tag:blogger.com,1999:blog-26794899678866704282024-03-13T03:08:16.626-07:00OT and Self RegulationThe art and science of keeping children with autism, ADHD and sensory disorders on task.Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.comBlogger120125tag:blogger.com,1999:blog-2679489967886670428.post-57313418248228148502021-03-07T11:12:00.002-08:002021-03-07T11:12:39.356-08:00Final Post<p> Dear Friends,</p><p>This is my final post--I've retired. I'd like to thank all my kind readers through the years for their thoughtful comments.</p><p>I'll leave the blog up because there's lots of good information here. Keep in mind, though, that things change and that new ideas for resolving self-regulation problems appear all the time. So don't get discouraged if you don't find an answer today. Just continue to search and to ask questions until you find what you need!</p><p>Take care,</p><p>Teresa</p><p><br /></p>Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com1tag:blogger.com,1999:blog-2679489967886670428.post-2396136402983241562016-09-10T06:52:00.001-07:002016-09-10T06:52:03.787-07:00Parenting Styles and Self-Regulation in Autism <div>
The latest issue (October, 2016) of the Autism journal contains an interesting study of how parenting styles affect self-regulation skills in children with autism. The article compares a child's temperament and ability to self-regulate with the parents' style of discipline and of interacting with their child. </div>
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In the study, 40 children with autism were matched to 40 children without autism. The initial assessment of temperament and self-regulation in the children with autism compared to their peers. Not surprisingly:</div>
<blockquote class="tr_bq">
Compared to their typically developing peers, children with autism spectrum disorder showed more noncompliance and less self-regulated compliance to parental demands and prohibitions and greater temperamental difficulties across several domains. </blockquote>
No differences in parental disciplinary styles were found in the parents of children who were better regulated as opposed to those who were not. But there was a difference in parent-child interaction styles. Parents of children who were better self-regulated were found to offer more support to their children and to request better attention from them. <br />
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The authors concluded:<br />
<blockquote class="tr_bq">
Findings highlight the importance of parental supportive presence in structuring the development of socialization in children with autism spectrum disorder.</blockquote>
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The article is titled "Self-regulated compliance in preschoolers with autism spectrum disorder: The role of temperament and parental disciplinary style." The authors are: S.<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; margin: 0px;">
Ostfeld-Etzion, R. Feldman, Y. Hirschler-Guttenber, N. Laor and O.
Golan.</span> </div>
<div class="contributor" id="contrib-1">
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Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com4tag:blogger.com,1999:blog-2679489967886670428.post-73332257269877438232016-08-16T11:38:00.002-07:002016-08-16T11:38:51.996-07:00A Quick Fix to Over-SensitivityToday was a dentist day. Now, in spite of being over-sensitive to just about everything, I am good with going to the dentist. As a child, I had a great dentist who told me to focus on something else while he worked on my teeth. I did so and got through the procedure without too much discomfort. It was a good lesson.<br />
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But I didn't generalize on it until much later. I was in the midst of a home remodeling project and hammered my thumb instead of the nail :{ I was dramatically in pain. A friend told me I was a wuss, and that I should focus my attention on something else until the pain died down. I did it, and miracle of miracles, it worked. How did he know that and I didn't. He had played sports. I had not. Sensory kids don't.do.sports because it's noisy and you get bumped a lot. And that's the point of this post sensory kids naturally react differently to pain, bumps and sounds and they avoid activities like sports where kids get so many life lessons, including "think about something else". <br />
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If Zoey is playing in the sprinkler and gets water in her face, she can focus on it with discomfort, or she can shift her attention outward to something else, like the sprinkler itself, her chest or her hands. If Martin is standing next to an alarm that sounds for several seconds, he can bring his attention back into his body (and his hands over his ears) and in that way stay grounded. <br />
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This particular lesson is a game changer, and here's why. Our brain operates with great efficiency, always trying to guess what to be ready for. If I focus on sensory discomforts, the brain says, "That's what she wants to pay attention to", and so it prioritizes the brain's focus to discomforts. On the other hand, if I am able to ignore the discomfort, and focus on something else, discomfort loses priority. What a concept. Discomfort loses priority, and we don't attend to it. What a great lesson for our kids!<br />
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By the way the circuitry that processes priorities is in the right anterior insular cortex (rAI). It feeds priorities to the anterior cingulate cortex (ACC) which takes action: behaviors, motor and emotional reactions and cognitive redirection. ....but that's a post for another day.Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com1tag:blogger.com,1999:blog-2679489967886670428.post-57339855835589591392016-07-25T11:04:00.002-07:002016-08-01T06:46:39.565-07:00Thoughts on CravingJust a short post today. I'd like to refer back to the last two posts (<a href="http://otselfregulation.blogspot.com/2016/07/the-confusion-of-sensory-craving.html" target="_blank">here</a> and <a href="http://otselfregulation.blogspot.com/2016/07/pre-satiation-technique-for-stereotypy.html" target="_blank">here</a>) which discussed stereotypy and sensory craving. I forgot to mention in the second post that the intervention used by Rispoli, et al. is the same approach I take to sensory craving in my book, <i><a href="http://www.pesi.com/ECommerce/ItemDetails.aspx?ResourceCode=PUB084350" target="_blank">Hands on Activities for Children with Autism and Sensory Disorders</a></i>. In the book, I discuss how to explore sensory activities to find a preferred type of activity. The book also contains 50 or so fun interventions including crafts.Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com1tag:blogger.com,1999:blog-2679489967886670428.post-50029329477915729072016-07-20T06:48:00.001-07:002016-08-01T06:48:02.227-07:00Pre-Satiation Technique for Stereotypy and Craving?<div style="margin: 0in 0in 10pt;">
<span style="font-family: inherit;">In the <a href="http://otselfregulation.blogspot.com/2016/07/the-confusion-of-sensory-craving.html" target="_blank">previous post</a>, I looked at the blurred lines across the (ASD) autism symptoms of stereotypy and sensory craving. This
post focuses on an intervention that may help both types of symptoms. The intervention is a well-conceived combination of
behavioral and sensory techniques that comes from a study by Rispoli, et al (2013). </span></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-family: inherit;">The research team studied three children with stereotypic behaviors. Five-year-old Antonio has autism and vocal stereotypy in the form of a high-pitched squeal. Twelve-year-old Jeff has intellectual disabilities and seizure disorder. He hits tables, chairs and walls repeatedly with various hand-held objects. Four-year-old Joel has autism and bounces small things (balls, toys and breakable objects) onto the floor. </span><br />
<span style="font-family: "calibri";"><span style="font-family: inherit;"></span><br /></span>
