attributes: sensory motor

What is the significance of these patterns and how can they be managed.

Quirky Kids- NESA Part 2

ATTRIBUTES: SENSORY MOTOR

Dr. Roby Marcou Singapore

The Right Hemisphere….

Lateralization in the brain is hardly absolute.. But..


The issues are fundamentally neurological.

Cerebellum and Corpus Callosum


Visual/Motor Challenges….

  fine motor: shoe lace tying, stringing, lacing   gross motor: sports, bike riding, running, dancing   graphomotor: paper/pencil tasks (writing)   visual motor integration: eye-hand coordination   visual spatial integration: judging proximity, seeing

details, foreground from background   visual memory   non-verbal concept formation: seeing something in your

mind, using inspiration..


Early life patterns

  minimal exploration of the world through crawling or hand manipulation

  preference for exploration through language

  low muscle tone, peripheral and truncal

  the tendency to feel ‘lost in space’

  difficulty perceiving ‘boundaries’


Sensory processing weaknesses

  the ability to organize the sensations of our day-to-day life- automatically

  3 primary systems  tactile: texture, size, shape- perception of touch as

threatening or not  vestibular: information through the inner ear about

balance, gravity, groundedness  proprioceptive: information about the position and

movement of our body derived from non-visual input


caveat

‘sensory integration’ is to a large extent an abstraction   minimal evidence basis for

the ideation and the remediation both

  no specific neurology or test; diagnosis made by report

  there is also widespread use


sensitivity to sound, touch, visual

  varying degrees of sensitivity to stimuli   auditory input can be painful   touch can be perceived as threatening   visual input can be distracting

  Behavioural responses and academic impacts abound   BUT, measures are not objective, they are entirely

subjective…….   Likely part of bigger picture..


core concept impacts on sensory- motor functions: higher cognitive function issues

  personal space and theory of mind

  visual-auditory input for self reflection- theory of mind

  sensory input and awareness of intent of others- theory of mind

  difficulty in organizing self, materials and central coherence

  failure to plan an organized approach to an environment- EF


arousal states   Maintaining optimal

level of alertness and arousal to allow for adequate attention  may be too high:

over stimulated, agitated

 may be too low: drowsy, distracted, diminished alertness


Improving mental arousal/alertness

  what interventions are you aware of that enhance this capacity

  a technique for enhancing alertness and arousal– mini meditations in practice  Square thinking  Progressive muscle relaxation  Mantra  Counting with breath

  Mindfulness trumps sensation/motion alone…….


Students with Sensory Motor Issues Are:

  perchers  what they are telling

you about what they need

  how to provide it: chairs/squares/tares

  safe spaces to regroup

 movement/rhythm and imagery

  fidgeters   a box of koosh and

doodles Dr. Roby Marcou Singapore

Physical and Sensory Environment

  inventory the student’s issues: very idiosyncratic

  need to provide space   Novel or cluttered spaces

  organization and structure   class organizations are often ‘social’>>must consider the physical

  own space, designated areas for materials

  every year, do it again...’coherence’ issues


The Extra Layers of Structure

  physical: designate with visual boundaries

  schedule: visual, developmentally appropriate (photographic, drawings, words)

  visual clarity: for near environment, for academic tasks, for curricular materials, for presentation of new information   keep a completed example

always available


simplify, simplify, simplify

  Auditory input   Motor tasks:

  struggles in private   avenues of motor

competency   readiness before instruction   verbally mediate with a

script; provide a model

  Separate the motor element of the task

  Cohesive visual organizational schemes


posture, position and perching

  OT interventions? Sensory diets   classroom seating   maintaining arousal state   recognizing and responding to physical cues in the

classroom


your physical boundaries

  what provisions are feasible at your grade level?   what are the potential negative impacts of these

provisions?   what are the changing developmental demands

and potential coping strategies?

  For Discussion: Providing the student with the learning of skills to help them be self sufficient, versus creating an environment with reduced challenge.


Ultimately, the learning of skills is key and all future outcomes are dependent on this.

ATTRIBUTES: COGNITIVE/ ORGANIZATIONAL


Revisit These

  Theory of Mind

  Lack of Central Coherence

  Weak Executive Functions

these come to roost in these domains


theory of mind- related patterns

  difficulty in predicting the behavior of others> fear and avoidance

  difficulty in reading intentions and motives of others> in literature and life

  difficulty in explaining one’s own behavior   difficulty in understanding the emotions of

self and others> leading to lack of empathy   trouble seeing the connection between one’s

behavior and the feelings of others which in turn affects motivation to please

  difficulty in knowing what others know or are interested in

  difficulty distinguishing between fact/fiction


Instructional Principles

  academic tasks can be a ‘relief’   explicit about saliency   ensure the student knows instructions pertain to them!   tasks always meaningful to the perspective of the student   articulate what you want to see


enhancing the ‘metas’

  meta-awareness of self: as a problem solver- require self reflection and recognition of self-experience

  meta-linguistics: awareness of the hidden intent of figurative language   teach idioms and

metaphors specifically


Central Coherence and Learning

failure to recognize wholes, events in context; preference for detail

  idiosyncratic attention/ perspective

  prefer familiar

  inability to quickly ‘get the drift’

  inattentive to new tasks

  difficulty in choosing and prioritizing


Poor Coherence

  Discussion: how does the overall curricular approach impact this child in their learning.

