All Things Sensory by Harkla

#245 - Therapy Case Study: 2 Year Old Sensory Seeker

March 01, 2023 Rachel Harrington, COTA/L, AC & Jessica Hill, COTA/L
All Things Sensory by Harkla
#245 - Therapy Case Study: 2 Year Old Sensory Seeker
Show Notes Transcript

We LOVE answering your questions! Today’s episode comes from a listener who reached out with a question about a client they work with.

“He’s 2 years old. Definitely has a large sensory cup. He is extremely rough and tumble. This kid has face planted on concrete and will get up and keep running. I tried a weighted vest on him but he ripped it off right away. I’ve informed mom about heavy work at home. Our sessions usually look like me chasing him around. Any tips / strategies for kids like him?”

We brainstormed and came up with some ideas on how to incorporate his preferred sensory activities (like running) into structured 2 step obstacle courses. We talked about meeting his sensory needs, using a visual schedule, and MORE!

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Jessica:

He's two years old definitely has a large sensory cup. He's extremely rough and tumble, this kid has face planted on concrete and will get up and keep running. I tried a weighted vest on him, but he ripped it off right away. I've informed mom about heavy work at home. Our sessions usually look like me chasing him around any tips or strategies for kids like him?

Rachel:

I'm Rachel.

Jessica:

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. We're so happy to have you here. We are kind of going a little bit of a different route today than our normal episodes. But it definitely still aligns with all the things that we do. We got a DM on Instagram from a fellow therapist asking about a kid that they are working with. So we're going to explain what they said. And then we're going to kind of just give strategies of like if we were working with this therapist, if we were collaborating with them what we would say and then I'll let Jessica explain it a little bit more.

Jessica:

We did provide this therapist with some ideas, we messaged her back. And then we also posted the message in our stories. And so many people responded and said, This sounds just like my child, like so many people resonated with this kiddo that we're about to describe to you. It was like, there are a lot of kids out there with these similar challenges. And the parents are struggling therapists are struggling. So let's just do it. So the message we received it said this.. "He's two years old, definitely has a large sensory cup. He's extremely rough and tumble, this kid has face planted on concrete and will get up and keep running. I tried a weighted vest on him, but he ripped it off right away. I've informed mom about heavy work at home. Our sessions usually look like me chasing him around. Any tips or strategies for kids like him?" My first thought was, I have worked with kids just like this. And I have one particular client in mind who I'm like, this was our first few sessions. Yeah. Oh my gosh, I know exactly who this child is. Yes. Not like, oh, I don't really know who he is. But you know what I mean.

Rachel:

You can connect it to an experience that you've had. I have someone in my mind. So this is a great question. These kiddos are often like, it's, it's difficult to figure out what is best for them and how to work with them. But it's so rewarding once you find those just right strategies for them. And then you start seeing all of the progress start to snowball. And then they get through their day successfully. And then they communicate to you their needs. And then they meet their needs on their own. So it's just, it's really cool once you can actually figure it out.

Jessica:

First of all, this kiddo sounds like a sensory craver with a very high threshold. He craves a lot of input, he can't seem to get enough. But at the same time, he's also unresponsive to sensory input like tactile, proprioceptive and maybe even vestibular. He's under responsive, which is why he craves it and has such a high threshold.

Rachel:

So she said that she tried a weighted vest on him. And he ripped it off right away. The ideas there. Yes, it's a good idea. It's a good strategy. We might want to change like the order of operations with the weighted vest. So instead of trying to put it on him to calm him down, we meet his high threshold, give him more of that probe, more of that vestibular input, more intense sensory input. And then once he's maybe a little bit more regulated, and you know, we're trying to like bring his attention down and focus then maybe trying a weighted vest or a compression shirt, something like that. So the idea is there, but I think we need to meet his high sensory threshold first.