<span style="font-family: inherit;">All three boys were unable to engage in demanding group tasks because of their stereotypy. The researchers posed the question: If each child were allowed to engage in his behavior until he stopped of his own volition (was satiated), would he then be able to engage in the demanding group tasks. </span><br />
<span style="font-family: inherit;"></span><br />
<span style="font-family: inherit;">To test this, they set up a three phases process. First they analyzed each child’s behavior to see if he was a good fit for the study. Second, they looked for toys that matched the child's stereotypy and had him play with them to discover which toy was preferred. Last, they tested over a 4-5 week period to see if pre-satiation with the preferred toy before a demanding 15-minute group activity decreased the amount of stereotypy during the group activity and allowed each boy to focus on his work. (The answers were yes and yes.) The study while small used good methods; it was a blind, controlled study.</span><br />
<span style="font-family: "calibri";"><span style="font-family: "calibri";"><span style="font-family: "calibri";"><span style="font-family: inherit;"></span><br /></span></span></span>
<span style="font-family: "calibri";"><span style="font-family: "calibri";"><span style="font-family: inherit;">The implementation details are below. The interventions (step three) can easily be done at home or school by a parent or teacher. The first two steps are the domain of behavioral or sensory therapists, but may be accomplished by an astute parent or teacher. Let's look at the details for putting this in place.</span></span></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: inherit;">Step 1: Analysis</span></b></div>
<div style="margin: 0in 0in 0pt 0.5in; text-indent: -0.25in;">
<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font-family: inherit;">1.</span><span style="font-family: inherit; font-size: small; font: 7.0pt "times new roman";"> </span></span></span><span style="font-family: inherit;">Analysis:
You note a stereotypic behavior that appears to have a sensory component. Note which senses appear to be stimulated by the behavior. Remember that movement is also sensed by the body. It is the combination of the vestibular sense (head movement) and the proprioceptive sense (body movement). Unless you discover otherwise (see the "unmatched preference" of step three), assume that the child is craving sensation and that his stereotypic activities are satisfying that craving.</span></div>
<div style="margin: 0in 0in 0pt 0.5in; text-indent: -0.25in;">
<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font-family: inherit;">2.</span><span style="font: 7.0pt "Times New Roman";"><span style="font-family: inherit; font-size: small;"> </span><span style="font-family: inherit; font-size: small;">To establish a baseline, c</span></span></span></span><span style="font-family: inherit;">ount
the occurrences of the behavior: count the number of
times and the total amount of time he engages in stereotypy during a demanding
activity. Also note when (time, place, type of activity) the child engages in
the behavior.</span></div>
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<b><span style="font-family: inherit;"></span><br /></b></div>
<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font-family: inherit;"></span></span></span><br />
<div style="color: black; font-family: "times new roman","serif"; line-height: normal; margin: 0in 0in 10pt;">
<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font-family: inherit;"><b>Step 2: Discovering the Preferred Object</b></span></span></span></div>
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<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font-family: inherit; font-size: small; font: 7.0pt "times new roman";"> </span></span></span></div>
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</span></span>
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<div style="margin: 0in 0in 0pt 0.5in; text-indent: -0.25in;">
<span style="font-family: inherit;">1. Identify
possible preferred activities for satiation tasks: Put together some optional
activities for him to engage in that might be just as engaging as the
stereotypy. Attempt to find activities that stimulate the exact same senses in the same way. A good preferred activity may be more intense than his
current one. </span></div>
<div style="margin: 0in 0in 0pt 0.5in; text-indent: -0.25in;">
<span style="font-family: inherit;">2. Put all of the candidate preferred activities (toys to help with stimming) in an otherwise empty room with the child on a few occasions. Let him play and see if a preferred object emerges. </span><br />
<span style="font-family: inherit;"> If you are unable to find a preferred activity that is similar to
the stereotypy, then try something else, perhaps access to a computer or a
cause-and-effect toy. This is called an </span><i style="mso-bidi-font-style: normal;"><span style="font-family: inherit;">unmatched
preference</span></i><span style="font-family: inherit;">. </span><span style="font-family: inherit;">The preferred toy for Antonio was a musical camera. Jeff was given an object he could use to strike walls and tables that would not hurt them. The choice for Joel was obvious; he was given a ball.</span></div>
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<span style="font-family: inherit;">Here are examples: </span></div>
<div style="margin: 0in 0in 0pt 1in; text-indent: -0.25in;">
<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font-family: inherit;">a.</span><span style="font-family: inherit; font-size: small; font: 7.0pt "times new roman";">
</span></span></span><span style="font-family: inherit;">For the child who lines things up, show him how
to stack and line-up Legos, and see if that becomes a preferred activity. This
is a big one for many kids. </span></div>
<div style="margin: 0in 0in 0pt 1in; text-indent: -0.25in;">
<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font-family: inherit;">b.</span><span style="font-family: inherit; font-size: small; font: 7.0pt "times new roman";">
</span></span></span><span style="font-family: inherit;">For the child that flicks his wrist, try a punch
balloon. </span></div>
<div style="margin: 0in 0in 0pt 1in; text-indent: -0.25in;">
<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font-family: inherit;">c.</span><span style="font-family: inherit; font-size: small; font: 7.0pt "times new roman";">
</span></span></span><span style="font-family: inherit;">If he is in constant motion, try a small
trampoline, a swing (this is huge!), climbing equipment or a ball pit (if you
have access to one). An older child may like riding a bike—perhaps on a
bicycle-built-for-two with the parent in front.</span></div>
<div style="margin: 0in 0in 0pt 1in; text-indent: -0.25in;">
<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font-family: inherit;">d.</span><span style="font-family: inherit; font-size: small; font: 7.0pt "times new roman";">
</span></span></span><span style="font-family: inherit;">Finally, an example of an unmatched preference:
the child flicks his finger, but you’ve discovered that given the opportunity,
he would play with a cause and effect toy for a long time. This is his
preferred activity. </span></div>
<div style="margin: 0in 0in 0pt 0.5in; text-indent: -0.25in;">
<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font-family: inherit;">3.</span><span style="font-family: inherit; font-size: small; font: 7.0pt "times new roman";"> </span></span></span><span style="font-family: inherit;">Practice
with the preferred activity: On successive sessions, let the child engage in
the activity for as long as he wants--until he has had enough. You will need to
know how long it typically takes for him to be satiated, so keep track of the
time. This is the satiation time.</span><br />
<br /></div>
<div style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: inherit;">Step 3: The Intervention</span></b><br />
<b><span style="font-family: inherit;"></span><br /></b>
<span style="font-family: inherit;">The intervention can be done prior to a demanding activity,
as a way of helping the child to self- regulate.</span></div>
<div style="margin: 0in 0in 10pt 0.5in;">
<span style="font-family: inherit;">First, let the child have unlimited
time doing the preferred activity, that is let him do it until he is satiated.
