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You don’t grow out of sensory difficulties: children with sensory integration or processing difficulties grow into teens and adults with those same issues but, hopefully, plenty of tools to handle them. The teenage years can be a tricky time for individuals with sensory difficulties as they experience all the hormonal chaos of puberty on top of their sensory challenges. This can hamper their ability to self-regulate and make handling all the transitions at this time (different classes, teachers, social situations, bodily changes, etc) hard. You’re quite right to identify that your child will need support during these years.
Individuals with sensory processing difficulties can experience emotions more intensely so it’s important to help them recognise and validate their feelings and employ appropriate calming strategies. Alice Boyes, PhD, writes that there are ten skills of emotional self-regulation that we need to learn before adulthood:
It might help to consider which of these areas your teen needs help with and to acknowledge areas they are already good at.
Here are some ways that parents can support their teenagers to develop their emotional and self-regulation skills:
Can you model good emotional self-regulation and discuss with your teen what strategies you find helpful when feeling strong emotions? Also, just as when your child felt overwhelmed as a toddler and needed a safe, calm adult presence, your teen still needs an adult in their life who can respond appropriately and calmly.
Writer Linda Stade describes these as “spaces and places for kids where they feel free to say how they feel without fear of being ‘shut down’. There is a limit on behaviour but there is not a limit on emotion.” It’s easier to talk to your teen about emotional regulation and strategies when they are calm, not in the middle of a meltdown.
Teens may develop different sensory preferences and may need different sensory activities presented to them. The best way to find out how to support your teen's sensory needs is to seek an evaluation by a Sensory Integration Practitioner who can make recommendations specific to your teen and circumstances.
Your teen will be well aware of what type of clothes, food, sounds, smells or activities soothe them and which distract them to the point of having to focus so much on tolerating them that they have no reserves left to cope with anything else. It’s easier to respect and work with these preferences rather than trying to fight them.
These could include incorporating sensory activities (appropriate to your teen’s sensory needs) into the daily schedule; employing mindfulness exercises; encouraging healthy eating and sleep patterns; learning how to recognise and gauge the intensity of emotions; discussing scenarios and how one might best react; or learning cognitive reframing techniques (reinterpreting a situation in order to change your emotional response to it).
A Sensory Integration Practitioner can help you refine a toolkit of strategies for your teen to help themselves to manage their emotions and responses.
Explain to your teen that their emotional behaviours impact on how other individuals behave and feel towards them. For example, talking over others, not respecting personal space and being over excited can be off-putting to friends.
Learn the indicators of anxiety or depression in your teen, and make time to discuss with them what that might feel and look like so they can self-report it to you too. Seek help from mental health professionals as appropriate.
Teenagers with sensory processing difficulties may be more aware than when they were younger of how their sensory difficulties make them different than their peers. Support them to find and be proud of the strengths of their different sensory experiences and unique perspectives.
The Out-Of-Sync Child Grows Up: Coping with Sensory Processing Disorder in the Adolescent and Young Adult Years by Carol Stock Kranowitz is a fantastic resource. It offers practical advice on living with sensory processing difficulties as well as covering the social and emotional issues that young people face. Topics include strategies for coping with the sensory aspects of grooming, social lives and dating, playing sports and music, and other issues, as well as how to find support and help from loved ones, occupational therapy, and other resources.
Finally, it may help your teen to read first-person accounts from other young adults with sensory processing difficulties:
“Sometimes we need things done a little differently because we can get overwhelmed, but if our needs are met we can be very successful. Do not think of people with sensory processing disorder as less than, because we are not. We can thrive just like everyone else. Sometimes we just need a little extra patience and help” - Alexzandra Benefield Puckett, What It's Like Having Sensory Processing Disorder as a Teen.
Consider your situation, right now, as you are reading this article. Say your goal is to get to the end of the article. This goal requires you to focus your attention: you may have reduced external distractions; you will need to manage any emotional or physiological intrusions that could interfere with your attention; and you will need to stay alert - so you may be sipping a drink or shifting in your chair.
During these few moments, your central nervous system has been registering, integrating and processing a huge amount of complex information from your external and internal environment. The process is both “top-down”, as you consciously ready yourself to focus on the article, but also ‘bottom-up”, as various structures in your brainstem and limbic system monitor and respond to demands in your environment. Your body is doing an awful lot for you to self-regulate enough to simply sit still and read to the end of this article!
But what do we mean by self-regulation? For our purposes, we mean the way in which we regulate our emotions, our levels of arousal, stress levels and levels of attention so that we can carry out the things we need and want to do in our daily life. Self-regulation occurs within our central nervous system and it includes both our ability to to consciously and automatically regulate our emotions, stress response, alertness and attention. It’s the conscious element of self-regulation which means we can learn strategies to improve focus, or help to keep us calm or alert.
