tires
(crunchy/chewy) his mouth and jaw. The idea is to give him enough input through
appropriate means that he stops chewing on inappropriate or unsafe things such
as toys or his hands.

His speech pathologist is using this thing to help with
oral-motor defensiveness. She got the mouse and cat attachments, and Punkin
really likes to give them kisses.

I continue this at home with brushing in the afternoon, followed by a
snack, and then bouncing upside-down and brushing right before bed.

This plan is WORKING! Combined with his meds, he is a calmer, less-anxious version of himself. I love it. It takes time to see real results, but it works! He is responding very strongly to the brushing, especially. The difference is visible before and after it's done. And it only takes about 5 minutes for the brushing and compressions.

The FX Foundation also has a place on their website where you can e-mail them. I've done this a couple of times, and a real live professional e-mails you back with a detailed, personal response.

Good luck!


Maddy said...

Sound advice indeed. I was also confused at first by 'sensory diet' in view of the food issues around here. It took a while for me to get the hang of it but eventually, when I started to see some positive results it all seemed worthwhile. Always needs tweaking though, probably something to do with the growing!

Anonymous said...

You are an amazing mom and Punkin is so blessed to have you. And we are blessed to have you both!
I love you, Aunt Patty

Holly's Mom said...

Thanks for the wonderful post.

TheXMom said...

Wonderful post. We tried the brushing but I was inconsistent so I'm sure that's why it didn't work. We are discussing trying it again with a more consistent home plan ofcourse.

Umma said...

I am a convert to the sensory diet as well. We had one written into Monkey's IEP right from the beginning but after the first year we realized even experienced special education teachers don't always understand what a sensory diet is! Your advice to get the whole team to sit down is right on.

The first year the teacher's version of a sensory diet was to give Monkey a chewy tube when he chewed on his clothes or his blankie when he was upset. It was all reactive rather than proactive. You need to identify the rough spots and intercede before they happen.

Monkey has had a REAL sensory diet since last October and his language has exploded since, his ability to participate in seated activities has done the same. We credit the mix of folic acid and the sensory diet.

Monkey's diet has much the same techniques one other thing that he has responded really well to is using lotion during deep pressure. It's in addition to the brushing protocol. Monkey LOVES his lotion...he prefers a foot massage above all else, lol. Can't blame him there.

Sarah said...

Thanks for this great post...really interesting. Quinn has an OT and she has mentioned the possibility of setting up a sensory diet for him, but I wasn't really sure how it would work if we did it - so it's helpful to read how Punkin's works (though I know Quinn's would likely be different).

Anonymous said...

It's amazing how much more info there is now than there was 20 yrs ago.
Robert had OT in St. Louis but lost it when we moved to CA. When I asked for it you would have thought I was asking someone to sell me their firstborn! Lost speech as well. Quite a different story when we moved to WA though. No problem getting services here.