Rachel Harrington, COTA/L, AC & Jessica Hill, COTA/L
We are your podcast DJs and today’s episode is answering YOUR questions!
We talk about challenges between young siblings, a 4-year-old Autistic sensory seeker, a sensory-seeking toddler who struggles at bedtime, strategies for a 2-year-old Autistic sensory seeker who will be traveling, and adopted children who are struggling due to drug exposure in utero!
Some of the ideas we talk about for these questions are: using emotional regulation tools and sensory stories to advocate for needs; asking your child’s OT for specific sensory diet activities; creating a personalized bedtime sensory diet routine; going outside and creating a sensory corner; and more!
We are your podcast DJs and today’s episode is answering YOUR questions!
We talk about challenges between young siblings, a 4-year-old Autistic sensory seeker, a sensory-seeking toddler who struggles at bedtime, strategies for a 2-year-old Autistic sensory seeker who will be traveling, and adopted children who are struggling due to drug exposure in utero!
Some of the ideas we talk about for these questions are: using emotional regulation tools and sensory stories to advocate for needs; asking your child’s OT for specific sensory diet activities; creating a personalized bedtime sensory diet routine; going outside and creating a sensory corner; and more!
My first thought was to create a social story. So when older brother is happy, calm, and younger brother is not around, and maybe one parent can sit down with older brother and create a social story about when little brother does X, Y, and Z, I feel frustrated. When I feel frustrated, here are the things I can do, and then have picture lists of three or four different things that he can do when he's frustrated.
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 to all things sensory, we're happy to have you here. I'm Rachel.
Jessica:
And I'm Jessica.
Rachel:
And we are your hosts! We get listener questions from our we have like a little form that you can fill out in the shownotes and we like to do episodes answering your questions. So in this episode, we are going to go through a couple of listener questions and explain what we would do how we would help as if we were in the clinic working with these kiddos.
Jessica:
Yep.
Rachel:
Yeah.
Jessica:
Let's do it. First question. The child is six years old and he has sensitivity to repetitive noises and hand motions that are typically made by his younger brother. Younger brother loves to sing silly songs and make silly noises. So older brother has sensitivity to that and the goal is for older brother, who's six years old, to remove himself, or wear his noise cancelling headphones. But he won't do either of those and he continues to stay in the situation.
Rachel:
And he's frustrated in that situation.
Jessica:
Yeah. And I'm assuming that it probably escalates from there. My first thought was to create a social story. So when older brother is happy, calm, and younger brother is not around, and maybe one parent can sit down with older brother and create a social story about when little brother does XY and Z, I feel frustrated. When I feel frustrated, here are the things I can do and then have picture lists of three or four different things that he can do when he's frustrated.
Rachel:
And the point is, like Jessica mentioned, not to work on this in the moment, right? We need to practice this outside of the moment separated, like, sit down and create this together, and practice those sensory strategies that you have in the social story. Practice them. Roleplay where you're going to go get the headphones from. He's going to walk into the closet and put his headphones on. He's going to practice getting up off the couch where his little brother is and going to a cozy corner or calm down corner that you've created and he can go relax and do something that is preferred. But also it kind of sucks too because as the sensory avoider, he's the one who has to leave the situation. Like let's say they're hanging out on the couch together, watching a movie or something and the little brother is making all the noise. It kind of sucks that the sensitive kiddo is the one that has to leave the situation like, oh, you know, like, I feel for him. Like, that's tough, but you have to teach him that he's in control of his body and he's in control of what works for him and what doesn't work and what he does. So teaching that and using those words with him and being honest, honestly, like, Yeah, dude, this does suck. I'm sorry, totally. Let's figure out a plan.
Jessica:
And it's just gonna be so helpful to teach him how to identify his emotions. So using an emotional regulation program as the zones of regulation or how does your engine run, is going to be super helpful down the road so that he can better understand his emotions and what he can do when he's feeling an emotion like frustration or anger.
Rachel:
Yeah, and I think too, having the siblings sit down and talk to each other depending on how old the younger brother is. But having the six year old talk about his feelings with the younger brother like, hey, it makes me feel frustrated when you do this, like, can you give me a high five insteador can you sing this song maybe a song that I like instead? And teach him that he can communicate his sensory preferences to other people and that other people have the opportunity to validate those sensory concerns.
Jessica:
Yeah.
Rachel:
Good. That makes sense. Yeah, hopefully that's helpful.