What is the link between self-regulation and sensory integration? Firstly, a little about sensory integration. Sensory integration is a theory and a therapeutic approach originally proposed by Dr Jean Ayres. Sensory integration theory draws on evidence related to how the brain works and how neurons in the brain can develop new pathways and strengthen pathways through learning and repetition.
The different parts of our body that receive sensory information from our environment (such as our skin, eyes and ears) send this information up to our brain. Our brain interprets the information it receives, compares it to other information coming in as well as to information stored in our memory and then the brain integrates and uses all of this information to help us respond to our environment. Therefore, sensory integration is important in all the things that we need to do (such as getting dressed, eating, socialising, learning and working).
For most of us, the development of sensory integration occurs when we are young as part of our normal development and in the things we do such as rolling, crawling, walking and in play; for others sensory integration is less well developed – and this can lead to difficulties.
The association between sensory integration difficulties and self-regulation has long been of interest to SI therapists. And many parents of children with sensory integration, or sensory processing, difficulties express concerns about their child’s abilities to manage their emotions. A study by Cohn and colleagues (2014) found that 72 percent of parents whose children were referred to sensory integration therapy reported concerns for, or hopes of improvement in, their child’s self-regulation ability.
Ayres identified that successful development of sensory integration underpins emotional stability, attention span and activity levels.
Because tactile, vestibular and proprioceptive systems support the child’s ability to engage with their environment, Ayres argued that these systems also support development of emotional stability because being unable to properly engage with the environment would be a frustrating, overwhelming or disengaging experience. The auditory and visual systems are also important: if a child’s auditory or visual threshold is too low, they are more likely to focus on these sensations and find it difficult to pay attention and focus on other stimuli, impacting on their ability to focus and engage with the social world.
Sometimes, our level of arousal can be very high:for example, when we are feeling worried, angry, stressed or excited. Other times, our level of arousal is too low, such as when we are feeling sad or tired. When our level of arousal is too high or low this can impact on our ability to do daily tasks. We need our level of arousal to be just right for that activity, whether it is reading, playing a game of tennis or winding down for bed.
Sensory integration difficulties can lead to increased sympathetic nervous system arousal and a heightened stress (fight-or-flight) response.
Think about a person who is under-responsive to sound or even a situation where you are so focused on what you are doing that you are not aware of sounds around you. Someone calls your name but you don’t notice. By the time the call has got your attention, they are so close and loud that it startles you, triggering a fight-or-flight response in your sympathetic nervous system.
On the other hand, if a person’s central nervous system struggles to inhibit sensory information, such as sound, they would experience those senses more intensely than other incoming information. Situations that others would find non-threatening, would be for that individual very stressful. Think about a person who is over-responsive to sound or times when you are more alert to a sound, such as when you are convinced there is someone outside your home. Every sound then would alert your sympathetic nervous system.
Research has shown that sensory over-reactivity and anxiety are found to occur together. And we understand that sensory reactivity can lead to a fight-or-flight response. This heightened activity of the sympathetic nervous system can make it more difficult for a person to regulate their stress response.
It is also important to note that a person who has needed to manage difficulties related to sensory integration all day, will have been in a constant state of fight-or-flight, and will have depleted resources by the end of the day. For example, an adult who has had to try to focus at work with auditory over-reactivity or the child with low postural tone who has had to sit still all day, will come home tired with their reserves run low. That child, struggling to self-regulate at home after school, could react by charging around the house, being over emotional and quick to react or be unwilling to do anything: they can’t modulate their responses any longer after having held it together at school all day.
A qualified sensory integration practitioner can assess an individual’s needs and abilities and make recommendations for specific exercises and activities, as well as adjustments to their home/school/work environment, that can help support their self-regulation.
A qualified sensory integration practitioner will have gained additional in-depth postgraduate training following their initial qualification to become a therapist. This training involves developing a detailed understanding of the neuroscience and evidence base underpinning sensory integration, as well as developing expertise in assessing and providing intervention for people with sensory integration difficulties.
If you are a qualified occupational therapist, physiotherapist or speech and language therapist and are interested in learning more about sensory integration theory and SI therapy, see our online, UK university-accredited modular SI practitioner pathway. Our Introduction to Sensory Integration Difficulties course is a good starting place.
As a Sensory Integration Practitioner, would you like to take your knowledge and practice to the next level in 2020 by achieving Advanced Practitioner status? You can do this on Sensory Integration Education’s fully refreshed online SI Module 4: Advanced Practice, which has been designed around the NHS’s advanced clinical practice definition and, like all our practitioner training courses, is accredited by a UK university. The first cohort starts in March 2020: could you be on it?
