Sensory Modulation is the ability to obtain a calm state in order to attend, interact, and learn in our environment.  When someone is in a high arousal state, they may appear to have “sensory overload” or to be overstimulated.  They may appear intolerant of activities, avoid interaction, and they may be anxious and distressed; they may appear to be frightened and may “flight” or withdraw from their environment.  In an attempt to calm themselves down they have a tendency to engage in or seek rhythmic sensory stimulation.  If their system continues to be in an overly stimulated state the child may go into “fight” mode and fearfully lash out in order to protect themselves from the danger they perceive.  Therefore, this child benefits from activities that are calming, soothing, and organizing.

A person with a low arousal state may appear to be seek sensory input in a very disorganized fashion; they have a tendency to love input that involves arhythmic sensory stimulation such as spinning, crashing, jumping, all in an attempt to feed their sensory system with more and more input.  If they are unsuccessful in giving their system the sensory input they need they may become lethargic and unmotivated.  Therefore, this child benefits from activities that help alert or wake up their bodies.

To be in a high arousal or a low arousal state is not an optimal state to function effectively in our environment.  Our optimal state of arousal is a range that falls between a high arousal state and a low arousal state that allows for our best performance.

Children with Sensory Processing Disorder may have a hard time obtaining and maintaining this optimal state of arousal and may demonstrate the symptoms described in the previous article for High Arousal and Low Arousal.

Our goal is to help our children find their optimal state of arousal by engaging our children in various therapeutic activities based on their arousal state.  Below is a list of activities for children with High Arousal and children with Low Arousal.

I am going to break them up into the different sensory systems – Tactile (deep pressure), Proprioception (heavy work for your muscles), and Vestibular (movement of the head in space)

Deep Pressure Activities:

• Give your child a massage by applying gentle, but firm pressure to arms, legs and back
• Squish your child’s arms, legs and back with a pillow
• Wrap your child up in a “body sock” which is a piece of spandex material (see picture)
• Roll a therapy ball over your child’s arms, legs, and back while they are lying on their belly
• Roll or wrap your child up in a blanket or a towel to make a “burrito” or “sushi roll”
• Have a child sit in a ball pit and bury them in the balls
• Compression Vest can be used to provide deep pressure (please check with your Occupational Therapist to see if this would be beneficial for your child)

Proprioceptive Activities (heavy work or whole body activities):

• Crawling (can crawl through tunnel, over beanbags or pillows)
• Running
• Climbing
• Marching
• Jumping on a trampoline
• Wheelbarrow walks
• Animal walks (bear walk, duck walk, crab walk, army crawl)
• Pushing heavy object (pushing a shopping cart, pushing a wagon, or a box filled with heavy objects such as bags or rice, cans of vegetables, books)
• Carry heavy objects (laundry basket, grocery bags)
• Jump and crash in a pile of pillows
• Bounce up and down on a hippity hop ball
• Push or carry a weighted therapy (medicine) ball
• Push a wheeled stool while someone heavy is sitting on it
• Have child propel self using hands on a scooter board while lying on their belly
• Push on a large therapy ball while someone else is pushing from the other side
• Weighted vest provides increased proprioceptive input (check with your child’s Occupational Therapist to see if this would benefit your child’s sensory needs)

Vestibular Activities (movement of head in space):

• Swing at the playground
• Have child sit in a blanket and you and another person swing the blanket
  
• Bounce House
• Tumble Saults
• Rolling along a mat or a towel
• Sit on the floor with your child facing you, hold onto each other’s hands and rock back and forth – sing “row, row, row your boat”
• Jump on a trampoline
• Have child look up (nose to ceiling) to retrieve a small ball and then have child look between their legs (crown of head towards the floor) to give you the ball back
• Sit and Spin
• Propel a child while he/she is sitting or lying down on a scooter board

When doing these activities with a child with high arousal, ensure that you provide rhythmic, predictable and unchanging input to help calm the sensory system which is on “sensory overload.”  These activities should be done in a manner that is calming and organizing for your child.