Jessica:

I was just thinking, she said in her message that their sessions usually look like her chasing him around. So you do have to figure out a way to get him to stop running away. And this can be done in a variety of ways. If you have access to a room with a door, you can set up the room before he comes in and close the door, and complete the therapy session in this room where he can't run away. You can use swings as a way to keep him with you, instead of running away and actually do want to be swinging him to me his sensory needs. But also if he likes to run, if running is enjoyable for him, and he's running to meet a sensory need, incorporate that into a session, but make sure you're teaching him: Ready, Set, Go and stop. And ask for more so that he's communicating, and it's more structured to meet his needs. So if you have a good hallway area that you can run down, hold his hand, don't let him go yet you're keeping him with you. You say, ready, set, go. And then you guys run down the hall as fast as he can, you know, you're running with him holding his hand, and then you stop at the end, you stop. And then you turn around and you say, Do you want more? And he you help him to communicate that he wants more, you do it again, ready, set, go. And you run again. And you do this repeatedly, until he gets to a point where he's independently communicating that he wants more, but also incorporate into your session so that a couple of times during your session, you're going to the hallway, or wherever you can run to run. And maybe during the session, if you notice that he's trying to go run, you can stop him and say, Do you want to run and he can communicate. Yes, he wants more he wants to run and you can go do it. So you're giving him the sensory input he wants and needs in a very structured way. And also encouraging and facilitating the communication piece.

Rachel:

Yeah, and I think you can also have so much fun with like, stop, go, stop. And you can do like red light, green light. Now, too, it could be a little bit too much. But like you could modify it, you could make like a stop sign and a go sign so that way, they can see the stop, the go, you can incorporate different, you know different ways of running, you can run backwards, you can run sideways, you can do bear crawls, and you bunny hop hop, you can skip and you can incorporate different running activities, different animal walks different ways to work on that start and stop. But I think that would be a really good baseline - is communication, asking for more, working on stop and go and then having them maybe if you have this on a visual schedule, and you're working on with a visual scheduler, a token board, make sure that you could maybe like build in the running as a preferred choice or like a positive reinforcement. So we're going to, you know, swing five times and then go run, or we're going to put five coins in the piggy bank, and then we're gonna go run. So something really simple and structured with that. It's got to be kind of quick because it sounds like he needs like quick, fast paced, you know, if you're in that room, you've got all of your activity setup in there, you're just doing one at a time. And you're kind of helping to drown out some of the other unrelevant sensory stimuli. So if you're in a sensory gym, and it's really bright and colorful, and their swings and everything all around, and he's trying to elope and he's trying to run, it's too much. And so like Jessica mentioned going in, in that small room, keeping the lights low, working on some, rhythmic movements, if possible, using that token board, we're gonna talk about some more activities here. But I'm just focusing on like that room, like I love that. And that's definitely something that we've done over and over again in the clinic.

Jessica:

Yeah, if you have access to the room, or maybe a pop up tent, or some sort of enclosed space that you can set up, you know, make sure you're in there. And then I liked the idea of the visual schedule. For him he's two years old, so it's going to be two things on his visual schedule, maybe even just one to start with if he hasn't used a visual schedule before. Ideally, two things on the visual schedule so he can see exactly what's going to happen. You do one thing in the room, and then you go do your running back and forth. Do one thing in the room, run back and forth. And you can do that the entire session. And by the time that session is done, chances are he's got that routine down and you're gonna be able to do it again. And everytime you do it, you'll make it more complex to meet, you know more needs and work on more skills. I was also going to mention that doing that running activity, the way that we described, is going to build rapport with him. And he's gonna do it as long as you are able to make it fun and engaging, and laugh with him and make it really kind of over the top, then he's going to love it, and he's going to start to enjoy his time with you, which is huge.

Rachel:

That's the goal. I was also just thinking about like musical chairs, if it's not too overwhelming to turn on music, like if you have music on your phone, like maybe he has a favorite song like Lion King, and you turn it on and while it while the music is on you run, run, run, run, run, and then you stop it. And when the music stops, his body has to stop as well. So incorporating some auditory input can be helpful too. And I was just thinking too, with the visual schedule, try using like a first then. We just played the pop up pirates game so that's what I'm thinking about. Like, first we put the sword in the pop up pirate, and then we run so it's like, he can see that. And maybe you take a picture of it before the session and you put it on the visual schedule. So that way he can see first pop up pirate, and like don't play the entire game. Like it's short. It's really focus on he's on like success and like, you know, if you help them put put a piece in. Let's go run, run, run, run, come back, put another piece in. Yay, run run run... like just because that over the top,

Jessica:

And you are going to be tired and sweaty by the end of this. You both will. But if you are able to do this, and he's following your lead and having fun, you're gonna see so much progress, and it's going to be so worth it when you're exhausted. You're gonna be like, yeah, I'm tired and sweaty. But that was so awesome.

Rachel:

I love that. Yeah.

