#223 - Tips for Implementing Sensory Strategies with Pre-Verbal Children
Sep 28, 2022
Rachel Harrington, COTA/L, AC & Jessica Hill, COTA/L
We received a question on Instagram about what sensory strategies we would recommend to help a child who has lower cognitive abilities or who is non-speaking or pre-verbal.
We’ve had many, many clients who had learning disabilities, used AAC devices because they didn’t communicate verbally, or who struggled overall with communication - expressive and receptive.
In this episode, we’re going to draw from our own personal experiences as well as research!
We received a question on Instagram about what sensory strategies we would recommend to help a child who has lower cognitive abilities or who is non-speaking or pre-verbal.
We’ve had many, many clients who had learning disabilities, used AAC devices because they didn’t communicate verbally, or who struggled overall with communication - expressive and receptive.
In this episode, we’re going to draw from our own personal experiences as well as research!
And I'm Jessica. And this is all things sensory by Harkla.
Rachel:
We are both certified occupational therapy assistants and together with Harkla. We are on a mission to empower parents, therapists and educators to help raise confident and strong children of all abilities.
Jessica:
On this podcast, we chat about all things sensory diving into special needs occupational therapy, parenting, self care, overall health and wellness, and so much more.
Rachel:
We're here to provide raw, honest and fun strategies, ideas and information for parents, therapists and educators as well as other professionals to implement into daily life.
Jessica:
Thank you so much for joining us.
Rachel:
Hey, everyone, welcome back to all things sensory by Harkla. We are so happy you're here. I'm Rachel.
Jessica:
And I'm Jessica. And today we are going to answer a question that we received on Instagram. Also, if you hear any weird noises in the background, that is a baby that we have in the podcast studio with us. So just, you know, filter it out.
Rachel:
Yeah. So before we get started today, and talk about what we're going to talk about, we do want to remind you that we do have our two on one mentoring sessions now available. So if you are looking for two great people to chat with, get some feedback, some strategies, some help, we are here for you. And that is why we created our two on one mentoring program. But just a quick disclaimer, that is not ot services at all. It is just a quick mentoring session, it's 45 minutes long with some awesome tools in your back pocket immediately.
Jessica:
Yeah, our one on one mentoring is perfect for parents. We also think it's great for therapists we love chatting with fellow therapists about their caseload about some challenges they're facing and just brainstorming. That's really what this is a brainstorming session. And then after the video call, we put together all of the resources and recommendations and email them to you.
Rachel:
So if you're ready to sign up and chat with us, then head to the show notes and click the link there, and we will get something scheduled for you.
Jessica:
Now today's topic is all about answering the question that we received on Instagram. And the question was, what sensory strategies we would recommend to help a child who has lower cognitive abilities? Or is nonspeaking or pre verbal. Now, we're trying to be as socially conscious as possible, if that's the right terminology and not say nonverbal, but instead use the term non speaking or pre verbal, just to try to be more what's the word Rachel inclusive.
Rachel:
And yeah, because we know that nowadays, we just have to be careful with the things that we say, and especially for those kiddos who are pre verbal or non speaking at this time, we know that they understand so much more than they can verbally communicate. And so we need to keep that in mind. So we challenge all of you listening, as well to kind of change your verbiage. And just be more mindful of what you're saying and how you're saying, and so just so you know, we aren't trying to hurt anyone's feelings today. We hope that we don't hurt anyone's feelings, but we're just here having an open conversation. And, yeah, let's talk about it.
Jessica:
Well, also, I was going to mention to, you know, don't judge us too harshly if we slip up and say something in a different way. Because we're not perfect. We're humans.
Rachel:
So we're trying our best.
Jessica:
We're trying our best. So just bear with us. Let us do our thing. Take the information we're giving you and let's go.
Rachel:
Okay. So, first of all, we have had a ton of clients who have had learning disabilities, clients who have used AAC devices, because they didn't communicate verbally, and they've struggled with overall communication, both expressive and receptive. And so we're going to draw from our personal experiences, as well as research that we have found in our careers as occupational therapy assistants, to chat with you about what these cognitive and learning deficits look like, and then how you can really tap into helping these children and helping their sensory needs if they aren't communicating like we normally would see.
Jessica:
So let's first talk about cognitive and learning deficits. First, let's talk about cognitive and learning deficits. Now we're taking some definitions from some research articles, some different online resources and these will all be linked in the show notes. Let's first cognitive deficits, also called intellectual disabilities, is a condition beginning in childhood in which people show significant limitations in their ability to learn and function.
