Out of Sync Child- Sensory Modulation Disorder

Have you ever interacted with a client who strongly objects to certain textures, avoids being touched, or displays strong sensitivity to light or a reflection? What about a child with the opposite response? One who doesn’t acknowledge touch, sound or different stimuli? Or how about a client who craves sensory stimulation, like feeling a lot of pressure on the body, listening to loud noises, or enjoying bright lights? Responses such as these may be indicative of Sensory Modulation Disorder.

Written by Carol Stock Kranowitz, “The Out of Sync Child” explores sensory processing disorders (SPD), one of which is sensory modulation disorder. According to the book, SPD is “the inability to use information received through the senses in order to function smoothly in daily life.” Considered an umbrella term, SPD encompasses a variety of neurological disorders, including sensory modulation disorder. Sensory modulation disorder is the “problem of timing in the central nervous system” which can influence inhibitions; this can in turn impact one’s threshold for sensations which can cause overresponsivity, underresponsivity and sensory craving behavior.

Overresponsivity in a child with sensory modulation disorder is the result of hyperresponsive sensations coming from one or several systems. This can result in a child appearing irritated, annoyed, or threatened by particular sensory stimuli. A child with an overresponsive response to sensory stimuli may also be considered a sensory avoider due to the amount of sensory input the child takes in which can make the child avoid situations where sensory arousal may occur (ex: a light touch, his/her reflection, or a loud noise could make the child have a meltdown, become defiant, or even withdraw completely from the situation).

Underresponsivity in a child is a lack of ordinary arousal of sensory systems, which can result in a child responding less intensely to sensations than neurotypical children. A child with an underresponsive response to sensory stimuli may be referred to as a sensory disregarder because of difficulty achieving alertness or arousal in the presence of sensory stimuli. The child may appear withdrawn or may not even recognize sensory stimuli (ex: no response to loud noises, difficulty understanding nonverbal gestures, lack of hunger signals).

The sensory craving child needs far more stimuli than other children and may not recognize when they have had enough sensory stimulation. The child may be attracted, or even addicted to, stimuli such as bright lights, touching certain textures, listening to specific sounds, or places that are busy such as crowds. For a sensory craving child, wanting more and more sensory stimulation is normal and it may be a challenge for the child to know when enough is enough.

So, what does this mean for music therapists? It is important to recognize when, or if, we see sensory modulation disorder characteristics in our clients. It is likely that a child can be a combination of sensory modulation types. For example, a client may be underresponsive to a particular sensory stimulus, such as loud sounds, while being sensory craving for another stimulus, such as reflective surfaces. We can use this information to inform our decisions as music therapists in regards to improving a client’s sensory regulation and also allowing the child to have the most opportunities for success in achieving their goal. If a child craves tactile stimulation, perhaps allow the child to sit on a tactile spiky cushion or incorporate the cabasa while addressing a therapeutic goal. For a child who has difficulty regulating proprioceptive input, you could have client hold weights or heavy instruments during the session. For a child who has trouble regulating vestibular sense, you may consider incorporating movement through the session or allowing the child to be spun in a chair periodically to receive that sensory input. Perhaps a child is overresponsive to visual stimuli; this child may need lights to be dimmed or even turned off in the therapy space, and visual distractions may need to be hidden away as best as possible. If a child is overresponsive to loud noises, lower the dynamics of a song or instrument to encourage the child to continue participating while still providing music stimulus. It may also be necessary to sing a cappella without an accompanying instrument to further decrease the amount of auditory stimulation. (It is also important to note, though, that sometimes quiet in a music therapy session may be necessary to regulate the client if the auditory stimulation proves too overwhelming!)

If you’re interested in learning more about SPD or the neurological disorders that fall under SPD, feel free to read Out of Sync Child!

Katherine

Guitars in the Classroom AMASE Conference: Meeting Clients’ Sensory Needs:

Near the beginning of my (Audrey) internship I had the opportunity to go to the Guitars in the Classroom AMASE conference, with Julie Guy, who presented on using Music Strategies for Sensory Integration in the Classroom. This was such a great experience for me, as I got to get out into the community during my first week of internship, connect with others, network, and help present on music therapy, all while learning more skills to use in my own music therapy sessions! 

