Sensory Integration in ADL Series (SCAN) – Topic – Behaviour

Hi All,

sharing details of another session which i have recently attended , it was organized by SCAN group. The session details are:

Session Name: Workshop on Sensory Issues relating to ADL (Activities of Daily Living) Training – Behaviour
Date and Timing: 15th Oct 2019, 10 am to 12:30 pm
Venue: Mitr, T-18/2, Coastal Road, Kalakshetra Colony, Besant Nagar, Chennai – 90
Charges: 150 Rs per Person ( Refreshments were provided)
About the Speaker: Mrs.Lalitha Sridhar is a rehabilitation consultant and developmental therapist specializing in sensory integration and neuro developmental therapy. She is an educator and counselor for children with development / special needs and their parents. Lalitha has over 30 yrs of experiences in India and abroad. She has worked with children across all age groups, from early intervention to vocational training and has been providing programs across age groups. Her core areas of work are assessment, intervention and developing holistic programs for children with special needs. She has worked with parents in guiding, training and empowering them in their journey.

This session was part of the ongoing Sensory Integration ADL Workshop/Training series, i.e. Feeding > Toilet Training > Sleeping > Communication > Behaviour. Today its BEHAVIOUR, which is the concluding part of the ADL series.

I was surprised to see a smaller crowd for the behaviour session, as this was the most awaited topic for many parents out there.

WHAT IS BEHAVIOUR ?

Our response to everything/anything that happens around is attributed as behaviour. She also suggested that we should focus on preventing the behaviour from arising, instead of managing it later. It should be arrested even before it is expressed.

FOCUS ON POSITIVE BEHAVIOUR

She asked about the behaviours which parents have experienced, the list came out as:

• Behaviours that arise due to Stress faced by the child
• Destructive Behaviours
• Inappropriate Behaviours etc..

None of the parents have spoken about any positive behaviours of their child, which is what she wanted to address. She only asked for behaviours of their child, she did not asked for PROBLEM behaviours of the child, however every one is of the assumption all
the time, that behaviour always refers to negative behaviours. We have to acknowledge positive behaviours first in order to work on the negative behaviours. We take positive behaviours for granted. Child will not connect to a parent when you are going to approach him with reinforcements or other means on negative behaviours alone. The connect is an important factor. If you do not give an equal weightage for both, the connect will not be there with the child, as a result whatever behaviour modification you attempt will not reach the child.

Children will respond well, when positive behaviours are acknowledged. Make it as a practice to identify 2 or 3 positive ones, apply a method or approach to appreciate / acknowledge / reward it for 7-10 days, this sets the tone for the child to engage and get
used to the framework/strategies. After which try to bring the same in addressing the negative ones. Kids often will miss on the verbal or non verbal cues, but they will be spot on in identifying the body language. When you take your child to specialists/therapists and complain about your child to them in front of your child, it highly demotivates them.

CAUSES OF BEHAVIOUR ISSUES

1. Toileting

Proper bowel movements help in:

• Functioning of Cognitive skills i.e. Focus and Attention will be there
• Regulation: Regulation means self regulation, it is an important inner aspect. You cannot be whatever you want to be anywhere. Also it refers to regulation to place, regulation to people, regulation to surroundings etc. Regulation will fall in place, when you are aware of what is happening around you. If you lack awareness, body movements and sensory systems are not in your control, you cannot regulate yourself.
  For example, a dog is chasing you, you run for safety. Similarly a vehicle is approaching the pedestrian crossing, so you await for the vehicle to pass and then cross. these are examples for regulation to the environment.
• Sense of Awareness
• Anxiety – Human nature is to feel being secured, when we sense insecurity we are at discomfort. It causes anxiety and all other behaviours.

Proper bladder training is also important and it helps in:

Some kids go to toilet every few minutes, as they feel the urge to pee even when they have 5 ml of urine in their bladder, which is way less than the actual triggering point in the bladder. Your bladder will get stimulated only when it touches the nerve which is
located half way above the bladder capacity. Child must be trained to hold the urine in the bladder. There will be accidents here and there, but do not highlight such accidents and cause self esteem issues to the child. Proper bladder retention and streamlined water consumption will regulate the body. When proper bladder control is established, it will stop the child from craving of excess water intake.

• For a 1 year old and above kids, practice by beginning every 1 hour
• For 4-6 years old children, practice by beginning every 1:30 or 2 hours.