You can use these same activities for a child with low arousal; however, your goal is to “wake up” their sensory system and provide them with sensory input to meet their “sensory seeking” needs.  Provide these activities in a more unpredictable, arhythmic, changing manner.

These activities should be pleasant and enjoyable for your child.  You should see a difference in your child’s arousal state with the goal of bringing your child to a more relaxed, calm, organized, focused, attentive, and/or alert state.

Please note that the above activities are only suggestions.  Each child’s nervous system and sensory systems are unique, and these sensory activities should be monitored and supervised by your occupational therapist to ensure proper carryover.  Timing, intensity and duration of these sensory motor activities can be best determined by your child’s Occupational Therapist in order to meet your child’s unique sensory processing needs.

Please post any comments or questions below and begin a discussion to learn more about  your child’s sensory system.

Sensory Modulation is the ability to process sensory information from the environment and from the body in an organized way so that a child can attend and interact with the environment effectively and efficiently in order to function as independently as possible in his/her activities of daily living.

When you are modulated your sensory system is at the “just right” arousal state for you to learn, engage, participate, and interact with people and objects in your environment.

The affects of sensory modulation disorders can interfere with academic learning, social skills and self-esteem. 

If your system is not at the “just right” state you may appear to have high arousal or low arousal.  Here is a list of symptoms for each arousal state.

HIGH AROUSAL Symptoms:  

• Poor eye contact
• Unable to attend at the table
• Defensiveness, overreaction, or fearful response to movement experiences
• Does not like the be tipped upside down, side-to-side, or backwards
• Avoids playground equipment such as swings, slides, ladders, merry-go-rounds
• Afraid of heights/fearful of feet leaving the floor
• Defensiveness or overreaction to touch, sounds, odor, tastes
• With defensiveness you see discomfort, avoidance, distractibility or anxiety
• Engages in self-stimulatory behaviors that arerhythmic such as hand flapping, rocking, spinning, head banging
• Covers ears often
• Distressed about having hair, toenails, or fingernails cut
• Does not like to have hair washed
• Does not like the bath or shower
• Does not like to have teeth brushed
• Does not like “messy play” such as sand, mud, water, glue, glitter, playdoh, slime, shaving cream/funny foam etc.
• Doesn’t like to walk barefoot or on the grass or sand
• Overreacts to mild cuts, scrapes, bug bites
• Picky about the clothing they wear, such as tags on shirts, seams on socks, etc.
• Prefers deep pressure touch as opposed to light pressure touch (prefers hugs or being squished)
• As an infant did not like to be held or cuddled; would cry, arch back, and avoid touch
• Picky eater, only eats certain foods, tastes and textures
• Mixed food textures tend to be avoided as well as hot or cold foods
• Does not like trying new foods
• Has difficulty attaining a stable emotional state, and may have strong negative emotional reactions
• Appears behavioral, unfocused, and attention is unattainable
• Difficulty falling asleep or staying asleep
• System may go into “Fright or Flight” mode; symptoms include: dilated pupils, reddish cheeks, body sweating, sweaty palms, increased breathing, increased heart beat

LOW AROUSAL Symptoms:  

• Unable to attend at the table
• Constantly in motion, seeks sensory input and can’t sit still
• Engages in self stimulatory behaviors that are unpredictable and arrhythmic such as crashing, jumping, spinning, tumbling
• Mouths objects excessively
• Appears under-responsive to sensory input
• Lack of awareness of:Touch
  • Pain
  • Smells (even mild odors)
  • Visual stimuli
  • Sounds
  • Tastes
• Craves fast, spinning, and/or intense movement experiences
• Loves/craves being upside down
• Loves being tossed in the air
• Jumps, crawls, climbs on furniture excessively
• Can spin around for hours and does not appear to get dizzy
• Loves rough play
• Loves messy play
• Is a thrill seeker and can appear to have decreased safety awareness
• Loves the playground and going from one piece of equipment to the next
• Appears to jump from one activity to the next
• Can go to the other extreme and appear extremely tired and lethargic
• Has difficulty with attaining a stable emotional state, and may have strong negative emotional reactions
• Appears behavioral, unfocused, and attention is unattainable
• Difficulty falling asleep or staying asleep