Let’s say that he usually requires 22 minutes to be satiated, and then plan to have
him start the preferred activity about 25 minutes prior to the next task. </span></div>
<div style="margin: 0in 0in 10pt 0.5in;">
<span style="font-family: inherit;">Afterwards, as he engages in the
demanding tasks, track his behavior to see if his stereotypy has
diminished. Counting the number of times and the total amount of time he
engages in stereotypy during the demanding activity. Do this over a period of
several sessions. If it appears to be helping, continue with the intervention
on a daily basis. If he acclimates to the preferred activity, then try
replacing it with something a little more intense or demanding. In some cases,
you may see that he no longer desires the preferred activity and that his
stereotypy has decreased, as well. This good outcome is possibly the result of increased
sensory integration skills.</span></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-family: inherit;">In the study, the child was used as his own control. By performing the intervention every other
session, his behavior on days that he was satiated could be compared to behavior on days that he received no intervention and was not satiated. They noted that after a few
weeks, the behavior appeared to improve both on the days that the intervention
was done and when it was not done. </span><br />
<span style="font-family: "calibri";"><span style="font-family: inherit;"></span><br /></span>
<span style="font-family: inherit;">Unfortunately, the researchers did not carry out the study long enough to see if the intervention
would lead to extinction of the behavior--which is a shame, because it might do so. </span><span style="font-family: inherit;">I have seen satiation work as therapy with children in my
setting. I separately treated wo children who craved movement. When given unlimited time on a swing
twice a week, both lost interest in the swing after a month. One boy with this
result was then capable of sitting at attention in the classroom
without getting out of his chair on most
days. Sensory integration theory suggests this outcome, but to my knowledge,
this type of scenario has not been documented in the journals.</span></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-family: inherit;">How long did the effect of the intervention last? Fifteen minutes? A few hours? The whole day? The
authors don’t discuss this, but the intervention is similar in nature to the
sensory diet which is thought to last 2 hours. In the sensory diet, children
are given 15 minutes (or so) of sensory stimulation usually including a movement activity every 2 hours as a means of
increasing self-regulation. A significant difference between satiation and the sensory diet is the inclusion of movement which is on its own self-regulatory. (BTW, the sensory diet has not yet been
sufficiently studied to validate its efficacy, but it is generally accepted as a
good practice.)</span><br />
<br />
I still have additional articles to review from <i>Behavior Modification</i>'s 2013 special issue on Stereotypy. So stay tuned for that. <br />
<br />
An update: Rachel Scalzo's 2015 PhD thesis on satiation of stereotypy has made a significant addition to the literature by clarifying the intervention process. I'll keep an eye out for future journal articles from her. In the meantime, here is her <a href="https://baylor-ir.tdl.org/baylor-ir/handle/2104/9488" target="_blank">thesis abstract</a>. </div>
<span style="font-family: inherit;"></span><br />
<div style="margin: 0in 0in 10pt;">
<b><span style="font-family: inherit; font-size: x-small; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;">References</span></b></div>
<ol start="1" type="1">
<span style="font-size: 12.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"><span style="font-family: inherit; font-size: x-small;">Rispoli,
M., Camargo, S. H., Neely, L., Gerow, S., Lang, R., Goodwyn, F., &
Ninci, J. (2014). Pre-session satiation as a treatment for stereotypy
during group activities. </span><i><span style="font-family: inherit; font-size: x-small;">Behavior Modification</span></i><span style="font-family: inherit; font-size: x-small;">, 392-411.</span></span></ol>
Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com1tag:blogger.com,1999:blog-2679489967886670428.post-75923619859566828932016-07-12T05:31:00.000-07:002016-07-12T05:31:00.398-07:00The Confusion of Sensory Craving, Stereotypy, Hyperactivity and OCD<br />
<span style="font-family: inherit;">
<span style="font-family: "inherit","serif";">It can
be difficult to accurately distinguish between sensory craving and stereotypy.
Both symptoms play a big role in autism and both are part of the ASD¹
diagnosis, so you might think they are distinct. But they're not. They can be
easily mistaken for each other and even overlap. Does it matter that we
identify exactly what is going on? Yes. How can we create successful
interventions without pegging the problem correctly? </span><br />
<br />
<div style="line-height: 115%;">
<span style="font-family: "inherit","serif";">Look at
the descriptions and examples below and see if you can pick out inherent
problems. See if you notice the areas of overlap and blurry lines
between them, and also with them and hyperactivity (ADHD²) and obsessive
behaviors (OCD).</span></div>
<br />
<div style="line-height: 115%;">
<b><span style="font-family: "inherit","serif";">Stereotypy:</span></b><span style="font-family: "inherit","serif";"> Rapp and Lanovaz³ say, "Stereotypy
is often characterized as repetitious, invariant behavior that generates its
own reinforcing consequences (rewards)." Examples are vocalizations,
flicking fingers, slapping things, nail biting, and similar habitual
activities. The DSM describes it in terms of motor movement or use of
objects and gives these examples: "simple motor stereotypes, lining up
toys, flipping objects, echolalia, idiosyncratic phrases."</span></div>
<br />
<div style="line-height: 115%;">
<b><span style="font-family: "inherit","serif";">Sensory
craving:</span></b><span style="font-family: "inherit","serif";"> I'll venture
this definition: <span style="background: white;">goal-driven behavior to satisfy
a sensory need.</span> The DSM more broadly talks about "unusual interest
in sensory aspects of the environment ... such as ... excessive smelling or
touching of objects, visual fascination with lights or movement."</span></div>
<br />
<div style="line-height: 115%;">
<span style="font-family: "inherit","serif";">Did you
catch any problems? Stereotypy is defined in terms of motor, craving in terms
of the senses—as if the two inhabit separate worlds or separate people. But
they don’t. Let’s look at a few cases and see how the symptoms might occur in
real life. </span></div>
<br />
<div style="line-height: 115%;">
<span style="font-family: "inherit","serif";">We’ll
start with the example of the child who frequently vocalizes simple sounds or
phrases. Is it echolalia--a motor repetition? Or is it sensory
seeking: fascination with the sounds she produces, or the sensation
in her throat? Or is she doing it for some other reason such as attention
seeking? Without knowing what is driving the behavior, it's hard to classify
it. In fact, the behavior may be driven by all of these factors.
The stereotypy may co-exist with sensory seeking, and once the child learns
that her behaviors draw attention, she may use them to do so. </span></div>
<br />
<div style="line-height: 115%;">
<span style="font-family: "inherit","serif";">How do
school professionals view this behavior? It will likely be a mixed bag. First,
behaviorists</span><span style="font-family: "Cambria Math","serif"; mso-bidi-font-family: "Cambria Math";">⁵</span><span style="font-family: "inherit","serif";"> and
sensory therapists will agree that the child is being rewarded by the sensation
of certain sounds. She is <i>craving</i> sensory stimulation; but she is
also engaging in <i>stereotypy:</i> behavior that generates its own reward.
While there is definite overlap of stereotypy and sensory craving here, they
will probably name it stereotypy and sensory therapists will look for any
connection to craving. Teachers, who are with children for long periods and can
see patterns in their behaviors, will be more attuned to the possibility of
attention seeking.</span></div>
<br />
<div style="line-height: 115%;">
<span style="font-family: "inherit","serif";">Now
let's explore this a little further. What about the child who has vocal
tics. Does he fall into the categories of stereotypy or craving?
No. Tics are involuntary speech and are usually the result of stress and
anxiety. </span></div>
<br />
<div style="line-height: 115%;">
<span style="font-family: "inherit","serif";">How
about a child who talks constantly? We see this in Asperger's Syndrome and
it is often pegged as repetitive behaviors, but constant talking is
also a symptom of ADHD hyperactivity. How do you distinguish between
impulsive talking and self-rewarding ("He just likes
to hear himself speak") stereotypy? For the unpracticed observer, the
signs seem subtle, but the give-away to it being a repetitive behavior is
constant talking about a single topic (such as types of
aircraft). Finally, is the non-stop talking a sensory behavior?