Jessica:
Okay, next question. Is a four year old sensory seeker - ASD. Sounds like, I'm reading her question. It sounds like they're in OT, but it's not helping her with her sensory challenges. The parent read through an article, maybe like one of our blog posts, and she feels like the daughter needs vestibular proprioception because she seems very dysregulated, disorganized, can't focus, no interests, poor visual scanning, limited interests in the outside environment, and parent doesn't know how to make a sensory diet for her to follow regularly. Not sure what she does at school and what kind of breaks she needs. School is very early, so it's hard to follow a morning ritual. And this is a four year old sensory seeker.
Rachel:
Yes. Okay. So if your child is in OT, and they have a therapist, you need to open that conversation with them and that communication with them and ask them these questions. Write them down, send an email, take the time to get your questions answered from the professional because they work for you. You pay them, your insurance pays them, they work for you, and it's their job to answer your questions and help you and help you get something like a sensory diet set up. So step one, talk to your OT.
Jessica:
Yeah, I mean, the OT is the professional. But that doesn't mean that you should be scared to ask questions or throw ideas out there and if for some reason you ask these questions, and the OT doesn't address them, and never provides you with ideas for home, it's really okay to fire your therapist and find a new one. But yes, yeah. It's totally okay. It's your therapists job is to help you and your child with these challenges and so if you bring it up to the OT, and they don't help you, find a new one. But hopefully, you can bring up these concerns and say, I need to make a sensory diet for my child. She's a sensory seeker, what can I do, and hopefully, they can give you some ideas.
Rachel:
Yeah, and the next thing I would do is just start really small and really simple with like one little change. If you can have the child jump on a mini trampoline, or jump on the couch before going to school. Like that might be enough to help meet her needs, in order for her to feel a little bit better, a little bit longer, and a lot of trial and error. But try something consistently for two weeks. Something as simple as that jumping on the trampoline, and then maybe crawling across the room, and squishing herself on the couch and getting into a really small spot on the couch. So really simple. Takes five minutes, if that, to provide some, just a little bit of input. But just start really small.
Jessica:
We do have a free sensory diet webinar and it teaches you the basics of sensory processing and sensory diets and it gets you started with some super easy sensory activities. And like Rachel said, pick one or two to start with, and be consistent with it.
Rachel:
Consistency is key.
Jessica:
Yes, it is.
Rachel:
For school, we definitely recommend going in and talking to her teacher. Email your teacher, find a good time, have an honest conversation, maybe send a journal back and forth for the teacher to just jot down a couple of quick notes. Hey, we did this today and it really helped or Hey, she really struggled today. We turned the fluorescent lights on today and she really struggled with it or is like in the past we just have our lamps on and she does better without the fluorescent light. So just really simple. Open that conversation. Have them send a little note home every day and get some information and then you can teach them what helps her and like things like taking a little sensory break going in the hallway and doing a bear crawl down to the end of the hallway and back. Just something quick like that can be enough to reset her nervous system and get her what she needs from a sensory standpoint. Yes.
Jessica:
Hopefully that was helpful.
Rachel:
Hopefully, always. I know it's tough when a child is struggling in so many different areas to really hone in on like what specifically to do, but I would definitely lean on your OT if you have one, for sure.
Jessica:
Next question. I suspect my toddler is sensory seeking. We've had a challenging time with her ever since birth, and lately her intense repetitive hitting and kicking walls, pillows, myself at bedtime while I nursed her to sleep have been driving me insane. I can imagine that would be crazy. Um, she does it pretty much nonstop for an hour. It's not out of anger or emotions, it's almost always seems like a nonconscious reflex going on, or a last minute attempt to get out every ounce of energy before bed. I can't figure out how to help her. It's frustrating. We're trying calming bedtime routines, magnesium butter on her legs, squeezes, but we sometimes forget. She's very sensitive to sounds, touch, temperature, pain, and sensory seeking in some things but avoidant in others.
Rachel:
That's very common for the sensory needs to be mixed. Seeking in some areas, avoidant and others, like the near senses, right. Like your vestibular, proprioceptive, interoception. Wow, pulling a Jessica, can't say that word today. Very common for kids to be under responsive or seeking in those near senses and avoidant to the far senses. Like you mentioned, sound, touch, temperature, pain, sight, sound.
Jessica:
So temperature and pain aren't close still.
Rachel:
But it could be tactile.
Jessica:
Absolutely, could be.
Rachel:
Yeah, from that stand point.