 ”JUST RIGHT” AROUSAL Symptoms:

• Focused
• Calm and organized
• Attentive      
• Ready to learn
• Engaged
• Interactive
• Tolerates sensations and situations that are challenging
• Limited sensory seeking and sensory avoiding behaviors
• Can handle and tolerate transitions
• Can filter out extraneous sights, sounds, smells in the background

As a parent you may ask, “What can I do?  How can I understand my child’s sensory needs?”  As a therapist, you may ask, “Where should I begin to address this child’s sensory needs?”   Every child is unique and there is not one cookie cutter shape that can apply to more than one child; however, it is helpful to know the different types of sensory processing disorder to give you some insight as to know how the child may feel at certain times.  Many things affect the ability to process sensory information.  Depending on where the breakdown occurred in the brain can help guide us as to what type of “sensory problem” there is.  According to research done by the Sensory Processing Disorder Foundation, Lucy Jane Miller, Ph.D., OTR, breaks Sensory Processing Disorder into 3 categories – sensory modulation disorder, sensory discrimination disorder, and sensory-based motor disorder (Sensory Processing Disorder foundation).

Sensory Modulation is the ability to process sensory information from the environment and from the body systems (as discussed in the Part I) in an organized way so that a child can attend and interact with the environment effectively and efficiently in order to function as independently as possible in his/her activities of daily living.  So, to explain further, sensory information comes in through our eyes, ears, nose, skin, mouth, vestibular and our propriocpetive systems, such as the bright lights, the noises in the environment, how our clothing feels on our skin, any odors in the rooms, etc.  First, our senses receive the sensory information and send it up to our brain to get processed at the lowest level (the brainstem) – all the information collects here.  Your brain is able to filter out the sensory information that is important and  not important (i.e.: example you are able to filter out the noise that is being made from the air conditioner, or the noises that are coming from outside such as trunks and cars, you can filter out the way clothing tags feels on your body.)  This process happens automatically and constantly throughout the day – we do not have to think about this.  However, if extraneous noise, visual stimuli, touch, and movement, etc. is not getting filtered out based on what is important/what is not important we will become overstimulated by so much sensory input.  We may we see a child who is in a high arousal state – they may avoid sensory input or become overwhelmed easily.  This is because he/she is receiving too much sensory information at once and it is getting stuck in the lowest level of the brain (the brainstem); similar to a traffic jam on the expressway – the more that comes in, the more traffic there is.  This child may appear to be in the a “fright or flight” state.  Since everything in this child’s environment is very overwhelming, this child may seek input very rhythmically to help them get calm and organized – you may see them engage in self-stimulatory behavior such as body rocking, hand flapping, covering their ears, they may  avoid interaction and eye contact because it is just too, too much for them.

On the other hand, sometimes the information is being sent to the brainstem, but the lowest level of the brain (brainstem) isn’t able to receive it and the brain wants more and more.  In this situation, the child may be in a low arousal  state – they are constantly seeking more and more and more input.  This child just can’t get enough.  He/she may  thrive on very arrhythmic, fast, unpredictable, changing input, by engaging in sensory input in all areas such as crashing, jumping, spinning, touching everything, etc. to help him/her receive more and more input so they feel more organized, but it may not look the least bit organized to you.

In either case, high or low arousal, the child is not able to obtain a modulated state.  This child is engaging in ineffective, inefficient, non-purposeful sensory stimulation to help get to an organized state, but it isn’t working.  So, at this level, we, as therapists, work on helping your child become modulated by providing him/her with the necessary input to foster a state of readiness to learn, engage, and interact! We engage the child in child-centered, just-right, and appropriate sensory motor experiences through the use of tactile, vestibular, and propriocpetive activities.  A sensory diet throughout the day may be necessary to allow your child to achieve a state of learning, focusing, and interacting.