  What about IB for the quirky child??

  difficulty in organizing self, materials and experiences

  difficulty in seeing connections and generalizing skills and knowledge  information is learned as

discrete bits rather than with true ‘understanding’

 retrieval of information that is not stored meaningfully is slow and labored

 apparent lack of compliance Dr. Roby Marcou Singapore

Teaching to enhance sense of coherence

a.

b.

c.

d.

Multiple

Choice?

  make the beginning and end points of tasks clear using lists of steps

  provide a completed model as reference   avoid ambiguity, use visual clues to highlight

meaning   provide multiple opportunities for generalization   make connections with previous skills or

knowledge explicit   draw attention to cause and effect, motives and

plot in visually sequenced stories


Impacts of EF Deficits

Plan

Self monitor

Flexible

Inhibit

Search

Working memory

  rigid, inflexible responses   minute scripts take the place of flexible responses

  perseverative behavior and wasted time   impulsivity   poor meaningful application of knowledge   need for routine   fail to learn from experience   low ability to mentally juggle information   Limited self awareness and need for external

input


principles of intervention- basic

  process rubrics   develop a hierarchy of

sub goals   sequence activities

towards the goal   help to learn to identify

main ideas   help to draw

associations between points of knowledge

  help to see the whole picture


routine, consistency, clarity, simplicity

work systems: how much work will I have to do? what work will I have to do when will I have finished? what happens when I have finished?


general communicative support

  call by name before addressing   concrete, explicit, visually reinforced instructions   one step at a time   check for understanding   repeat instruction without rewording   teach a phrase to use when not understanding   turn questions into statements   recognize that comments may not reflect intentions   no use of sarcasm or irony– it is not understood   activities that practice turn taking and reciprocity


maintaining routines and schedules

  provide safe, predictable environment

  minimize transitions>> watch for over scheduling

  pictorial schedules, in proximity

  classroom rituals   avoid surprises-prepare

in advance for change   allay fears of the

unknown through pre-introduction

  monitor for anxiety


Adult Transitions: The Prepared Classroom and Teacher

Avoid compromising the new situation by identifying in advance:

 the types of activities-structures-environments

 the student’s strengths, skills, methods of conveying what they know (ensure that records do not only itemize weaknesses)

 a sense of a ‘worst possible day scenario’- play what if so that responses are pre-planned


Specific Transitions

  to a new school: videos, visits, interviews, brochures, newsletters, websites, dinner

  to middle and high school: flip chart schedules and other considerations

  Assume: Your personal assumptions about what constitutes a significant transition does NOT coincide with this student’s perspective.


Helping with Slower Processing

  discuss the nature of the issue with the child, give them a language to use when they need time>>>give time

  teach estimation strategies

  use clocks and watches   noticing time- when

something is due   how much time is given


Application Time.

  Think about a recent new concept/skill/expectation taught in your classroom and answer these:  Why (which neuropsychological construct) was this difficult

for the quirky student?  What did I assume that was not true for this student?  What would I do differently the next time?  Why would that work?

 Share.


What patterns do quirky kids show and how can they be anticipated or managed. Why are the emotional aspects vital to success ultimately and what does this say about school admissions considerations?

Attributes: Emotional


consider the experience of

  not understanding why others are doing what they are doing

  not understanding the subtleties of the language they are using

  feeling overwhelmed by your physical environment   feeling that everything is new   not understanding why you feel afraid or how to explain

it to your teacher

  not having any idea where to start first


or how about

  feeling the teacher must always be talking only to you?

  not being able to consider alternative outcomes or interpretations

  having a very firm unique interest that in endlessly engaging

  never feeling satisfied enough with an outcome

  knowing facts, but not understanding concepts

  feeling overwhelmed by sensory input

  finding even routine motor tasks challenging


WHAT DOES THIS LOOK LIKE?

  CONFUSION   FRUSTRATION   ANGER   ANXIETY   RESTLESSNESS   PANIC

  INCREASED RIGIDITY   INCONSISTENT

RESPONSES   REPETTIIVE BEHAVIORS   EXPLOSIVENESS   SOCIAL IMPACT


INSIDE OUTSIDE

COMPLICATIONS


  Reactions of peers and adults   Failure to see these responses as

reactive to a mismatch: misjudging the student

  Anticipation can be difficult as the specific trigger can be obscure

  Cumulative responses

keep in mind

  patterns will be habitualized, no learning occurs during stress

  relapses common after breaks

  an emotional touchstone can be key, particularly for the adolescent

  choices and flexibility create opportunity to reduce stressful interactions


strategies for stress reduction

  evaluate natural cycle, when are they most ready for ‘hard work’

  physical activity

  monitor impact of fatigue teach relaxation strategies and engage them regularly

  make curricular and environmental choices to reduce stress


Working on Self Management and Awareness


maintain motivation

  unmotivating environments precipitate avoidance behaviors

  task intersperse: maintenance and learning tasks

  vary tasks for enhancing attention

  reinforce effort/attempts consistently   teach the student to

continue to attempt rather than developing learned helplessness


a prepared environment?