For instance,
A Child who did not have bladder training, and uses to pee every 5 ml or less will have a constant urge most of the time. If the teacher says that children are allowed to pee every 1 hour and not in between, it will make the child uncomfortable to begin with, soon it will be overwhelming. Once that happens, child will begin hand flapping or disturb other children etc. Now teacher again restricts his movement by saying no hands flapping, which introduces anxiety to the child. Do you see where is the problem? It is not the behaviour of the child or learning difficulty, child is not fully developed for next phase. Child did hand flapping, etc, because to compensate something, he needs to do something else.

2. Sleep

8 hours of sleep is important for the internal organs to work at the optimum level. Gut should function at its minimum, for all other supportive systems to start functioning.

3. Communication

If a child is non verbal, open up some avenue for the child to communicate.

• 0-7 years, focus on Verbal Communication
• Above 7 years, some sort of communication tool needs to exposed to the child, in order to exhibit his needs.

Focus on making the child understand. When the child does not understand others, even if we are asking the child to calm down or offer help to him , he will not be a position to understand what we are communicating to him.

4. Sensory

As parents, we think every issue faced by our child are sensory in nature, take him to occupational therapist for fixing the same. How many of you have succeeded in eliminating a sensory issue, by taking OT therapy sessions alone ? Sensory systems are not bad, they are essential to the body for proper functioning. Sensory is a continuous process, it will not always be the same, It will have its Ups and Downs. Also there is no behaviour that is caused due to 100% sensory issue.

• For age 0-7 years, more weight on sense.
• For age 7-14 years, less weight on sensory and more on ADL activities.

At the age of 14, child enters in to adolescence and faces with Hormonal component. Every change you see with your child from age 14 is due to hormone changes. If we do not address it, we will not get desired results be it male or female. At this age, kids will
eat more, hence focus on their diet, if you let loose there is a very good chance that they will become obese. Also please refrain from performing any hormonal replacement therapy. Give heavy physical work to the child, Sports activities helps to have necessary hormonal discharge. Also at this age, check for Thyroid, Sugar and any other metabolic diseases.

OTHER TIPS / RESPONSE TO PARENTS QUERIES

1. In responding to a parent who is working on Auditory issues of her child, that, do not work on auditory alone. Focus on Tactile and Proprioceptive along with it for better results. Most of the Auditory and Visual issues are due to an imbalance in Tactile and
Proprioception, hence if you focus on that , you will get rid of sensory issues related to Auditory and Visual. Every issue which you encounter which your child, cannot be treated as an isolated instance, the root cause would be an imbalance on any of the
sensory systems. Always have a holistic approach to it.

2. She also mentioned that for women who reaches the age of 50, during menopause there will be an imbalance in tactile and proprioceptive senses, which will take its own time to settle down.

3. She mentioned about the AUTCON, which is a conference dedicated for Autism that is scheduled to happen in coming March. The venue would be st.isabels hospital located in mylapore, conference would be addressed by various professionals, team of doctors,
KCDU of Ramachandra etc. She would share the details about the conference later.

4. When you are tired please don’t work on any behaviour modification or activity with the child, don’t do it as chore. When you give your 100% the response will be great, even if the time you spent is 5 minutes it will be very effective. The person engaging with
the child is important in addressing the behaviour.

5. When one particular sense falls behind the development, some other sense gets strengthened like compensating for the loss of one. For example, visually impaired (Blind) people have a greater hearing sense.

6. She referred about an article regarding Circadian Gut, which speaks about the body clock and rhythm. I assume it must be the below article published on 14th October 2019
https://www.thehindu.com/life-and-style/fitness/every-organ-works-on-circadian-rhythm-but-cr-governs-the-gut-the-best/article29681866.ece

7. There was a question from parent, where she mentioned that her kid does everything at home but when travel for outside, his whole system goes for a toss. For example, he goes to potty within 1 hour of waking up in the morning at home, whereas when area at
some others residence, he does not do that.
Mrs.Lalitha responded that generalization should happen from day one, if a kid is able to respond for a particular thing, he should be able to respond in the same manner any time, any place, anyone etc.