At this level, either in a high or low arousal state, the goal is for your child to achieve a “just-right” level of arousal so that his/her mind and body is ready for learning, focusing, and interacting.  As we are working on attaining a modulated state, we work on his/her ability to self-regulate in order for him/her to sustain this state for a longer period of time.  This will be discussed in the next article.

Please see “Sensory Modulation Checklist” under the Sensory Modulation tab for a list of signs and symptoms of sensory modulation disorder.

Please stay tuned for more information on self-regulation disorder, sensory discrimination disorder, and sensory-based motor disorder.

Thank you, please ask questions, leave comments, and begin a discussion!

According to Jean Ayers, the pioneer of sensory integration, sensory integration is the ability to receive, process, and organize sensory information that comes in from our environment and from our own bodies, and to use it effectively and efficiently so that we may function as independently as possible in our activities of daily living.  So what does this mean and where does the sensory information come from?  Well, we are all familiar with our 5 senses – touch, hearing, vision, taste and smell – our skin, ears, eyes, tongue, and nose are responsible to receive this input, respectively, from the environment and send the information up to our brain so that our brain can process it and make sense of it.  However, we have 2 more systems that tell us more about our own body – these are our Vestibular and Proprioceptive systems.  The sensory input we receive from our senses is so essential – it is like “food for our brain, and it provides the energy and knowledge needed to direct the body and mind” (Ayers, Jean).  Here is an explanation of our sensory systems that are responsible for telling us more about our body:

The Vestibular System is located in our inner ear and it gets stimulated when our head moves in space.  It detects the pull of gravity, tells us how fast or slow we are moving in space, and helps us to know where our head is in space.  It is also responsible for our level of alertness, our balance, equilibrium, muscle tone, coordination of our eye muscles, the ability to use both sides of our bodies together (bilateral integration), and it also works very closely with our auditory system.

Our Proprioceptive System lets us know where our body parts are on our body without the use of our eyes.  There are proprioceptors in our muscles and joints that get stimulated when our muscles contract or stretch or when we move our joints.  We receive the greatest proprioceptive input when we are moving, but our proprioceptive system is constantly sending information to our brain even when we are standing or sitting still to help us keep our posture.

Just to review, our Tactile System is our touch sense.  We have tactile receptors throughout our entire body that receive information about touch, pressure, texture, temperature, and pain.  This is the largest of our sensory systems and it is our first system to develop in the womb.  When we deep pressure (a form of tactile input), it is very calming and organizing to our bodies – it helps us feel safe, secure, organized, and balanced.

These three systems (vestibular, proprioceptive, and tactile) are extremely important during our first year of development as they really get enhanced and “integrated” as a child explores and moves around; through the integration of these systems, we are able to make sense of our environment and our own body.  For example, when a baby crawls, his/her entire system works together – the child’s head is moving in space, muscles and joints are being stimulated, and the child is receiving tactile input on his/her hands and knees. The eyes and ears also become involved and integrated as the child crawls towards and visually focuses on a toy, or localizes and crawls towards a sound that was made. As we develop and have sensory-motor enriched experiences, all of our systems work together, and this is what we mean by Sensory Integration. Sensory integration lays the foundation for future learning and academic skills.

When we have good sensory integration we are able to attend to task, we are focused, we are ready to learn, we are interactive and engageable, we can play, we are able to cope with changes in our environment or schedule, we are able to move our bodies in a coordinated manner, we can do things automatically, we can multi-task, we have good balance and good body awareness, handwriting and reading is easier, and we become independent learners.  When we don’t have the ability to receive, process, and organize the sensory information coming in we may have a sensory processing disorder that may affect our ability to perform those skills and affect our success during our activities of daily living.

Lastly, we may ask what can affect our ability to process and organize sensory information and cause sensory processing disorder?  Some factors that may play a role in the way we process information is genetics, our birth history, lack of sensory motor experiences as we develop, food and nutrition, digestive problems, food allergies, and sleep.  Some factors may be out of our control to correct; however, a child’s nutrition and sleeping patterns are essential to brain development.  We must ensure that a child is receiving proper nutrition and sleep on a daily basis to ensure that the brain and body is being nourished properly.