Jessica:

Okay, swinging. I'm curious how he feels about swinging. The kiddos that I'm thinking of who were just like this oftentimes had some gravitational insecurities. I was thinking, Yes, so they love movements, but it has to be on the ground and in their control in their control on the ground has to include some sort of probe, right, so running is very proprioceptive activity. But once their feet leave the ground and they're in a swing, they don't know what to do. So it's very scary. If you can get them to become comfortable in the swing, and it just takes time and consistency of exposing them to the swing, helping them in it, you getting in it. Once they're comfortable in the swing, it's gonna be great.

Rachel:

I would do one of those interactive songs on the swing. So like Five Little Monkeys swinging around the tree tees and Mr. Alligator can't catch me along because Mr. Alligator quiet as can be and snap. And then when you snap that monkey right out of the tree, you help them like fall out of the swing onto the crash pad, crash that or snap that monkey right out of the tree. And then they have to say, Okay, there's four monkeys left. And so it's, it's structured, because you're gonna do it five times, or like Five little monkeys jumping on bed. Five little ducks, you know.

Jessica:

You might have to start smaller, even with just like to one little one, one or two. I think two is good just to get that repetition. But for sure. I think you work up to five, right?

Rachel:

And sometimes you don't even make it you maybe you do like five little so you do four little ducks and then you've lost them, then you have to go back to your quiet room. But like that's a great way to build up that rapport. So it's fun, and they're crashing out and you're helping them like you know, you're just the goal here is to be just super animated so that way they don't feel like you're putting them on a swing and it's really posture really insecure for them and they're uncomfortable. Nope, we're gonna swing five times. Nope, you're gonna sit about right there were five times like

Jessica:

I didn't like when you said it like that either.

Rachel:

They don't come Yeah, you're gonna sit your butt right there on that's when

Jessica:

I mean I said that to Logan. But that's different.

Rachel:

My favorite too is like having the kid bonk into you trip really loves it right now and it's a fun way for him to like, be okay in swings like if he's uncomfortable or having one of those days, like, you know, playing peekaboo and you know, having them bonk into you, it provides more of that proprioceptive input

Jessica:

Or if you have a good crash pad, you can have them bonk into the crash pad. If you have them in like a stretchy Lycra swing that reaches the floor. You can lift up use your hands to lift the swing up and have them crash down onto the crash pad in this meeting. That's another one. But getting them comfortable in the swing is going to be a huge success because then you'll be able to do so much more

Rachel:

Okay, moving on from swinging, we're going to recommend crawling next. So you know that crawling is as innate as blinking. And it's a very important skill to not only work on bilateral coordination, but also it provides proprioceptive input and it slows them down. So whether you're crawling through a tunnel crawling through a lycra tunnel crawling under a couple of chairs, crawling from room to room, putting a stuffed animal or like a weighted animal on their back, so he has to, like, crawl slowly so it doesn't fall off. Take a video of him doing this. Put them in front of a mirror so he can see make it very silly.

Jessica:

Giggling Yeah, get a heavy medicine ball and have them push the medicine ball. Oh my gosh, this. This is hard for a variety of reasons. One, it's new, indifferent to they're in a crawling position. So they, you know, really have to motor plan through it. But three, those medicine balls are heavy. And so they have to really activate their muscles and use a lot of force. And it's a great way to meet the sensory needs of a sensory craver.

Rachel:

Yeah, another one I love our assisted big body frog hops. Another one that I'll do with kids to help them transition from activity to activity, especially if they're runners or they're elopers. So like really, like, almost like you're gonna throw them in the air, but like really big frog hops. So they jump on the ground, and then they bounce up and you're helping them get a lot of air. Yep, you're holding under their armpits. But you're also not lingering. So you're not like lifting them up and like holding them. It's like, they're it's like an active passive movement all in one. Yes. Like, I need to do a video demonstration. Because I've had Daniel do that with Tripp one time and yeah, keep doing it all wrong.

Jessica:

Yeah, I think I think this is important to note too. Like if the child is low muscle tone, or lacks joints, you just have to be careful where you're holding them and how you're holding them. I would almost if you're able to hold them more at their trunk versus under their armpits.

Rachel:

I guess that's that's in my head. That's what I'm thinking. Yeah. Because you don't want their armpits to like sub lacs and like, No, you don't want them to elevate.

Jessica:

Yeah, so like just below their armpits to stabilize it, they're drunk.

Rachel:

But if you're not feeling that muscle contraction of their, like, shoulder girdle, like holding your arms under there. You don't want to do this one super intensely. Good point. Do you want to feel them like supporting your arm. Like keeping their arms down.