Rachel:
The DSM five defines intellectual disabilities as neurodevelopmental disorders that begin in childhood and are characterized by intellectual difficulties as well as difficulties in conceptual, social and practical areas of living. We will link the research articles that we got those from in the show notes, so you can check those out. But a couple more that we want to talk about, we want to break down these concepts a little bit more. The first one is deficits in intellectual functioning. So things like reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience.
Jessica:
That sounds just like executive functioning skills. Yes, right. Yes. deficits in adaptive functioning, that significantly hamper conforming to developmental and socio cultural standards for the individual's independence and ability to meet their social responsibility. That was a mouthful, I'm really proud of myself for getting through it. But basically, what we're saying there is challenges in the ability to complete social activities, social emotional skills, and all of those things in between the social components. Yep.
Rachel:
And these articles also say that the terms mild, moderate, severe and profound, have been used to describe the severity. But I feel like in today's culture, those terms are frowned upon. And the more that I am learning and unlearning things that using different terms to describe the person can be helpful.
Jessica:
So quick overview, cognitive learning disabilities, intellectual disabilities, learning deficits, however you want to call them, are originated in the brain. And they're, which means they're neurodevelopmental disorders, and basically cause difficulties with, you know, learning in school, social skills, and ADLs activities of daily living. Yep, we do have an episode on executive functioning skills, which falls right into this category. So that would be a good one, a good podcast for you to also listen to, that dives into these details a little bit more, for sure.
Rachel:
We'll link that in the shownotes as well. And let's move on and talk a little bit about children who are non speaking or pre verbal. So most children who are not speaking will learn to communicate in some way, but it might not always be through spoken language, which is totally fine. It's important to remember that even though a child may not be able to speak their nonverbal communication, such as their body language, or facial expressions, writing or motioning is still communication.
Jessica:
And also remember that their receptive language skills, which is their ability to understand what's being said to them, or around them, those skills might be at age level, even if their expressive language skills or not.
Rachel:
So the term pre verbal communication describes a group of social communication behaviors that are used to send an intentional or purposeful message to a partner, rather than being verbal. So things like words or word combinations, pre verbal communication consists of some combination of Eye Gaze, Gesture, or vocalization. And again, we'll link the articles that we're getting this information from, we just think that it's important to kind of have a baseline of the terms that we're going to be talking about when we share our strategies. Next,
Jessica:
it's also important to remember that oftentimes, our kiddos who are not communicating verbally, will struggle with some of the same challenges that children with intellectual disabilities struggle with, right? Not always. But because they aren't communicating verbally, oftentimes, these challenges do appear, because maybe those around them don't understand what they're trying to communicate. Right. Yeah. Especially, you know, in social situations, those are probably the biggest ones
Rachel:
for sure. Yeah. So if you have a child of your own, or if you're a therapist, and you're working with a child who falls into any of these categories, these are strategies that we have used and we recommend to help them work with communication, self regulations, sensory processing, and just overall like functioning.
Jessica:
Did you say executive functioning? I did not know. So also executive functioning. Yes, that's a big one. And the cool thing is that a lot of the strategies we're about to talk about are backed by research. So we were talking about this before we started recording that, we're going to try to continue to include more research into our podcast episodes since the field of occupational therapy is research based. And so, dive into all the research that we're giving you in the links in the show notes. I just
Rachel:
so fun to find articles that like back what we're doing, right? It's just so exciting to me. And honestly, I wish there were there were more articles, but maybe one day,
Jessica:
Some of its lacking. Yes. And the research articles that we're using in our episodes, we are making sure that they are current. So within the last couple of years, versus like old ones from the 90s. I can't believe old is the 90s. Now,
Rachel:
we're old.
Jessica:
All right, let's jump into our strategies.
Rachel:
Yes. Okay. First one, this is our favorite tool is to use visuals, a visual schedule is like, literally the number one tool that we recommend for almost anything. We use them ourselves, we have our kids use them. Pictures are easy to follow, they're simple to use. And then having pictures of tasks and activities allows the child to show you what they want, as well as helps with sequencing memory and attention skills. So not only understanding what's next what's coming up, but also again, those executive functioning skills of sequencing and problem solving and then emotional regulation because if they want to do a certain task, they can see where it is on their visual schedule. And you can help work them through if they're getting upset because they're not doing the activity that they want. We can show them it's coming but first we're going to do our sensory diet or whatever.