Good sensory integration is when all the information is received via our sensory organs and flows to its destination in the brain and becomes organized.  With sensory integration disorder, there is a “traffic jam” and the sensory information coming in gets stuck, or not enough sensory information is going where it needs to go.

On this note, there are different kinds of sensory processing disorders.  This depends on where the break down occurs as the information goes from our sensory organs to our brains.  I will discuss, in the next article, the different types of sensory processing disorders, along with a list of symptoms, so you may continue to learn what it may mean when you hear “your child has sensory issues.”

Stay tuned…

School can be very unfamiliar or scary for your child, so it is important to discuss with your child about what to expect in school.  You can show your child a photograph of the building a few days before hand so your child can visualize where he/she is going on the “first day” of school.  You can discuss with your child how he/she is getting to school; if your child is taking the bus or walking, you can go over the route with your child.

It is important to make this transition to school as positive as possible; this includes the days leading up to the “first day.”  Ensure that your child feels prepared to begin school.  Take time to enjoy going shopping together for school supplies.  Help your child lie out all the supplies needed, and help pack his/her backpack and lunch box with all the new supplies.  Help your child with developing organizational skills to maintain throughout the year; this can foster your child’s independence and help your child become more responsible.

Sleep is very important, so ensure your child gets enough rest every night.  Make sure your child wakes up early enough to allow sufficient time to get ready in a calm manner.  Help your child manage his time; make a schedule that includes the time to wake up, eat breakfast, leave for school, come home, eat a snack, take a movement break, do homework, eat dinner, get ready for bed, and go to sleep.  A routine and schedule can help your child feel organized and know what to expect on a daily basis.

If your child is fearful, anxious or nervous about the first day reassure your child that it is natural to feel this way.  Share with your child times when you were anxious; share your experiences you had on your “first day” of school.  Tell your child stories about the good things that happened in school for you such as meeting your best friend or how you had a favorite teacher.

Be understanding.  All children adapt to change differently, and your child may require extra support and attention to cope with the transition to school.

You can discuss with your child what concerns him/her the most about school.  Listen to your child’s concerns and allow your child to process what he/she is feeling; help him/her express ways to deal with his concerns and problem-solve different solutions.  You can ask your child, “What can you do when a situation like that arises?”  Allow your child to express his/her emotions.  Ask open-ended questions such as, “How did your day go?”  “How did you feel today?”  “What made your feel frustrated?”

Encourage your child to get involved in extracurricular activities.  Talk to your child about which activity he/she would like to get involved in.  Sports, music, art, dance, yoga, karate, gymnastics, running, swimming are just some fabulous activities for a child to be a part of.

Remember to be as involved as possible in your child’s school year.  Be sure to get a copy of the school’s calendar and handbook.  Get to know your child’s teacher and what the teacher expects of your child.  Keep track of when homework assignments are due, testing dates, and when major projects are due.  Attend parent-teacher conferences throughout the school year.  If you have a concern, report it as soon as possible.

If your child is receiving related services (OT, PT, or speech), introduce yourself to your child’s therapist. Your therapist can be a great advocate for your child in his/her school environment. It is important to maintain contact with your child’s therapist throughout the school year. Begin a communication notebook with your child’s therapist to ensure you know how your child is progressing in therapy and how it is positively impacting his participation and functioning in the classroom environment.

Remember as the parent or caregiver it is very important for you to maintain a positive attitude; always expect for an optimally successful transition and school year.  It may take time, but staying positive can help instill ease and confidence in your child and it can make all the difference.

From the first day of school and throughout the school year, it is important to work together with your child’s teacher to identify and meet you or your child’s concerns.  There is always a solution to any concern you may have.  Being an active participant in your child’s learning, being aware of the expectations for your child’s grade level, and communicating with your child’s teacher and therapist can make for a great, promising school year!