Jessica:

It's really hard to verbalize. Yeah, that one. Just be cautious with for sure, I think.

Rachel:

Alright, so the next strategy would be, we've kind of mentioned this a little bit, but we're gonna give some more examples like structured simple two step activities to meet those high sensory needs. So like, the activities need to have like a consistent start and stop. So trying something like jump five times on a mini trampoline, and then, you know, have them jump on the crash pad or help them like throw them on the crash pad, and then repeat that five times. So jump and then crash, jump, jump, jump, and crash.

Jessica:

A couple of tricks with this, you have to be very simple with your verbiage, but also very consistent. So with your jumping, you're counting out loud with them. 1-2-3 crash! Let's do it again. One more time, two more times. And you're making it fun and silly and loud and obnoxious. And if somebody were to walk in on you guys doing this be like, Wow, they're over the top. And you're like, Yeah, because it's working.

Rachel:

And I think to another strategy is in the power of the pause, and I was just thinking about this because we have another episode. I think it's called that "Power of the Pause". We'll have the link in the show notes, but waiting for him to engage with you. So you jumped on jump and you crash on the crash pad and then you wait and you observe and you see what his reaction is. Is he happy? Is he sad? Is he looking like he wants more? Wait for him before you're like, Okay, let's do that was so fun. Like, wait for him? Does he want more? Does he look like he wants to run away? Does he look like he is calm and maybe could attend? Wait for him to maybe initiate communicating more or all done. I think that's going to be helpful.

Jessica:

Yeah, you're going to be really slow with your communication, right? You're not going to be like, Do you want more? Are you all done? It's gonna be more or all done. You're gonna be really slow and simple. If you know that he wants more so you're doing the jumping on the trampoline and crashing on the crash pad. Add, and he's on the crash pad, and you're asking him more or all done. And instead of communicating with you, well, I mean, this is a form of communication. But instead, he just runs back to the trampoline and gets on the trampoline to jump again. That's, you know, let him do that. But then before he can jump and crash, again, help him communicate more, whether that's with a sign using his hands to sign more, or trying to make the sounds of more, or using the Visual Schedule and pointing that he wants more trampoline, making sure you're consistent with him identifying if he wants more, or if he's all done, because if you're consistent with this, he will start to catch on, he'll start to do it more independently, which will then carry over into other environments. Yeah, and the communication is just so big, because it affects everything. And so we want him to be able to communicate his wants and needs.

Rachel:

Okay, another little example, could be slide, and then push a medicine ball through a tunnel. So you have like, maybe you have the medicine ball at the top of the slide, and he pushes the medicine ball down the slide. And then once he gets the bottom, you help him push it through either a tunnel or a lake or tunnel, and then once he gets it through, maybe he has to take it back up to the top of the slide, or you can help him. And you complete that three times.

Jessica:

You might even complete this 10 times if he loves it, or one time or one time, you never know. If it's not a winner, you never know. I think it's okay to know that you can do these little simple two step obstacle course activities. For the majority of the session, if he's communicating, he's meeting his sensory needs, you're building rapport with him, depending on the length of your session, if he is continuing to enjoy this, and he's doing well. And communicating and whatnot, maybe you add in a simple container play activity like a cookie jar, and after he pushes the ball down the slide and goes down the slide himself at the bottom, he very simply pushes a cookie into the cookie jar. And you've just added one more little functional piece to it. Because he's gotten the hang of the first two. He's meeting his sensory needs, and he's communicating. So now add one more thing to increase the challenge.

Rachel:

Okay, one more quick little example, one favorite for kiddos who have high threshold or maybe elopers. I'm still going to use that term, even though I don't know if it's actually accurate. But using a lycra tube, and you getting it on one side, and then the child getting it on the other side, and like rowing back and forth. I'm doing it right now, but you can't see me but like doing Row, row, row your boat, you're like holding hands and like going back and forth, back and forth. So you're getting some vestibular input. So doing that, and then have your child pull them on their tummy on the scooter board all the way to the wall and then push the wall, like try to move the wall. So that's like technically three steps, but three pretty simple steps. And so like Jessica mentioned, you know, adding and maybe one more function, so maybe they have to put a, they've got sticky tape on the wall, and they have to like put a picture up on the wall or like, do something simple like cause and effect.