Jessica:
We do have a free Visual Schedule Template that you can download. It will be linked in the show notes. It's on our freebies page. Number two is vestibular input. My personal favorite sensory system, vestibular system, studies have shown that vestibular stimulation may have a positive effect on verbal communication. This is really exciting. I truly believe this is true just from personal experience in clinic. Yeah. Some studies have also shown improvements in learning following vestibular stimulation. So that vestibular system really activates certain parts of the brain wakes up the muscles in the body and just prepares the person the child for learning and communication. Right. I challenge you
Rachel:
to hop on a swing and see how you feel afterwards. Do you feel more chatty? Do you feel like you just want to let out a squeal? Do you feel? Sorry? We'll just because when I was on the swing of it last I was like, oh, you know you just you want to let out of squeal. Okay, we'll yes we're squealing over here with the vestibular. A few of our favorite vestibular activities for these kiddos. The first one is swinging while singing a song like the ABCs stop after the song is ended and have the child request more or all done. You can try counting before swinging. So saying something like 123 and then helping the child to communicate go.
Jessica:
I will say that it does not matter if you have a crappy singing voice. I cannot carry a tune to save my life. But in clinic, it didn't matter. All the kids were so into singing while they were on a swing that it did not matter.
Rachel:
It was just her co workers that were bothered
Jessica:
at that point, okay. Another one is swinging and throwing to a target. So in whatever type of swing you have your child in whether it's a playground swing, compression, swing, pod swing platform swinging whatever you have, use stuffed animals or beanbags or crumpled pieces of paper, have those items in the swing with the child requests to have them maybe pick a specific one, like throw the red bag or throw the tire Tiger and throw it to a target. So the target, you know distance will vary depending on the child right and they're, you know, hand eye coordination, their force modulation so make sure you set them up for success with this activity. Make sure you are swinging them in different directions, maybe include a little bit of spinning or rotary input as well. And then we always recommend following up vestibular activities with a little bit of heavy work or deep pressure.
Rachel:
Yep, we've got a couple of research articles that explain this in more detail. If you want to check them out. They will be linked in the show notes. Our next activity that we love are just simple two to three Step obstacle courses. These can be done by all children and should be done by every child using the visual system to show them the sequence of the obstacle course walk them through the obstacle course, for full completion, and then include a motivating factor, something that the child really loves, like sour spray, or maybe a vibrating ball. include things like balancing jumping animal walks, and make sure that you are modeling right along with them. They're great for learning sequencing attention, practice, like you know that we love obstacle courses so much. One other thing that we like to do during obstacle courses is just using like a whiteboard and adding a visual countdown so the child knows when they're finished, just like little check boxes, or a visual timer. So try those activities. We will link a YouTube video that talks about how to set up obstacle courses. Have the child complete it maybe two to three times, if possible, and make it fun.
Jessica:
If you are in a clinic setting, and you can do suspended obstacle courses, those are awesome. Those are always my favorite. And you're getting a lot of vestibular input when you're doing obstacle courses with swings and suspended equipment. So you're getting you know two for one deal there. You can also incorporate a lot of vestibular input into non suspended obstacle courses, like doing animal walks such as a bear walk where the child's head gets inverted. You can incorporate things like windmills, or rolling and somersaulting jumping and crashing. So you can really include vestibular input into these optional courses for that added effect.
Rachel:
Another activity we really enjoy is tactile input. So using messy play activities to really facilitate, like building rapport, as well as just overall tactile processing. I remember back in the day, when we were in one of the clinics, we would do, like full on shaving cream day.
Jessica:
Oh, that was the worst week
Rachel:
of it, it was my all time favorite week. It was a lot of olfactory input that was kind of hard to process. But when you have mats and swings and garbage bags, and you can just slide in the shaving cream and draw in it and get your entire body just covered in shaving cream. It is so much fun. So much tactile input to process as well as olfactory input because a lot of it is very fragrant. But get creative with your tactile messy play activities. You know, start at the table with some shaving cream and then progress to doing drawing activities with your feet and shaving cream. And then get the entire body covered in shaving cream and run and slide on your tummy. Austin wants to try that I think she probably will. Um, so yes, tactile play activities are great,
Jessica:
messy tactile play activities are also great to practice spelling and math problems. So you can really incorporate that cognitive processing component, even just simply matching letters, matching numbers, matching colors, matching shapes, so you can get really creative to incorporate some learning into for messy tactile play. Yep.
Rachel:
Another one we love is vibration. So there are a ton of products that you can use to get that vibration. But using vibration has great tactile and proprioceptive input. So it really is often alerting for some kids but can be calming for other kids as well. So things like HoMedics has a lot of vibrating tools. They have vibrating balls massagers there are like vibrating helmets. I've found I think one is called. I need to write it down pure therapy. I don't know if they make it anymore, but that's an option.
Jessica:
Full Body vibrating machine. Yes, those are great.