Jessica:
For sure. Yeah, that's a good point. My first
Rachel:
If you haven't listened to our bedtime, our sensory recommendation is getting in-person OT evaluation. Talk to strategy bedtime podcast episode, we'll link that. I your pediatrician, let your pediatrician know tha this is negatively impacting your child's ability to go to sleep definitely recommend that. But also, since she's a toddler, and bedtime routine, and just get a referral for OT. Get an evaluation and see what they say. using visuals, create a visual routine that includes a lot of proprioception, a lot of heavy work, a lot of deep pressure, a lot of massage, deep brushing. Like focus your bedtime routine on meeting that need instead of like, Oh, we're trying to calm down like no, we're jumping, we're crashing, we're moving, we're crawling, we're pushing things, we're pulling things. I know it seems counterintuitive, but it can really help meet that high sensory threshold that she does have.
Jessica:
Yeah, I think if she's hitting, kicking things while nursing, then there's a sensory need that's not being met. So you're going to have to just do some trial and error on the timeframe for all of this. But I would also recommend going outside for like 30 minutes before you start the bedtime routine, if possible. Just because getting outside is so so regulating and she could go run and jump outside. Then come in, do some jumping and crashing, crawl through a tunnel, pushing and pulling, doing that kind of sensory diet routine to really get that high sensory threshold met, like Rachel said, and then move down to your calming routine with the magnesium butter, massage, squeezes, a bath, dim the lights, turn on some calming music, get some oral motor input going and do it that way. So yeah, kind of the order of operations is would be go outside, lots of movement, lots of pushing and pulling, then calming.
Rachel:
Yep.
Jessica:
And yeah, it's the hardest part is being consistent. It really is, but the more consistent you can be, the more often it will be beneficial. And I think Rachel mentioned using visuals, so using some visuals to help not only your child know the routine, but also so that you don't forget any of the pieces.
Rachel:
Yep and let your toddler pick the activities. Do they want to push a heavy basket or do they want to roll up in a tortilla roll? Let them choose and they will be so much more inclined to participate.
Jessica:
Yes, absolutely. Especially in that toddler.
Rachel:
Oh, yes. Okay. My two and a half year old son has an autism diagnosis and based on your sensory profile. We don't have a sensory profile checklist. That's like a legit standardized assessment. So we have just like a non standardized assessment, just FYI. But based on that checklist, he is a sensory seeker and unresponsive in all of the sensory categories. So as you can imagine, he's a very busy little boy. Touches everything, needs to open and shut every door and every cabinet, gets very upset about denied access. He loves to run and jump and dance and crash and rough play and has all of the high energy, physical things. We have room for running down the hall, jumping and crashing on the sofa in the playroom, mini-trampoline, weighted balls to play hide and go seek in, other areas to give him the input that he needs. We also have areas of our house gated off, where he can roam free; otherwise, we have to follow him around the house to keep things out of his hands or from keeping them from getting into things that he shouldn't safely touch or destroy. We're traveling to stay with family for Christmas, and a small house where everything is accessible, and I won't have all of the things to keep him regulated. Can you please offer any strategies and schedules you may have for getting him the input he needs while traveling away from home?
Jessica:
First of all, apologies that this episode is coming out after Christmas.
Rachel:
Yeah.
Jessica:
But I think it's still helpful. My first thought is, if you are traveling to a place where you don't have access to equipment, it's small, there's not the opportunity to to like gate off a safe area for him. Can you talk with the owners of the house about putting things out of reach while you're there? Or if it's like an Airbnb, can you go ahead and just kind of rearrange some things really quick, or contact the hosts ahead of time and say, hey, my toddler is into everything. Are there things that we can put up and away where he can't get to them? But if you're staying with family, then just talk with your family ahead of time and say, Hey, these are the things we need to do to keep my two and a half year old, safe and happy and hopefully, they're accommodating to that and can help put things away for safety promises.
Rachel:
Yep, I would say going outside multiple times throughout the day, taking walks, finding parks, really spend time outside as much as possible. If you're traveling and you're going to do events and stuff, just make sure that you're building in those sensory breaks. Whether it's a nap. Whether it's a break to go to a quiet space and regroup. Whether it's one on one time where you can connect and tickle and play and rough house. Focus on taking those breaks, getting outsid,e and playing.
Jessica:
I like the idea of having a space in the house that's like a jumping crash station. So it's a small house, there's not as much room, but can you designate one corner space of a bedroom or the living room that has cushions and blankets and your child can jump and crash and bury themselves under the cushions and just spend time regulating in that space.
Rachel:
Can you create a car sensory box or an on the go sensory box where you have some of his favorite tools like in a little bag that you can have in the car or you can just bring into the Airbnb or the house that you're at? So it's a little bit familiar, whether it's like a stretchy exercise band, or fidgets that he can play with, or I don't know. Maybe you're a little bit crazy like me and you bring a therapy ball that's not blown up and you pump and you pump up a therapy ball because it pumps up and.