That's possible, but less likely. </span></div>
<br />
<div style="line-height: 115%;">
<span style="font-family: "inherit","serif";">Let's
look briefly at a few more examples: children who touch everything or
sniff things. Are these considered sensory cravings? Almost certainly, but it
may be more than that. Some children learn about their world using alternate
sensory paths: smell or touch instead of vision and hearing, and so the seeking
behaviors may be a form of learning. But which came first: the craving or the
learning pattern? It’s hard to know. And to further complicate things, the
behavior can also be tagged as stereotypy, if she smells or touches the
same things over and over in an “invariant pattern”. </span></div>
<br />
<span style="font-family: "inherit","serif";">Finally, let’s ask if a
behavior that looks like stereotypy is actually obsessive compulsion
(OCD). Hmm, it could be. The child who touches things in a certain prescribed
way, may have OCD. The motivation for the behavior will be fear-based: "If
I don't move in this exact sequence, something bad will happen",
rather than the reward-based behavior of stereotypy. (The topic of
differentiating OCD from stereotypy is explored in an article by Chok and Koesler
in the September, 2014 issue of Behavior Modification journal, a special issue
devoted to stereotypy, and I may blog on that at a later time.)</span><br />
<br />
<span style="font-family: "inherit","serif";">You can see that symptoms
can be easily confused. In my years of teaching classes on the topic
of self-regulation, I heard numerous accounts of doctors confusing
craving or stereotypy with hyperactivity or OCD and giving children
ADHD or OCD meds. It's truly important to distinguish the nuanced behavior
so that the correct intervention is given.</span><br />
<br />
<span style="font-family: "inherit","serif";">In my next post, I'll look
at the approaches taken by behavioral and sensory therapists to stop these
behaviors. Sometimes the interventions are surprisingly alike.</span><br />
<br />
</span><div style="line-height: 115%;">
<b><span style="font-family: inherit;"> Footnotes and </span></b><span style="font-family: inherit;"><b>References</b></span></div>
<ol>
<li>
<span style="font-family: inherit;">Autism Spectrum Disorder</span></li>
<li><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-no-proof: yes;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span><span style="font-family: inherit;">American Psychiatric Association. (2013). </span><i><span style="font-family: inherit;">Diagnostic and Statistical Manual of Mental Disorders.</span></i><span style="font-family: inherit;"> Arlington, VA: American Psychiatric Association.</span></li>
<li><span style="font-family: inherit;">Attention-Deficit Hyperactivity Disorder</span></li>
<li><span style="font-family: inherit;">Rapp, J. T., & Lanovaz, M. J. (2014). Introduction to the special issue: Assessment and treatment of stereotypy. </span><i><span style="font-family: inherit;">Behavior Modification</span></i><span style="font-family: inherit;">, 339-343.</span></li>
<li><span style="font-family: inherit;">Rispoli, M., Camargo, S. H., Neely, L., Gerow, S., Lang, R., Goodwyn, F., & Ninci, J. (2014). Pre-session satiation as a treatment for stereotypy during group activities. </span><i><span style="font-family: inherit;">Behavior Modification</span></i><span style="font-family: inherit;">, 392-411.</span></li>
<li><span style="font-family: inherit;">Chok, J. T., & Koesler, B. (2014). Distinguishing obsessive compulsive behavior from stereotypy: A preliminary investigation. </span><i><span style="font-family: inherit;">Behavior Modification</span></i><span style="font-family: inherit;">, 344-373.</span></li>
</ol>
<span style="font-family: inherit;"></span><br />
<span style="font-family: inherit;"></span><br />
<br />Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com1tag:blogger.com,1999:blog-2679489967886670428.post-34039435462049936212016-07-08T09:34:00.004-07:002016-07-08T09:34:55.472-07:00Intro Post: Distinguishing Sensory Craving, Stereotypy, Impulsivity, Tics and Obsessive Compulsion
<br />
<div style="line-height: 115%;">
</div>
<div style="margin: 0in 0in 10pt;">
<span style="font-family: calibri;">The ASD¹ (autism) symptoms of sensory craving and stereotypy
are described separately within the ASD diagnosis in the DSM-5², so you might
think they are distinct from each other. But that is not the case. They can be
easily mistaken for each other, and at times they overlap with each
other. In the next two posts, I’ll take a look at the blurry lines between
them and with other similar issues: the hyperactivity of ADHD³,
tics, and obsessive compulsion. I'll discuss the implications for both
assessment and intervention.</span></div>
<div style="line-height: 115%;">
</div>
<div style="margin: 0in 0in 10pt 0.5in; text-indent: -0.5in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: calibri;">References</span></b></div>
<ol>
<li><div style="line-height: 115%;">
<span style="font-family: calibri;">Autism Spectrum Disorder</span></div>
</li>
<li><div style="line-height: 115%;">
<span style="font-family: calibri;">American Psychiatric Association. (2013). </span><i><span style="font-family: calibri;">Diagnostic and Statistical Manual of Mental Disorders.</span></i><span style="font-family: calibri;"> Arlington, VA: American Psychiatric Association.</span></div>
</li>
<li><div style="line-height: 115%;">
<span style="font-family: calibri;">Attention-Deficit Hyperactivity Disorder</span></div>
</li>
</ol>
<div style="line-height: 115%;">
</div>
Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com1tag:blogger.com,1999:blog-2679489967886670428.post-8983598942987722122016-06-27T09:32:00.003-07:002016-08-01T06:49:18.010-07:00Environmental Enrichment (Multisensory Enrichment for Autism!)Environmental Enrichment (EE) is an awesome protocol that has been shown to decrease autism symptoms and sensory issues and to increase receptive language and cognitive skills in children with ASD of all ages. It was designed as a low-cost program for parents to do at home. But, it can also be done in a school setting, or better yet, shared between home and school. <br />
<br />
EE is a 6-month protocol with activities that change every two weeks. Parents/teachers select several multi-sensory activities from a list of 34 activities and do them for the two week period. They work with the child twice a day for about 15-20 minutes each. As the sessions progress, the child gains awareness of sensation and gains multi-sensory integration skills. The activities also build joint-attention skills, which are known to decrease autism severity.<br />
<br />
The protocol is simply described in two published papers (listed below). They are open-access (available for free online). In addition, my Hands-On Activities book devotes 80 pages to the protocol, providing perhaps 200 activity variations and talking through program implementation details. <br />
<br />
Give it a try and let me know how it goes!<br />
<br />
<u>References:</u> <br />
<br />
<span style="font-family: "calibri";">Woo, C. C., & Leon, M. (2013). <a href="https://www.apa.org/pubs/journals/releases/bne-127-4-487.pdf" target="_blank">Environmental enrichment as an effective treatment for autism: A randomized controlled trial</a>.
</span><i><span style="font-family: "calibri";">Behavioral Neuroscience</span></i><span style="font-family: "calibri";">, 487-97.</span><br />
<br />
<div style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; text-indent: -.5in;">
<span style="font-family: "calibri";">Woo, C., Donnelly, J. H., Steinberg-Epstein, R. R.,
& Leon, M. (2015). <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4682896/" target="_blank">Environmental enrichment as a therapy for autism: a clinical trial replication and extension.</a> </span><i><span style="font-family: "calibri";">Behavioral Neuroscience</span></i><span style="font-family: "calibri";">,
412-422.</span></div>
Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com1tag:blogger.com,1999:blog-2679489967886670428.post-32420443044756276762016-06-27T07:11:00.000-07:002016-08-01T06:50:48.245-07:00My latest book, Hands-On Activities for Children with Autism and Sensory Disorders is available through my publisher, <a href="http://pesi.com/ECommerce/ItemDetails.aspx?ResourceCode=PUB084350" target="_blank">PESI.com</a>, and at <a href="https://www.amazon.com/Self-Regulation-Interventions-Strategies-Emotions-Disorders/dp/1936128772?ie=UTF8&ref_=asap_bc" target="_blank">Amazon</a>. It has all new interventions and focuses on sensory, especially multi-sensory, activities. Topics include Environmental Enrichment for children with autism, sensory enrichment for all children, and aerobics for the classroom. It's great stuff. Check it out!<br />
<br />
As I begin to work on my next book: self-regulation strategies for the Pre-K to grade 2, I'll be previewing topics in my blog posts. So stay tuned for lots of great new material!<br />
<br />
TeresaTeresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com1tag:blogger.com,1999:blog-2679489967886670428.post-13812222234439400932016-03-21T10:19:00.002-07:002016-03-21T10:34:54.059-07:00I will be at AOTA. Stop by my poster session 9:00 on Saturday. I'll be at poster station 6066.<br />
<br />
I'm very excited about my new book,<i> Hands-on Activities for Children with Autism and Sensory Disorders</i>. It presents a range of sensory activities for sensory awareness, desensitization, immersion and regulation. It's out in April. Click on the photo on the right for more info.<br />
<br />
Also, I am giving a new workshop this year in New Jersey and Chicago called, <i>Regulating Children with Autism or Sensory Disorders: Cutting Edge Interventions to Satisfy Sensory Cravings and Sensitivities</i>.<i><b> </b></i>The material is based on the content of my new book. The workshops are being presented by <a href="http://pesi.com/" target="_blank">PESI.</a>Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com0tag:blogger.com,1999:blog-2679489967886670428.post-40000358604713065772014-07-31T09:28:00.000-07:002014-07-31T09:28:59.375-07:00Sensory and Autism - Differences in Brain WiringToday is a good day for research results. <a href="http://www.sciencedaily.com/releases/2014/07/140730140918.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fmind_brain+%28Mind+%26+Brain+News+--+ScienceDaily%29" target="_blank">Here</a> is a science digest synopsis of research showing that sensory and autism issues can be distinguished from each other using MRI DTI techniques. The entire article is open access and can be found <a href="http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0103038" target="_blank">here</a>.Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com1tag:blogger.com,1999:blog-2679489967886670428.post-31399869369190091042014-07-31T06:08:00.001-07:002014-07-31T06:08:42.094-07:00Food Intolerances; Brain InflammationAutism Speaks Science Digest is a great source for keeping track of research findings that affect the day-to-day lives of parents of children with autism. This issue had two interesting articles I'd like to share with you. The first talks about <a href="http://www.autismspeaks.org/blog/2014/07/18/can-food-allergies-aggravate-autism-symptoms?utm_source=email&utm_medium=text-link&utm_campaign=sciencedigest" target="_blank">food intolerances and behaviors</a>. The second is about <a href="http://www.autismspeaks.org/science/science-news/researchers-target-inflammation%E2%80%99s-role-brain-disorders?utm_source=email&utm_medium=text-link&utm_campaign=sciencedigest" target="_blank">brain inflammation and autism</a>.<br />
<br />
You can subscribe to the digest to an email version that shows up twice a month in your mailbox.<br />
<br />
<br />
<br />
References:<br />
<br />
1. Food and intolerances: <a href="http://www.autismspeaks.org/blog/2014/07/18/can-food-allergies-aggravate-autism-symptoms?utm_source=email&utm_medium=text-link&utm_campaign=sciencedigest">http://www.autismspeaks.org/blog/2014/07/18/can-food-allergies-aggravate-autism-symptoms?utm_source=email&utm_medium=text-link&utm_campaign=sciencedigest</a><br />
<br />
2. Inflammation: <a href="http://www.autismspeaks.org/science/science-news/researchers-target-inflammation%E2%80%99s-role-brain-disorders?utm_source=email&utm_medium=text-link&utm_campaign=sciencedigest">http://www.autismspeaks.org/science/science-news/researchers-target-inflammation%E2%80%99s-role-brain-disorders?utm_source=email&utm_medium=text-link&utm_campaign=sciencedigest</a>Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com1tag:blogger.com,1999:blog-2679489967886670428.post-82042462241403398962014-01-12T10:03:00.000-08:002014-01-12T10:03:34.028-08:00New Materials from CDC on Autism<br />
There are a few new items worth checking out on the autism page of the Center for Disease Control (CDC).<br />
<br />
** <a href="http://www.cdc.gov/ncbddd/actearly/ACT/class.html" target="_blank">Autism Case Training</a> is a program to train health practitioners in "identifying, diagnosing, and managing autism spectrum disorders through real life scenarios." There are 5 training segments with lessons, videos and printable handouts. What I like best is the series of back-to-back videos showing development and behaviors of typical children versus that of children with autism. The training program was developed with pediatricians in mind, but it is valuable for others working with children with ASD.<br />
<br />
** The <a href="http://www.cdc.gov/ncbddd/features/SEED-announcement.html" target="_blank">CDC's Seed II Study</a> is conducting a large, multi-state study of the risk factors in autism and developmental delays. The study focuses on the differences in children ages 2-5 with and without autism. It looks at environmental factors, genetics and physiological data including saliva, blood samples and bowel activity. <br />
<br />
** A <a href="http://www.cdc.gov/ncbddd/autism/documents/ADDM-2012-Community-Report.pdf" target="_blank">report on the state of autism</a> based on the large study that the CDC conducted in 2008 is also available.Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com1tag:blogger.com,1999:blog-2679489967886670428.post-13338845042273152272013-12-30T08:14:00.004-08:002014-01-03T18:49:03.366-08:00Identifying safe products for families - EWGHello to all and a Happy New Year!<br />
<br />
I have written about EWG before, but let me put in a plug for them one more time. These folks are making a difference.<br />
<br />
There is ample evidence that environmental factors are at play in many disorders -- autism is associated with air pollution and landfills. ADHD has known links to lead, pesticides and food additives and coloring. Alzheimer's is similarly affected by toxins in the environment. And of course, there is cancer. Research continues to establish risk factors, but how do we keep track of what is safe? <br />
<br />
EWG is a non-profit organization devoted to doing just that. They maintain large data bases of consumer products (cosmetics, soaps, foods, etc.) that provide for each product an overall safety rating, a list of ingredients and associated health and environmental risks due to using that product. <br />
<br />
They make the database available to all, and they are easy to use. You can look up products you are using or research new products you intend to buy and make decisions based on factual data as opposed to advertised claims. <br />
<br />
EWG does fund raising throughout the year and are currently conducting their year-end drive. They are worthy folks. Check them out at EWG.org. If you like what you see, consider sending them a gift via Paypal at <a href="mailto:donations@ewg.org"><strong><span style="color: #317f4f;">donations@ewg.org</span></strong></a>.<br />
<br />
TeresaTeresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com1tag:blogger.com,1999:blog-2679489967886670428.post-10019963226282048792013-12-24T07:44:00.001-08:002014-01-03T18:49:20.419-08:00Autism and gut microbesHere is a quick bit of info about autism and gut microbes and MAYBE the start of some very important medical interventions. Hang onto your hats, it's going to be a ride.<br />
<br />
A new and very important bit of research shows that:<br />
<br />
<a href="http://www.sciencedaily.com/releases/2012/01/120109211825.htm">Gut bacteria in kids with autism differs greatly from that of their peers</a>.<br />
<br />
Recent work with mice showed that <a href="http://www.sciencedaily.com/releases/2013/12/131205141900.htm">probiotic therapy alleviates autism-like behaviors in mice</a>.<br />
<br />
Another <a href="http://www.sciencedaily.com/releases/2013/12/131219130742.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fmind_brain+%28ScienceDaily%3A+Mind+%26+Brain+News%29">story confirms the importance</a> and calls it groundbreaking.<br />
<br />
In Canada, <a href="http://www.sciencedaily.com/releases/2013/04/130424112309.htm">one study is using a vaccine</a> (uh-oh, the "V" word) to control <em>Clostridium bolteae </em>bacteria in the gut.<br />
<br />
Hope some of this (dare we hope, all of it) pans out!!<br />
<br />
Happy holidays, everyone!Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com2tag:blogger.com,1999:blog-2679489967886670428.post-79500899477253433692013-11-25T14:45:00.001-08:002013-11-25T14:56:57.938-08:00A Quick Look at Barkley's Theory of Executive Functions<span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; mso-fareast-font-family: KaiTi;"><em>Here is a post for theory lovers.</em></span><br />
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<span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; mso-fareast-font-family: KaiTi;">Psychologist Russell Barkley's new book, <em>Executive Functions</em> (Guilford Press, 2013), contains a large-scale theory of executive function and self-regulation skills. </span></div>