Rachel:
Those are great. They used to have him at the gym. I remember seeing them at the gym. Yeah. And you can get them like from Amazon as well. Yep. And those are really fun too. You can stand on them. You can put your arms on them, you can do push ups on them, you can put your feet on them, doing a plank push up tons of fun ways to use those. So just getting creative with some vibration input and seeing what just like watching their arousal level like what happens when they are using that vibration.
Jessica:
Another activity is anything with a specific start and stop. So we talked about this briefly in the vestibular swinging activities to do you know a song or a countdown with the movement and then you stop and then when you're ready to go again you have the child communicate, when it's time to Though you count down, they count down, say go. And then you go again, or making sure that your obstacle courses include these start and stop components. So they jump three times and then crash, they balance for five seconds, they swing and push off the wall five times. So incorporating, counting and sequencing with a start and a stop is going to be really helpful for that language development as well as for the cognitive processing.
Rachel:
Yep. And the last one we want to recommend are multi sensory activities. So things that are combining multiple senses at once simultaneously, as well as using the metronome during these activities. So something like sitting across from your child or the client that you're working with, and having the metronome set at 60 beats per minute, and you're just clapping together or clapping your hands towards each other, like giving high fives, you are passing a beanbag around to each of your hands. And make it even more intense by sitting in. Like one of those lycra tunnels, you know, are the lycra tubes, we call them the happy hugs that we sell on our Etsy shop. So a little plug for that. But sitting inside of those, that way, the child can't elope that way. They're getting more proprioceptive input. Yeah, I love multi sensory activities.
Jessica:
Yeah, and metronome activities are great because it provides a consistent rhythm for whatever you're doing. And that consistent rhythm can be very regulating, it can be really helpful for communication, expressive communication and learning, you know, counting, singing songs, that kind of thing. And then you can also incorporate the metronome in and you can also incorporate the metronome into learning activities. So practicing spelling words, practicing math problems, and get, you know, multiple senses going. So maybe you are tossing a ball at the wall and catching it on every other beat, while simultaneously spelling a spelling word. So you can really get creative, incorporate these into obstacle courses, incorporate it into swinging, use a visual schedule, visual sequence and a visual timer. With it, you can really create a really great therapeutic activity with all of these suggestions and put them all together and do it on a consistent basis and see what improvements occur.
Rachel:
If you're not already following us on Instagram at all things sensory podcast, we highly recommend checking that out because we post activities and videos every week that you can try it with your child or with your clients. So head to Instagram, follow us. And then when you're trying these activities, tag us on Instagram as well, so we can share them with our community and just really promote the functional implementation of therapeutic activities.
Jessica:
And before we leave, you just want to remind you that every child's sensory system and development is on its own path, its own trajectory. So what works for one child will most likely not always work for the next child. It takes time trial and error consistency, to figure out what works and what doesn't and what doesn't work. So just keep that in mind.
Rachel:
Yeah. Okay, make sure that you check out our show notes. We have tons of research articles, products, everything that we talked about today is linked there. And if you have questions, don't hesitate to reach out. You can find us on Instagram, you can find us@harkleroad.co We're here to help you. And we hope this episode was fun.
Jessica:
All right, we will talk to you next week. I'm gonna redo that.
Rachel:
How I had to take these off. It's really kind of messing with my mind a little bit. Okay, so okay
Jessica:
sorry, we're probably gonna have to pause because she definitely pulled out a diaper. Oh, no. Oh, do you want to pause the recording? Can you pause it?
Rachel:
Thank you so much for listening to all things sensory by
Jessica:
heart. If you want more information on anything mentioned in the show, head over to Harkless Dotco slash podcast to get the show notes. If you have
Rachel:
any follow up questions. The best place to ask those is in the comments on the show notes or message us on our Instagram account which is At Harkless underscore family or at all things sensory podcast, if you just search Harkless you'll find us there.
Jessica:
Like we mentioned before our podcast listeners get 10% off their first order at heart glad, whether it's for one of our digital courses or one of our sensory swings, the discount code sensory, we'll get you 10% off. That's s e n s o
Rachel:
r y Head to Heart glut.co/sensory to use that discount code right now,
Jessica:
we are so excited to work together to help create competent kids all over the world. While we make every effort to share correct information, we're still learning.
Rachel:
We will double check all of our facts but realize that medicine is a constantly changing science and art.
Jessica:
One doctor or therapist may have a different way of doing things from another.
Rachel:
We are simply presenting our views and opinions on how to address common sensory challenges, health related difficulties, and what we have found to be beneficial that will be as evidence based as possible.
Jessica:
By listening to this podcast you agree not to use this podcast as medical advice to treat any medical condition in either yourself or your child.
Rachel:
Consult your child's pediatrician or therapist for any medical issues that he or she may
Jessica:
be having. This entire disclaimer also applies to any guests or contributors to the