Jessica:
Or the Harkla hug.
Rachel:
The hug is also easy to travel with and you can do so many different activities with them and gives them a safe sensory place. So think about an inflatable tool to bring with you to help meet their sensory needs.
Jessica:
Yeah, it's gonna take a little bit of creativity, but it's definitely still possible to meet his sensory needs in a smaller space away from home.
Rachel:
Yes. Okay. Hopefully that helps.
Jessica:
After Christmas.
Rachel:
After Christmas. I know I'm sorry. Maybe we need to post this on Instagram or something beforehand.
Jessica:
Maybe.
Rachel:
Yeah.
Jessica:
Last question for today. Hi, ladies, big fan of the podcast. Thank you. I'm wondering what you're hearing or seeing in the field regarding prenatal opioid exposure. I'm raising two boys. Both adopted at birth and have become intimately aware of the long term outcomes of this exposure. While the opioid epidemic is now 13 years old, I'm still not hearing discussions about the sensory and behavioral issues these kids live with. Is it being dismissed in the OT world at all? I liked this question.
Rachel:
Yeah.
Jessica:
This is very important. Yeah. I've worked with children who were exposed to drugs and alcohol in utero and almost always these kiddos have sensory processing challenges of some sort, whether it causes them to be sensory seekers or sensory avoiders, ADHD or ADHD type symptoms. I just think that in utero, if the baby is exposed to drugs or alcohol, it goes into their brain and it causes misfires between the brain and the body, which then causes these sensory challenges.
Rachel:
Yeah. I have definitely taken some continuing education courses on the topic, especially like in the past working with kiddos who were born addicted. In addition to the sensory challenges, the ADHD, I see a lot of connection with ODD - oppositional defiant disorder, and a lot of emotional regulation challenges as well as retained primitive reflexes.
Jessica:
I was just gonna say that because these babies are more likely to be born premature, which a baby who was born premature is at a higher risk of having routine primitive reflexes.
Rachel:
Yeah, yeah. So I think people are talking about it. But in niche areas, and I don't think a lot of OTs are talking about it if they aren't working with clients who are struggling in this area or who were exposed to prenatal opioids. But for therapists who are working with kiddos in this area, I hope that they are addressing it, and they're talking about it. But as far as the research, I found one article, just really quick, There was a lot of articles. Yeah.
Jessica:
I did find quite a bit, actually.
Rachel:
But this one prenatal exposure to opioids and neurodevelopment in infancy and childhood, a systematic review. So yeah, there are articles out there. I will have to do a little bit of digging to find some new courses that are like new, new courses that are talking about treatment strategies and interventions for OT in this area because it's been, it's been a year or two since I've really looked.
Jessica:
All of the research I found shows the correlation between prenatal opioid exposure and neurodevelopmental challenges.
Rachel:
Yeah.
Jessica:
So it's there. It's very real. As far as like, what do we do about it? I think that a lot of the things we talked about on the podcast, are still very relevant: primitive reflex integration, using emotional regulation programs to teach about emotions and to teach strategies.
Rachel:
Therapeutic listening program.
Jessica:
Yes.
Rachel:
Yeah, so really working from the inside out as much as possible and getting their brains to function at the highest ability wherever that is for each unique child. But I'm really glad that this question came in, because I definitely don't feel like it's talked about enough or at least we don't talk about it enough.
Jessica:
I don't know that we ever have.
Rachel:
Maybe we need to do a podcast episode on it. A full episode.
Jessica:
We probably do.
Rachel:
Okay, well added to the list. I'm writing it down now.
Jessica:
If you have a question that you want us to answer on the podcast, go to the show notes and click on the link to fill out the form and we will answer it as soon as we possibly can. I'm so sorry that we didn't get to the Christmas one before Christmas. Apologies, we will try to do better,
Rachel:
I know. Leave us a review on iTunes or Spotify, if you found this episode, or any of our episodes helpful. If you are a longtime listener, thank you for your support. Thanks for being here. The best way to support us is just to leave us a review and give us a shout out on Instagram and share this podcast with people who need it most and who can benefit. I think that's it.
Jessica:
That's it.
Rachel:
That's it. We love chatting in your ear and jibber jabbering and thanks for being here. Hopefully you enjoy our sense of humor when we can laugh with each other and hang out and not take life too seriously, because that's no fun.
Jessica:
All right, we'll talk to you next week.
Rachel:
Okay, bye. 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:
Head to Harkla.co/sensory to use that discount code right now.
Jessica:
We are so excited to work together to help create confident 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 be having.
Jessica:
This entire disclaimer also applies to any guests or contributors to the podcast.