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<span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; mso-fareast-font-family: KaiTi;">He begins the book by arguing that we do not have a clear picture of what executive function is. Next he uses logical reasoning and a method derived from the work of evolutionary biologist, Richard Dawkins'(<em>The Selfish Gene) </em>to create a model of executive functioning consisting of five distinct layers or levels that we move through as we develop and mature. Finally, he describes each layer, how it works, what can go wrong and what types of interventions are helpful. The material in this last section rests firmly on the advances of neuropsychological research. Before he has concluded the book, he claims that executive function and self-regulation are equivalent and further claims that ADHD is the chief disorder of executive function. </span></div>
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<span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; mso-fareast-font-family: KaiTi;">Here are the five levels:</span></div>
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<span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif;"><span style="line-height: 115%; mso-fareast-font-family: KaiTi;"> </span><b><span style="line-height: 115%; mso-fareast-font-family: KaiTi;">1. Pre-EF</span></b><span style="line-height: 115%; mso-fareast-font-family: KaiTi;"> underlies true executive function (EF) in the brain. This is our raw sensing, attention /awareness, motor, emotions, language and our automated responses. We may respond to what we feel, see and hear but do not exert anything but primitive control over our reactions.</span></span></div>
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<span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif;"><span style="mso-fareast-font-family: "Times New Roman";"> </span><b style="mso-bidi-font-weight: normal;"><span style="mso-bidi-font-family: Aharoni; mso-fareast-font-family: KaiTi;">2. Self-directed EF </span></b><span style="mso-bidi-font-family: Aharoni; mso-fareast-font-family: KaiTi;">is the first level of true EF. With this level's set of skills we create our first set of reactions to what is happening within us and around us. These reactions are directed inward rather than outward to others. This level allows us to regulate our response to our body, emotions and environmental input (via our senses). The functions are:</span><span style="mso-fareast-font-family: "Times New Roman";"> </span><span style="mso-bidi-font-family: Aharoni; mso-fareast-font-family: KaiTi;">Self-awareness, self-restraint (inhibition), sensory-motor actions, private speech or self-talk, appraisal including calculating the emotional cost of an action, play, reconstitution of memories and thoughts, and problem-solving.</span><span style="mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; mso-fareast-font-family: KaiTi;">Here is an example: if I am confused and don’t want anyone to know, I will work to keep my face from showing confusion. To the degree that I keep my body still and hide my emotions, no one is privy to what I am feeling. </span><span style="mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif;"><b style="mso-bidi-font-weight: normal;"><span style="line-height: 115%; mso-bidi-font-family: Aharoni; mso-fareast-font-family: KaiTi;">3. Self-reliant EF </span></b><span style="line-height: 115%; mso-bidi-font-family: Aharoni; mso-fareast-font-family: KaiTi;">gives us the self-management skills necessary to be independent with activities of daily living (ADLS) such as dressing, preparing food, eating and so on. Barkley compares the person operating at this level to Robinson Crusoe who was able to manage his life on his own without social support. However, at this level, we may find ourselves occasionally competing for resources. People operating at this level are performing in a social context, but it is “everyone for themselves.” A child at this level will be competing for toys or play-space during parallel play, or competing with a sibling for a parent’s affection.</span><span style="line-height: 115%; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif;"><span style="line-height: 115%; mso-fareast-font-family: "Times New Roman";"> </span><b style="mso-bidi-font-weight: normal;"><span style="line-height: 115%; mso-bidi-font-family: Aharoni; mso-fareast-font-family: KaiTi;">4. Tactical-reciprocal EF:</span></b><span style="line-height: 115%; mso-bidi-font-family: Aharoni; mso-fareast-font-family: KaiTi;"> At this level, we use social relationships to achieve our goals. We learn to share and we provide mutual help to friends. We learn what it means to be a friend, and we begin to act accordingly. We begin to regulate our actions, emotions, sensory behaviors, and social behaviors for the purpose of successfully interacting with others. For the first time, moral rules come into play. </span><span style="line-height: 115%; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif;"><b style="mso-bidi-font-weight: normal;"><span style="line-height: 115%; mso-bidi-font-family: Aharoni; mso-fareast-font-family: KaiTi;">5. Strategic-cooperative EF</span></b><span style="line-height: 115%; mso-bidi-font-family: Aharoni; mso-fareast-font-family: KaiTi;"> is more an extension of tactical-reciprocal EF than a set of new functions. At this level, our actions have a larger scope. We may make career decisions, volunteer to help with a community project, get involved with political activities, or organize a large group for a united goal. The concerns of this level are adult-oriented, but an older teen can begin to work through issues that involve strategic-cooperative EF skills. </span><span style="line-height: 115%; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; line-height: 115%; mso-fareast-font-family: "Times New Roman";">Knowing these five levels of executive function can guide those of us who work with children and young adults with ADHD. It helps us select interventions that are appropriate to their EF development level as opposed to their age level. In this way, we can help them move from where they are stuck into the next level of their growth.</span><span style="line-height: 115%; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com0tag:blogger.com,1999:blog-2679489967886670428.post-59257746745453339602013-11-25T12:53:00.002-08:002016-12-08T12:38:30.348-08:00Nurtured Heart Approach<br />
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</v:shape><![endif]--><!--[if !vml]--><!--[endif]--><span style="font-family: "calibri" , "sans-serif"; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">When I mentioned Howard Glasser's
work, <em><span style="font-family: "calibri" , "sans-serif"; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">The Nurtured Heart Approach </span></em><em><span style="font-family: "calibri" , "sans-serif"; font-style: normal;">during one of my seminars as an example of a
program for developing positive parenting/teaching/therapy skills, someone in
the back asked, ‘Is that back in style again?’</span></em></span><br />
<br />
<em><span style="font-family: "calibri" , "sans-serif"; font-style: normal;"><o:p><span style="font-family: "times new roman";">The</span></o:p></span></em><em><span style="font-family: "calibri" , "sans-serif"; font-style: normal;"> question caught me by surprise. Things go in and out of fashion, it’s
true. But this method seems to have a great deal of relevance today: </span></em><br />
<em><span style="font-family: "calibri" , "sans-serif"; font-style: normal;"></span></em><br />
<em><span style="font-family: "calibri" , "sans-serif"; font-style: normal;"> “<span style="font-family: "times new roman";">Parenting skills training helps parents learn how to use a system of rewards and consequences to change a child's behavior.</span></span></em><span lang="EN" style="mso-ansi-language: EN;">Parents are taught to give immediate and positive feedback for behaviors
they want to encourage, and ignore or redirect behaviors they want to
discourage.”</span><em><span lang="EN" style="font-family: "calibri" , "sans-serif"; font-style: normal;"> </span></em><em><span style="font-family: "calibri" , "sans-serif"; font-style: normal;"><o:p></o:p></span></em><br />
<br />
<em><span style="font-family: "calibri" , "sans-serif"; font-style: normal;"><o:p><span style="font-family: "times new roman";"> </span></o:p></span></em><em><span style="font-family: "calibri" , "sans-serif"; font-style: normal;">There are other “flavors” of positive interaction programs including
Love and Logic and Positive-Parenting. It is the simplicity of the Nurtured Heart
Approach that draws me to it.<o:p></o:p></span></em><br />
<br />
<em><span style="font-family: "calibri" , "sans-serif"; font-style: normal;"><o:p><span style="font-family: "times new roman";"> </span></o:p></span></em><em><span style="font-family: "calibri" , "sans-serif"; font-style: normal;">Glasser’s three big lessons are:<o:p></o:p></span></em><br />
<br />