Jessica:

Yeah. All these are great. You know, this question was for a two year old, but a lot of the comments that we got back from other parents and therapists was that their kiddos were like this when they were younger. And now their kiddos are like eight or nine years old. And they have big emotions and big reactions to little problems and poor mid range control and forest modulation. And so for those older kiddos, again, it's still going to be important to meet their sensory needs and give them the sensory input they need so that their body feels more regulated. I think using visual schedules is great for kids of all ages. I use a visual schedule.

Rachel:

Yeah, absolutely. I thrive with lists.

Jessica:

So some more ideas for those older kids too.

Rachel:

A couple other strategies. The deep pressure brushing protocol or the Wilbarger brushing protocol would be a great one when you're in that quiet room if you have it available or maybe when you're inside the lycra tube together. Using the brushing protocol can be helpful. We've talked about visual schedules, token boards, depending on the level- if you've got like a token board with dinosaurs, and he's really into dinosaurs- every time he completes one of those little obstacle course sequences, he gets to put a token board on a token on the token board. And then once the token board is full, he gets to run, run, run or like do a preferred activity.

Jessica:

I think token boards are great for older kids, too.

Rachel:

I think that in this case, a token board might be a little bit advanced for this particular client without knowing him. But there's definitely older kiddos.

Jessica:

Yeah, those older kids who are those sensory Cravers with high thresholds? Definitely using the token board with them is going to be a great choice. A great idea.

Rachel:

Let's see crawling under a lycra sheet. So if you have like a compression sheet, maybe you have a crash pad or a maybe one of your crash pads is an old mattress, you could put a compression sheet, lock it down, Jessica, almost, you could put a compression sheet on the crash pad of the mattress and have them crawl under it to retrieve like puzzle pieces. So they're getting a lot of heavy work under that. crash pad and that under that lycra sheet.

Jessica:

That's a great one. I love that one. I like that one in the clinic. Yeah, to go under the CrashPad to get the pieces. That'd be great for this two year old. Just be smart about it.

Rachel:

Okay, these are common sense. I feel like there's you know, so many sad stories in the news of like, kids suffocating under weighted blankets and It's just awful.

Jessica:

It's terrible. And I cannot imagine what those families go through. Oh, I can't literally makes me want to cry. Yes. Oh, okay. And at the same time, when you're doing these treatment activities, use your common sense and be smart.

Rachel:

The last one here that we had brainstormed was like laying under a weighted animal or squeezing stuffed animals. So like giving big squishy stuffed animals or like the, you know, we have like a way to dinosaur from Target or like the Harkla weighted animal, like squeezing them and giving them big hugs could be a great way to get some more input.

Jessica:

Running with the weighted animal would be great as well. Yeah.

Rachel:

Maybe since he's apprehensive to the weighted vest, having them connect with the weighted animal can be helpful. Hopefully this was helpful.

Jessica:

It really threw me back to the clinic.

Rachel:

I know. I liked it though. This was fun.

Jessica:

If you have a client, therapist, or if you are an educator and have some students that you are struggling to help, or if you're a parent struggling to help your child and you want us to do an episode like this, to answer your question, let us know you can send us a message on Instagram. And we'll do it!

Rachel:

If you are a parent or a therapist or a teacher, who is in need of more specific strategies and would like to brainstorm one on one with us. We do have two on one mentoring sessions available. It's not therapy. It's not a replacement for therapy. It's not medical advice, but it is a really helpful tool that you can sign up for.

Jessica:

All right, share this episode with somebody you know, like somebody who is also struggling in this area.

Rachel:

And don't forget to screenshot while you're listening, tag us on Instagram at all things sensory podcast and make sure you leave us review on iTunes and Spotify. We love reading those especially if you like these kinds of out of the box different type episodes.

Jessica:

Okay, that's all we got for you. We're out of here. Bye.

Rachel:

We'll see you next week. Thank you so much for listening to all things sensory by Harkla.

Jessica:

If you want more information on anything mentioned in the show, head over to harkla.co/podcast to get the show notes.

Rachel:

If you have 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 Harkla_family or at all things sensory podcast. If you just search Harkla You'll find us there.

Jessica:

Like we mentioned before our podcast listeners get 10% off their first order at Harkla. Whether it's for one of our digital courses or one of our sensory swings, the discount code sensory will get you 10% off.

Rachel:

That's s e n s o r y... head to harkla.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. We are

Rachel:

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 be having.

Jessica:

This entire disclaimer also applies to any guests or contributors to the podcast.

Rachel:

Thanks so much for listening