Working with and supporting researchers and practitioners at the leading edge of sensory integration, we invested a year of development in updating and reinvigorating our Advanced SI Practitioner qualification.
SI Module 4: Advanced Practice will enable you to develop the knowledge and skills you require to become an SI Advanced Practitioner working across settings and clinical populations. In addition to achieving the advanced status, you can work towards a Postgraduate Diploma and Masters in Sensory Integration.
We began with the NHS’s definition of advanced clinical practice, which has currency worldwide,...
“It is a level of practice characterised by a high degree of autonomy and complex decision making. This is underpinned by a master’s level award or equivalent that encompasses the four pillars of clinical practice, leadership and management, education and research, with demonstration of core capabilities and area specific clinical competence. Advanced clinical practice embodies the ability to manage clinical care in partnership with individuals, families and carers. It includes the analysis and synthesis of complex problems across a range of settings, enabling innovative solutions to enhance people’s experience and improve outcomes”
… and designed the module around these principles, enabling you to further develop your knowledge and skills gained from your PG Certificate in SI.
Let’s look at the recharged course. The course is designed to train clinicians in the practical skills and activities of therapy as well as the principles behind therapy. There are three themes around which your advanced practitioner learning is focused:
In order to support your advancing clinical reasoning and clinical skill development, you will hear from national and international experts, in addition to SIE-certified Advanced Practitioners. Our Advanced Practitioner Module e-Mentors will support your learning throughout. In order to ground your developing skills, you will undertake 20 hours of clinical practice supported by a Clinical Mentor. All learning is supported by high quality, specifically-commissioned, online learning content.
Upon successful completion of the three assessment pieces, you will be entitled to use the title SIE SI Advanced Practitioner; gain 20 UK university academic credits which are globally recognised and highly transferable; and be listed as an Advanced Practitioner in the Association of SI Practitioners' Register.
On a practical note, you can find all the information you need on the course here, as well as details of membership discounts and interest-free monthly payment plans.
If Advanced Practitionership is your goal for 2020, we sincerely hope you consider achieving it with us!
You can find a round up of our recently featured journal articles below and kick off 2020 with some CPD reading.
This study explored caregivers’ perceptions of how children with Sensory Processing disorders participate in community outings, strategies to support successful outings and if multi‐sensory environments mitigate participation barriers.
New research shows that the use of sensory modulation rooms in acute inpatient psychiatry settings is viewed positively by both service users and health care providers.
In this research paper, Occupational Therapist, Renee Watling explores the relationship between sensory processing and maladaptive behaviours in relation to Down Syndrome. Though maladaptive behaviours as a result of sensory processing difficulties may impact on daily life occupations, they also may serve a positive function including escape, attention etc. Gaining an insight into the association of sensory processing and maladaptive behaviours supports the understanding of the potential factors instigating the behaviour, which may support targeted interventions.
Results for this study indicate that the Spanish version of the Adolescent/Adult Sensory Procession is conceptually and semantically equivalent to the original version. Great to see sensory assessment tools being made more accessible internationally.
This literature review looks at the importance of sensory friendly environments to improve accessibility and subsequently quality of life for individuals with Autistic Spectrum Disorder who have difficulties with Sensory Processing and Sensory Integration.
In one of the first studies to investigate sensory processing in people with multiplesclerosis (MS), researchers found that this population experiences difficulties with registering and modulating sensory input. These difficulties were found to impact on ability to perform activities of daily living and may be a marker of disease severity.
Here, a university team present their process of auditing their learning environment from a sensory perspective and make recommendations on how to make the environment more accessible for those who have difficulties with Sensory Processing and Sensory Integration.
This recently published scoping review in the American Journal of Occupational Therapy offers an excellent overview of somatosensory functioning, its role in child development and its prevalence in the ASD population.
The subjective meaning that people attach to their occupations may explain the association among participation, health, and well-being - but most studies have been on adults, and the ones on children have been mostly qualitative studies. This recent study aimed to explore the perceived meaning that typically developing children attribute to their everyday activities and to assess the correlations between children’s perceived meaning and their participation as assessed by parents. It found that children aged 6-12 were able to reflect on the meaning of their everyday activities and the researchers suggested that the Perceived Meaning of Occupation Questionnaire (PMOQ) was a useful tool for facilitating this and that it could be a useful for engaging young children in setting meaningful goals for therapy.
This is a great fact sheet from American Journal of Occupational Therapy.
Have you thought of making New Year Resolutions to reinvigorate your sensory integration therapy practice? You spend a large proportion of your life at work, so why not focus on making it the best experience possible for you and your clients and colleagues. We’ve suggested some areas below but we’d love to hear your career resolutions too!