<div style="margin-left: 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><em><span style="font-family: "calibri" , "sans-serif"; font-style: normal;"><span style="mso-list: Ignore;">1)<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span></em><!--[endif]--><em><span style="font-family: "calibri" , "sans-serif"; font-style: normal;">Do
not feed a child’s negative impulses with attention to him when he is
acting-out </span></em></div>
<em><span style="font-family: "calibri" , "sans-serif"; font-style: normal;"><span style="mso-list: Ignore;"> 2)<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span></em><!--[endif]--><em><span style="font-family: "calibri" , "sans-serif"; font-style: normal;">Give tons of positive attention to the child
at times when he is not acting out</span></em><br />
<div style="margin-left: 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "calibri" , "sans-serif"; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-list: Ignore;">3)<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><em><span style="font-family: "calibri" , "sans-serif"; font-style: normal;">Absolutely follow through with consequences when
a rule is broken rule so that there is no confusion regarding what is okay and
what is not okay.</span></em><span style="font-family: "calibri" , "sans-serif"; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><o:p></o:p></span></div>
<br />
<span style="font-family: "calibri" , "sans-serif"; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"> </span><span style="font-family: "calibri" , "sans-serif"; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">A 6-hour <a href="http://www.childrenssuccessfoundation.com/nha-trainings/online-trainings/"><span style="color: blue;">internet-based
training class</span></a> (for CEUs) is available from Glasser that very clearly
describes his philosophy and shows how his techniques can help the challenging children and
adults in your life. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span><br />
<br />
Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com1tag:blogger.com,1999:blog-2679489967886670428.post-16290973646432761762013-11-03T10:55:00.001-08:002013-11-03T10:55:25.717-08:00The Book is WrittenIt is great to be back writing the blog again. My book, Self-Regulation Strategies and interventions, is written and edited. The publisher, Premier Publishing, is prettying-up the graphics and laying out the book. They haven't given me a release date, but I believe it will be late December or early January. <div><br></div><div>Content is similar to the topics I cover in this blog and in my PESI course, Self-Regulation in Children -- but with much more theory and a ton more interventions than I have time for in my class. I'll announce the publication date when I get it. </div>Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com0tag:blogger.com,1999:blog-2679489967886670428.post-64526761557787063972013-06-02T19:22:00.002-07:002013-06-02T19:22:46.465-07:00OT Self-Regulation BlogTaking a Break for the SummerDear Readers,<br />
<br />
I will be on break from the blog until sometime in September while I complete a book on Self-Regulation and help see my ailing mother through a bit of a crisis. See you then!<br />
<br />
Teresa<br />
<br />
Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com0tag:blogger.com,1999:blog-2679489967886670428.post-51849485184502579472013-04-13T10:35:00.001-07:002014-01-03T18:50:11.367-08:00The Sun and ADHD DiagnosisAnother brief post: the <a href="http://questioning-answers.blogspot.com/2013/04/adhd-and-sunny-disposition.html">Questioning Answers</a> blog has a nice discussion on the topic of solar intensity and the occurence of ADHD. Also go <a href="http://bio-medical.com/media/blog/arns-2013-geographic-variation-in-the-prevalence-o.pdf">here</a> for a discussion of the research on this topic by its key author.<br />
<br />
*Corrections made to links on 6/2/13Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com0tag:blogger.com,1999:blog-2679489967886670428.post-1697336304484662042013-04-12T09:37:00.002-07:002014-01-03T18:50:44.255-08:00Paul Whiteley's Questioning Answers and IACC 2012 Research HighlightsThere is an excellent blog out of the UK called <a href="http://questioning-answers.blogspot.com/" target="_blank">QuestioningAnswers</a> that tracks biological research in autism around the world. Paul Whiteley, the blog's author is a researcher himself as well as a competent writer. He provides the context of the articles he reviews as well as pointers to similar papers. If you like to go deep and see what's out there, this is for you.<br />
<br />
In that same light, the Interagency Autism Coordination Committee (IACC) published a <a href="http://iacc.hhs.gov/summary-advances/2012/index.shtml#citation-list-selected-articles" target="_blank">review of advances in autism research this past year</a>. Paul Whitely reviewed the review this past week (April 9, 2013) and added to it. Check it out.<br />
<br />
<u>References</u>:<br />
<br />
1. IACC Website: <a href="http://iacc.hhs.gov/summary-advances/2012/index.shtml#citation-list-selected-articles">http://iacc.hhs.gov/summary-advances/2012/index.shtml#citation-list-selected-articles</a><br />
<br />
2. QuestioningAnswers blog:<a href="http://questioning-answers.blogspot.com/" target="_blank">http://questioning-answers.blogspot.com/</a>Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com1tag:blogger.com,1999:blog-2679489967886670428.post-63392948078333455372013-03-21T17:25:00.001-07:002014-01-03T18:51:08.074-08:00UCLA Mindfulness MeditationI found a source of Guided <a href="http://marc.ucla.edu/body.cfm?id=22" target="_blank">Mindfulness Meditation at UCLA</a>. And best of all, the meditations (7 for PC, 15 for iTunes) are free. If you have an iPod, iPhone, iPad you can download them from iTunes. If you are using a PC, you will select to play the meditation on your computer. Bookmark the web page so that you can easily get back to it. <br />
<br />
Remember, 15-20 minutes of Mindfulness Meditation a day increases attention skills in teenagers and adults with ADHD by 30% - with or without meds. And by the way, this is 30% over and above the effect they are getting from meds if they are on them. Meditation also decreases anxiety and makes people happier :)<br />
<br />
If you want to learn more on the topic, there are two lectures on the UCLA site including a Ted lecture on Mindfulness Meditation by Diana Winston.Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com1tag:blogger.com,1999:blog-2679489967886670428.post-8061835085800515112013-01-18T10:47:00.000-08:002013-01-18T10:47:15.154-08:00Videos on Diet and ADHDI am a fan of psychiatrist, Dr. Charles Parker - author of <em>The New ADHD Medication Rules</em>. Dr. Parker makes a study of the roles our gut and brain chemistry play in sensitivities to meds. He has put together a set of short <a href="http://www.youtube.com/playlist?list=PL321-bGRTfd8aFE_AhB43UnsRTiYAo6me" target="_blank">videos</a> that speak to those issues and to food sensitivities. There are related articles on his website at <a href="http://www.corepsych.com/" target="_blank">CorePsyche.com</a>. Check it out!Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com2tag:blogger.com,1999:blog-2679489967886670428.post-21002709451266574322013-01-09T07:41:00.000-08:002014-01-03T18:52:06.007-08:00Update for Short Sensory Profile SDsLast month I created a post explaining the method used to diagnose SMD (Sensory Modulation Disorder). I was missing a little data and promised an update ... It is now updated. Go <a href="http://otselfregulation.blogspot.com/2012/12/criteria-for-screening-smd-with-sensory.html" target="_blank">here</a> to read the updated post.Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com0tag:blogger.com,1999:blog-2679489967886670428.post-87669817086802700292012-12-31T17:20:00.000-08:002014-09-02T11:57:51.149-07:00Polyvagal Theory, Sensory Challenge and Gut EmotionsHave you heard about Dr. Stephen Porges' Polyvagal Theory? The theory, already 20 years old, replaces our old notions of how the sympathetic (fight/flight) and parasympathetic nervous systems (rest and recuperation) help to keep us calm, alert and safe. The area covered by Polyvagal Theory is huge. It impacts the way we understand our nervous system, senses, emotions, social self and behaviors. We see diagnoses like autism, sensory modulation disorder, borderline personality and others, in a new light. <br />
<br />
Polyvagal Theory claims that the nervous system employs a hierarchy of strategies to both regulate itself and to keep us safe in the face of danger. In fact, it's all about staying safe.<br />
<br />
Our "highest" level strategy is a mechanism Porges calls social engagement. It is a phenomenal system - connecting the social muscles of the face (eyes, mouth and middle ear) with the heart. You knew that your heart came alive with social interaction, and it's true! This system is regulated through a myelinated branch of the vagus nerve. In evolutionary terms, this is our most evolved strategy (mammals only) for keeping ourselves safe. We use this all the time to clear up misunderstandings, get help, plead for forgiveness, and so on.<br />