8. There was a question from another parent, where her child was having sleeping issues whenever they stay in a hotel accomodation. But there was no issues, when slept at relatives house.
Mrs.Lalitha responded that prepare the child with visual input, bring the distinction between hotel and house. Have a very clear demarcation, like if we are carrying a particular bag it means that we are going to hotel.

9. Another parent posed a question that her child is comfortable staying inside the hotel room during their trip in kumbakonam, he does not want to come out of the room. The resort they stayed in had Museum, animals etc, which was meeting the children outside
needs.
Mrs.Lalitha responded, that it is normal behaviour for a teenager. How many 18 year old will come to a temple trip with family for kumbakonam, out of 100 may be 2 or 3 might come.

10. Another parent expressed that her Kid is a visual learner, whereas most of the therapies or school wants to reduce the screen time. She is against it, as her kid learned a lot from visual media.
Mrs.Lalitha responded, that we do not say NO screen time. We suggest to avoid cartoons which make the child to speak in a robotic way.

11. Work on concrete and then move to abstract. Work on one small area within a restricted boundary and then expand the boundary. Move out of the restricted boundary at the earliest.

12. Crying, adamency, jealous are normal for 0-7 years age. Only when they interfere with learning, we need to decide what can be done. It is not a red flag as long as it is not self injurious and not injurious to others.

13. Another parent asked a question that her child laughs deliberately to annoy others. Mrs. Lailtha responded, saying ask the child Yes/No questions to see what does like and what he does not like. A simple Yes/NO will open up a new world of communication.
Parent also mentioned that her child responds to firmness, for which Mrs.Lalitha responded that it is called adaptive behaviour. Like in circus, you take a rope and train all animals to walk in an order, you have trained your child to respond to firmness. If all of them are doing the same thing same way, that doesn’t mean it is a right.

14. Another parent asked question that her son is having avoidance behaviour. Mrs.Lalitha suggested not to talk about a incident/accident caused by the child immediately. Even for a husband and wife relationship, if there is a conflict in decision
making, you will not address the conflict immediately, you will give some time before either party starts justifying their actions. It is the same way for the child as well. Give a gap of 30 mins.
When addressing about a particular behaviour or related incident, instead of direct advise, tell a social story and explain how he should have behaved during that time. If you do that, he may also try to communicate from his end, why he behaved in such a manner. Do not advise during the heated moment, nothing good can be achieved from that. Stop advising immediately after the incident, also it is better that one of them move out of the room. When the child is not in the platform to receive, cut it off. For younger children, time out is better like don’t give eye contact, make him seated in a cozy bean bag. Child needs time to unwind it. For older children, use them directly and rationalize about the incident.

15. Diet and Rhythm is very important for a child in behaviour.

She concluded with a live incident that happened in the session, where one the participants child came inside the room where the session was happening, sat next to the presenter and told her “Aunty, can be be quiet” (Auntry, amaithiya erungo). Every one bursted in laughter as it was a cute moment, however we did not do the right thing by laughing at that incident.
From the kids perspective, we have given him a message that what he did is OK, and we are enjoying it. We reinforced the child to make him speak like that in future. Please remember that we drive the child. The child was adaptive to the environment, she would not have given eye contact and avoided response for few minutes, which would
have made the child to loose interest and venture to something else, instead by laughing at his action it gave a positive reinforcement.

MY PERSONAL FEEDBACK

I felt the content shared on the Behaviour is very less when compared to the initial sessions, even though she justified that she was only able to cover the basics on these sessions, still the coverage was less. Participants have requested for another session
dedicated to Q&A. I felt the behaviour session itself became a Q&A session half way through and also too much time was spent on areas that were already covered in the earlier sessions. Compared to her very first session on ADL, where she stopped questions from participants mentioning such interruptions affects her flow, in her last session she accommodated questions from all participants which clearly affected the flow and took a different direction. Honestly i am disappointed on the Behaviour session.

I truly miss her insights, the knowledge and experience which she has shared in the entire series is something which i have not heard of earlier, which clearly tells us she speaks out of personal experience. It is time for us to put things in action, and
focus on development which will in turn improve the learning issues faced by our child. The most admired aspect about her is the energy, i saw the same level of energy in all the sessions. I pray that her services should reach and benefit a larger number of
children.

I thank Scan for organizing the entire series on ADL, i look forward for such sessions in future which are highly beneficial to the Parents with special needs children.

Regards,
Saranya and Karthik
karthiksaranyaparents@gmail.com