  shared control to minimize rigidity by providing sufficient external predictability

  use of rules   All must be explained   rules/praise/ignore

  rules are neutral, but the child might over-apply them

  state the rules positively


Teacher: emotionally detached and compassionate

  battles of wills will never be won

  lack of empathy, imagination of alternatives and negotiating skills comes off as ‘confrontational’

  be calm, neutral, orderly in approaching the child

  firm expectations for work completion

  praise specific behavioral choices

  control your own need to control!


allow for intense interests

  at identified times   in identified places   to an identified extent (for repeated questions, a given

topic)   recognize that at times they are a stress reducer   can be used as reinforcer or reward at the end of a

sequence   as an inroad to other topics or behaviors

  to facilitate social interactions


non curricular elements

  assemblies: vital? if more relaxed, more likely successful; explain rules; seat at periphery; praise appropriate behavior; provide a buddy

  moving around school: stagger arrival and departure initially; multiple visits to secondary schools; buddies

  in a cafeteria: clear rules, role play, attend to place in queue, teach simple conversation skills


sense of self

  to increase confidence in self as an individual   strive to identify positive

affiliations   discuss the child’s ‘diagnosis’

at an appropriate time and level

  demystification allows them to see a reason for why they do what they do- and is empowering

  help the child diary or engage in other activities to reflect on their own role in events

  encourage meaningful application of areas of interest


interventions for behavioral difficulties

  must be planned, as impulsive efforts may exacerbate behavior

  enlist a team for planning   look for the positives, the interests and the natural

motivators for the child   identify the functional purpose of the behavior for

the child   define the actual behaviors


observe and accurately record

  child’s behavior   setting conditions   triggers   actions of the child and

others   results of behavior

  recording should be rigorous, statistical and comprehensive


elements of an intervention program


  facilitate alternative behaviors  using an understanding of child’s

strengths, interests, preferred activities  do not attempt to entirely extinguish or

eliminate behavior, instead try to replace   relate rewards to the child

 based on interests  back up rewards from home  powerful, meaningful, predictable,

consistent

Useful and Alternatives…

  Instead of asking yourself, ‘What’s it going to take to motivate this kid to behave differently?’ ask ‘Why is this so hard for this child? What’s getting in his way? How can I help?”

  Compassionate detachment


remember

  many behaviors which appear oppositional are reflective of a lack of skills to do otherwise

  children need multiple repetitions to apply newly learned behaviors in a stressed situation


Acute Episodes- Stress Cycles of Child and Adult Experience

  both the child and teacher experience cycles related to stress- rumbling/rage/recovery

  the stress responses are typically more intensive for the child

  how the pair navigates the cycle is key-early identification is key!!

  the child can only be expected to use skills they know well in the most intense parts of the cycle; in the recovery stage they can be taught new skills

Rumbling Stage

  behaviors/student   fidgeting   noises   grimacing   refusal to

cooperate   rapid

movements   tears   tension   voice volume

changes   verbal threats

  interventions:   non-punitive removal/cool zone   proximity control   non-verbal signal   touch   humor (with care)   support from routine   interest boosting   redirecting   acknowledge difficulty but

articulate expectation   just walk/don’t talk   avoid blame discussions

effective adult behaviors

  stay calm   use a quiet voice   deep breaths   prevent power

struggle   re-evaluate student

goals   be flexible- the child

cannot

rage stage   behaviors/student:

  disinhibited   acting impulsively   emotional   explosive   destroying property   self injurious   screaming   biting   hitting   kicking   internalizing behavior

  interventions:   emphasis on safety for all   don’t discipline   remove the audience   be non-confrontational   plan a graceful exit strategy   obtain assistance   prompt to a cool zone   use few words   prevent a power struggle   be flexible   set a timer


  control your own fight or flight tendency- deep breathing (relaxation response)

  remember that less is more: TALK LESS

  remain calm and quiet   do not personalize

behaviors   disengage emotionally   be conscious of your

non-verbal cues

recovery stage

  behaviors:   sleeping   denial of rage

behaviors  withdrawal into

fantasy   apologizing

  vulnerable to re-enter cycle

  interventions:   allow to sleep if needed   support use of previously

learned relaxation strategies   do not refer to the rage   support with structure   possibly: redirect to

successful task or area of interest; provide space

  check student is ready to learn

  do not make excessive demands


 remain calm and quiet

 take time for yourself to regroup

avoid burn out

  student- failing to see school as fun, increasing anxiety, over-therapized, areas of interest not elaborated

  parent- continued negative reinforcement; unrealistic expectations, control issues

  teacher- ‘case management’ demands, the reality of very gradual gains


Emotionality and School Admission


attributes: sensory motor

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