The challenge of presenting at this event, was that there was such a wide range of skills, settings, and challenges for the attendees with their students. When asked what challenges these teachers experienced in their classroom or facility they worked at, there was a huge list of behaviors such as biting, distracting noises, hiding under tables and desks, running or jumping, rocking, or scratching. Despite the wide variety of people attending this session at the conference, there was an overwhelming amount of difficulties related to sensory seeking behaviors. Almost all of the behaviors that these individuals noted were related to this. I got to hear all sorts of suggestions and ideas for how to handle these behaviors, and I thought it would be helpful to compile them all in one place!

The first thing to understand is that many of these behaviors that come across as aggressive, mean, defiant, or chaotic may directly relate to a sensory processing disorder. These individuals may not be intentionally disruptive, they may just be trying to get the input they need. Clients may be over or under stimulated, and need something to help calm them down or alert them. Below I have listed many different ways to help clients to receive the sensory input that they need.

First, clients who bite or frequently put objects into their mouths, may benefit from using a chew tubes (often called “chews” or “chewies”) which are usually small rubber items. Chewies can be chewed or sucked on when need sensory input to the jaw. Some styles can be put on a necklace so they are always accessible for a client to help calm them down and provide tactile sensory stimulation.

Next, vibrating pillows. I have seen these used in a session before when a client was exhibiting aggressive behaviors, such as throwing things and hitting the floor and wall. The therapist brought the pillow to him and pushed it against his feet as he was laying on the floor, and this immediately helped the client to calm down. These pillows vibrate when pressure is put on them, so a client can squeeze them, sit on them, put in their lap, lean on them, or any other positioning to create the vibration effect. 

Lastly, any variety of rollers for sensory input can be very effective! You can use foam rollers, ones used for muscle relaxation, or anything that can provide sensory input for clients who are sensory-seekers. 

 

Using instruments that may be calming to a client, or provide sensory stimulation that they may be seeking is a great tool. Examples of sensory instruments include tactile egg shakers, which have bumps on them which provides tactile stimulation and the sound of the shakers can provide auditory input. 

Cabasas are also great source of tactile and auditory input. The cabasa can be rolled along a client’s hands, arms, legs, back, as it may provide a calming sensation for them. 

An ocean drum provides auditory stimulation, as the balls roll around inside the drum, providing a louder sound for clients who may be seeking that. Clients also may enjoy the way that the balls look (visual input) when they roll around in the drum. 

Other items or ideas that may help clients to receive sensory input and stimulation:

• Ice cubes or ice packs 
• A bag filled with sand or rice (can be put on clients lap, or clients can push/pull/lift it)
• Squeezes along client’s hands, arms, or legs
• Squeeze balls
• Bear hugs
• Yoga balls

There are so many more ideas out there for sensory stimulation for clients who may be seeking this! Do you have any other techniques or tips? Let me know in the comments!!

Click here to access presentation handouts for more information.

See you next time!

Audrey 

PS The Out-of-Sync Child is a great resource to learn more about sensory regulation!

Proprioception: A quick guide for the sensory seeking child

Something’s Touching Me!

Your body is always touching SOMETHING. What an interesting thought that most people don’t spend too much time dwelling on. That’s because the brain with a well-regulated tactile sense only briefly makes note of the thing that the body is touching, and then ignores it in favor of more important thoughts and sensations it needs to process. But for a person whose tactile sense is out-of-sync, the textures of certain fabrics or presence of a tag on their clothing may be a source of extreme discomfort and the cause for much distress. Or they may lunge at you for a bear hug because they crave the feeling of deep pressure squeezes. Or they may not seem to notice that their hand is on a hot pan until they have a third degree burn. These are only a few examples, of course. The main point is, our tactile sense helps us determine what we are touching and if the things touching us at every moment of every day are harmful or helpful. An out-of-sync tactile sense may make a person overresponsive to stimuli, underresponsive to stimuli, sensory seeking, or a combination of these, or may make it difficult to determine what the tactile stimulus is or where it is touching.

How does this affect my work as a music therapist? I can start by considering the environment of my treatment space. What is the client’s reaction to the texture of the chair he/she is sitting in? For some of my clients with tactile sensory needs, sitting on a fuzzy pillow that buzzes provides the tactile sensations they need to be aware and in control of their bodies. For other clients, sitting on a rubbery and bumpy cushion serves this same purpose. What is the client’s reaction to the carpet? I have clients who prefer to have their shoes off during sessions. One such client likes having the afore mentioned rubbery cushion under his feet. From which direction is the air conditioning blowing and is it blowing directly on my client? I’ve barely scratched the surface of tactile elements to consider in the environment of the treatment room, but you get the picture.