1. Stop procrastinating.
If there’s something you’ve been meaning to do to enhance or change your career, write a list of steps you are going to take to achieve it, and commit to taking action on a step a day or week as appropriate. Research that area. Book that course. Apply for that position.
2. Meet new people.
New people bring new opportunities. Overcome your shyness and make time to network (virtually or in real life) with people in your field or the field that you aspire to. You might even have fun! If you want to dip your toe in the water with online networking, we have a friendly, professional and inspiring community of people on our Facebook SI Groups and we host an annual SI Autumn Conference in the UK for sensory integration students and therapists.
3. Volunteer.
Can you use your skills (career or otherwise) to volunteer at a local group, home, shelter or school? Ensure any work you do is covered by your professional insurance. Volunteering is a great way to boost your esteem, confidence and CV whilst giving back to your community.
4. Set yourself career goals.
You set your clients goals within therapy because you know that it helps to track progress and motivate, but do you set yourself small, manageable career goals, specific to you, that build to a big achievement? Come on, grab a pen and set down your long-term goal, with the measurable outcome and the timeframe for achieving it. Then write down the short-term goals (with specific details and time frames) that will support you in achieving your long-term goal. Now put this list somewhere you will see it every day to remind you of your direction and commitment.
5. Get involved in research.
Contributing to your field’s body of evidence and seeing your name listed in a published article is pretty thrilling and rewarding. Sensory Integration Education offer support and advice for SI researchers as well as the opportunity to pursue a UK university accredited MSc in Sensory Integration which involves engaging in an independent piece of research activity under the guidance of a supervisor.
6. Remember self-care.
The very nature of your job involves being an active listener which can be draining if you don’t have an adequate debriefing process. Your workplace should have appropriate provision for staff’s mental wellbeing: if it does, get involved; if it doesn’t, lobby for it. If you work for yourself, then building time in your working week to reset your mind and body will pay dividends.
7. Make CPD fun!
Set out your continuing professional development goals for the year. Check what your professional body’s CPD requirements are (and the level of evidence required) then set goals that support your wider career goals. If you can make them enjoyable, you’re more likely to achieve them. Are you looking to keep up with the latest research (ahem, such as listed in our monthly newsletter EmphaSIze, biannual magazine SensorNet, and daily social media posts)? Get a research buddy or two, then agree to read the same article or book each week and discuss it (over a coffee, online, it really doesn’t matter as long as you do it).
Who doesn't need a little inspiration now and again? Over on our social media channels, we are posting 12 Days of SI Inspiration. In case you don't follow us on Facebook, Twitter, Instagram, Pinterest or Linkedin, here is our festive offering to the wonderful sensory integration community:
Welcome!
Sensory-based gift ideas. A reflection on the Autumn Conference. Legacy Award Winners announced. An update on the EASI project. And a special Christmas giveaway! As well as our usual selection of SI research, jobs, resources, books and products. This really is a bumper edition of EmphaSIze.
If you didn't manage to join us in our Silver Jubilee celebrations at the SIE Autumn Conference last month, look out for the a full write-up on the speakers, presentations and event in the next issue of our magazine SensorNet.
Best wishes
EmphaSIze Team
PS. Be sure to follow along on our social media channels as we'll be signposting you to lots of festive SI inspiration and advice.
Click here to see our December edition
A: The excitement and chaos of Christmas can be overwhelming for a lot of children and certainly even more so for those with sensory integration difficulties.
In the build up to Christmas, be mindful of the type and how many Christmas decorations you have at home: scented candles, natural Christmas trees, flickering lights, reflective tinsel, baubles and musical ornaments can be a lot of additional visual, auditory and olfactory sensory information your son doesn’t normally need to process at home - and may contribute to sensory overload. Consider more subtle decorations or, if you can, involve your children in making homemade Christmas decorations they can display proudly around the house!
On the day itself, make it a Christmas day that works for your family. Keep routine activities, eg, getting up, bath times and meal times, at the same time as this predictability can be helpful in maintaining an active-calm level of arousal. Also, think about what your son does on a typical day and when and how he currently accesses the sensory feedback he needs to modulate. Does he play with particular toys? Spend time outside? Use particular equipment? If possible, ensure these activities still happen.
Finally, Christmas dinner should be a special meal which everyone is looking forward to so,with that in mind, ensure that your son has his preferred foods on the day. Food restrictions due to sensory integration difficulties can be really challenging and, therefore, it would be better to work with a trained sensory integration practitioner to assess and address this in detail rather than focusing on strategies that may or may not work on one particular day.
We hope Christmas Day goes smoothly for you and your family!
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