<br />
The next mechanism, or strategy, is fight or flight. It's regulated by the sympathetic nervous system. This system is our fall-back strategy when social engagement isn't a good fit. (Think of seeing someone sneaking up on you!) Note that freeze is <em>not</em> a part of fight or flight. <br />
<br />
Our freeze option is primal and is a remnant of our reptilian past. Freeze is a great strategy for turtles and lizards, but it's usually a bad idea for humans - think of fainting. Therefore, we typically use it last, when social engagement and fight/flight aren't going to work for us. But there are good uses for freeze. During severe injury, it shuts us down and turns off our registration of pain. We also make use of it during sex, and it helps women regulate pain and response to pain during labor.<br />
<br />
Now these systems appear to work in tandem. The social engagement system puts the brakes on the other (fight, flight, freeze) strategies, thus keeping our heart and body active while we work through a situation. The social engagement system will release the brakes to engage a different response to the environment (i.e. running) if engagement doesn't help to get us into a safe situation.<br />
<br />
<strong>What Can Go Wrong</strong><br />
We want our nervous system to operate using the social exchange most of the time. It is our most evolved way of being. It is restful and healthy because it allows our gut and other organs to do their job uninterrupted. <br />
<br />
However, some of us are programmed from an early age to work from a fight/flight mode. Think of people who are sensory sensitive and recoil from sound, touch, smell or taste. Think of people with autism (in this case, the face to heart connection is not working). Think of people with borderline personality, depression and perhaps other disorders, too. When we are not able to work from our social engagement strategy, then we revert to a modified fight/flight strategy, which puts us in high alert. If we use too much of the fight/flight or freeze strategies, we may end up with gut issues because the gut comes to a halt and we stop digesting food during fight/flight activation.<br />
<br />
The Polyvagal Theory has gained great acceptance over the years as pieces of it are shown to hold under laboratory findings. From a psychological viewpoint, it provides us with a rich understanding of self-regulation in the body. From a sensory processing viewpoint, it informs our understanding of sensory modulation. <br />
<br />
If you are unfamiliar with the topic, check out the many articles on <a href="http://stephenporges.com/" target="_blank">Dr.Porges' website.</a> The most comprehensive article is <em>The Polyvagal Perspective, </em>and it is <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1868418/" target="_blank">published here </a>on the NIH Public Access site. It contains the physiological underpinnings of the theory as well as perspectives on development, emotions, trauma and many other topics. There is a short video of it <a href="http://www.youtube.com/watch?v=8RKC3Ga6shs" target="_blank">here</a>.<br />
<br />
<strong>Sensory Connection</strong><br />
Two researchers looked at a biological marker of the social exchange system, RSA, in typical children and in children with sensory modulation issues. RSA is the measure of high-frequency fluctuation in the heart between heart beats. It is a window into the social exchange system. The researchers found that children with sensory modulation issues have a lower level of RSA than their peers, meaning that these children are better prepared to put the breaks on social strategies and instead use fight-or-flight strategies.<br />
<br />
As part of the study, the children were (each in turn) given a sensory challenge. The chairs they were seated on tilted backwards unexpectedly. The level of RSA was monitored in each child throughout the incident. The RSA of typical children dropped quickly and then stayed low for a short time. The children with poor sensory modulation skills had a very brief drop of RSA and a quick rebound to their RSA baseline. <br />
<br />
This implies that children with sensory modulation symptoms use different strategies to handle safety-related situations than their peers. At this time, it is harder to draw greater conclusions since we do not have an easy-access window into the fight/flight system or the freeze system. With time, we'll get a better understanding of this. The article can be <a href="http://www.frontiersin.org/Journal/Abstract.aspx?ART_DOI=10.3389/fnint.2010.00004&name=integrative_neuroscience" target="_blank">found here</a>.<br />
<br />
<strong>Emotions</strong><br />
Perhaps the most interesting new work making use of the Polyvagal Theory is the work of A. D. (Bud) Craig. Mapping our emotions, this is what he found. (<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2685814/" target="_blank">Read about it here</a>.)<br />
<br />
Emotions arise from feelings in our organs and gut. The feelings are sent via the vagus nerve to the Anterior Insular Cortex (AIC) in the brain. (There's a lot going on in the vagus nerve - think of it as a cable with lots of separate wires.) The AIC captures feelings over time and stores them as snapshots of feelings. This is our working emotional memory. These feelings are massaged and integrated with the social exchange to give us both an emotional response to the world around us as well as a safety-driven strategy. <br />
<br />
Think of this: I am relaxing in a lounge chair on the beach. I feel safe. Suddenly, a beach ball hits me. My fight or flight instinct kicks in and the sympathetic nervous system stops everything that's happening (i.e. digestion) in my organs and gut. The gut passes the feeling of stoppage as "alarm" to the brain. This translates in the brain to fear and my body is set in motion. I quickly turn and see it's a ball and that a child is nearby and smiling at me. My social engagement strategy puts the breaks on my fight/flight response and also calms my heart. I smile at the child. This sends a sense of relief to my gut and it in turn sends a "warm" feeling to the AIC. My heart is still pounding from the surprise, but my response is guided by compassion. <br />
<br />
In the above scenario, we specifically looked at a situation with a challenge to safety. But in fact, we spend much of our time worrying about safety. Unless I am completely safe, listening to quiet music in a locked room, I will most likely have safety challenges to respond to. The challenge may be from the scary book I am reading, or from the sense of anxiety I feel when I drop a spoon on the floor. Almost any activity will involve the combined interaction of the various strategies. The bottom line: we are constantly adjusting ourselves to meet the world. Polyvagal Theory gives us a look at how this works.<br />
<br />
This is pretty complex stuff - and the theory is still in flux. It changes with each new study that looks at the implications of Polyvagal Theory on our response to the world. It is going to impact research greatly in the years ahead. As I mentioned at the beginning, Polyvagal Theory adds a new dimension to how we see autism, sensory issues and other disorders and will, I think, inform our interventions for those disorders in a big way.<br />
<br />
<strong>References:</strong><br />
<ol>
<li><span style="mso-no-proof: yes;"><span style="font-family: Calibri;">Porges, S. W. (2008, February). The Polyvagal Perspective. <i>NIH Public Access</i>, PMC1868418</span></span></li>
<li><span lang="EN" style="mso-ansi-language: EN; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span lang="EN" style="mso-ansi-language: EN; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">Schaaf, R. C., Benevides, T., Blanche, E. I., Brett-Green, B. A., Burke, J. P., Cohn, E.S., Koomar, J., Lane, S. J., Miller, L. J., May-Benson, T.A., Parham, D., Reynolds, S., Schoen, S. A. <span style="mso-spacerun: yes;"> </span>Parasympathetic Functions in children with sensory processing disorder. Front Integr Neurosci. 2010; 4: 4. Published online 2010 March 9. doi: 10.3389/fnint.2010.00004</span></span></li>
<li><span lang="EN" style="mso-ansi-language: EN; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;"><span style="mso-bidi-font-family: Calibri; mso-bidi-font-weight: bold; mso-bidi-language: EN-US; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span style="mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-bidi-language: EN-US; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-fareast;">Craig, A. D. (2009).
Emotional moments across time: A possible neural basis for time perception in
the anterior insula. Philosophical Transactions of the Royal Society of London.
364,1933-1942.<o:p></o:p></span></span><span style="font-family: Times New Roman;">
<o:p></o:p></span></span></li>
</ol>
Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com2