What about my choice of instruments I use with my clients? Does the client seem to want to touch textured things? I have many clients who are more engaged in our interventions when they play an instrument like the cabasa (picture below), which allows them to rub their fingers along the bumpy beads. Other ideas of instruments with great sensory feedback are guitar strings, chimes, hand drums, ocean drums, and resonator bells. The cabasa is one of my favorite instruments because it acts as a great massager, providing sensory input to arms, legs, backs, and soles of feet. For clients who are seeking tactile sensory stimulation, instruments like the cabasa can provide this in an appropriate way. Encourage the client to play the cabasa (or other instrument) and use it to provide sensory input independently. This way, the client is learning to self-regulate his/her out-of-sync sensory systems.

 

Or for clients with an overresponsive tactile sense, choose instruments that don’t have a rough or uneven texture. Then encourage them to explore tactile sensations using the texture and vibrations of various instruments. This could help reduce defensiveness to certain tactile sensations.

As with all other sensory systems, there are so many things to consider when your child or client has an out-of-sync tactile system. Hopefully the ideas and considerations discussed here have sparked some ideas and increased your awareness of needs related to the tactile sense. Now, I challenge you to stop every now and then and become aware of the sensations on your skin and the things touching your body. Then imagine what it would be like if you could not seem to get enough of or control one of these sensations. How would you fix that?

-Chiara

When Your Vestibular Sense is Out-Of-Sync

First of all, what is the vestibular sense? And where is it? Vestibular receptors are found in the inner ear, in the form of tiny hair cells. The vestibular system helps tell us when we’re up or down, moving or still, which direction we’re moving in, and how fast we’re going. When someone’s vestibular sense is out-of-sync, they may crave speed or be overly sensitive to it, they may be able to spin endlessly without getting dizzy or get motion sickness very easily, they may love dangling upside-down or be terrified of it, or they may not be able to tell if the train they are on is moving or if it’s the train next to theirs. An out-of-sync vestibular system, just like any other out-of-sync sense, likely leads to compensatory behaviors. Some of these may be harmful, disruptive, or not socially appropriate. Furthermore, they may interfere with the person’s ability to function smoothly in everyday life.

           What happens if one of your clients or your child has an out-of-sync vestibular system? They may be underesponsive or overesponsive to vestibular stimuli, or they may seek or crave vestibular stimulation. Any of these forms of sensory processing disorder can cause disturbance and frustration in their everyday functioning. Is the client terrified of moving/being moved? They may have an overesponsive vestibular system. Does the client not notice they are moving? They may have an underesponsive vestibular system. Does the child crave swaying, spinning, or being upside-down? They may be seeking more vestibular stimuli. The challenge arises in the fact that the child’s behaviors are not always so straightforward, and the category of sensory processing disorder under which their symptoms and behaviors fall may not be very clean cut. What I found most challenging is, how do you determine what sensory needs the child has and how to best address them?

The author of The Out-of-Sync Child, Carol Stock Kranowitz, recommends that parents or caregivers keep a diary of their child’s “troubling times,” noting the behavior, the date and time of day, and the circumstances. Parents and caregivers should also keep a diary of the child’s “terrific times,” again noting the behavior, date and time of day, and circumstances. This may help determine triggers for challenging behaviors and also the things or circumstances that lead to the child feeling in-sync. Matching the out-of-sync trigger with the in-sync antidote, can help parents, caregivers, and therapists determine which category of sensory processing disorder the child’s symptoms fall under, and how to provide the appropriate sensory diet and therapy for the child. I am challenging myself to keep track, in a similar way, of “troubling times” and “terrific times” in my some of my clients who have sensory processing needs, in order to better track cause-effect-solution patterns. In doing so, I hope to understand better what I can do to help their senses feel in-sync.

To better understand sensory processing disorders (SPD), or if you suspect your child, a client, or someone you know may have SPD, I highly recommend reading The Out-of-Sync Child by Carol Stock Kranowitz.

– Chiara