Occupational Therapy (OT)
Sensory sensitivity/processing difficulties - People with autism may experience some form of sensory modulation or processing and integration difficulties, which can appear in one or more of the eight senses – sight, sound, smell, touch, taste, proprioception, vestibular and interoception. With sensory modulation difficulties, a person’s senses may be over and/or under responsive to sensory stimuli. People with sensory processing difficulties may also find it harder to organize and move their body functionally, such as when trying to dress, eat or negotiate a crowded room without bumping in to people or furniture.
Children with a diagnosis of Autism have a high incidence of associated sensory processing difficulties. The way the central nervous system (brain and spinal cord) registers and processes sensory stimuli can mean some children over or under respond to certain sensory input, and can find it difficult to organize and move their body functionally, such as when trying to dress or eat. Within Rosehill School, children’s sensory needs are identified, prioritised and addressed by occupational therapists and trained staff to improve the child’s ability to respond to, and process, the sensory environment.
A sensory approach is integral to the school curriculum. There is a focus on sensory regulation strategies, which are used to support children to achieve a state of readiness to learn. Within Rosehill School we refer to this state of ‘readiness to learn’ as being in a ‘just right’ sensory alert state. It is about the child learning to adjust their level of alertness (or arousal level) to match the task, situation or environment. Sometimes children need help to achieve their ‘just right’ sensory alert state via ‘co-regulation’, where trained members of staff help the child to regulate throughout the school day. It is also recognised that presenting curriculum topics in a multi-sensory and experiential way can enhance and promote learning. This is particularly relevant for children who have difficulties with understanding spoken and written language.
The structure of the school day incorporates activities to promote sensory regulation and the ‘just right’ sensory alert state, for example, sensory circuits before starting lessons. Staff are trained by the Occupational Therapy Service to undertake these activities and how to use associated equipment. The Occupational Therapy Service also works directly with staff and pupils to meet individual pupil’s sensory needs.
Pupils have access to equipment and a designated regulation space, the Balance Room, within each classroom area. Additional resources are provided by the ‘mini MILEs’ (a Multi Immersive Learning Environment) in lower, middle and upper school, and the ‘MILE’ (a larger area) available for all classes, which support self and co-regulation. Outdoor and playground areas also incorporate opportunities for sensory play and regulation. To support multi-sensory learning teachers have access to additional resources to deliver lessons with sensory themes, such as ‘animals’ or ‘travelling’, which run across the academic year. These resources can be used in the classrooms, mini MILE and MILE spaces to complement topics taught in class. They are used to bring the lesson to life, using all the senses: taste, touch, body pressure, sight, smell, movement and sound!
The OTs working in school have additional specialist training in Sensory Integration. Therefore, the primary focus, when looking to address any participation challenges in daily activities for Rosehill pupils, is their ability to register, process and integrate sensory input.
OTs are also trained in ‘activity analysis’, and they may identify other areas of difficulty, not involving sensory processing, which are contributing to the pupil’s participation challenges, such as difficulty with fine motor skills reducing independence with getting dressed. If it is not appropriate for the school OTs to address the identified difficulty, for example, by recommending equipment or adapting the activity, they can give ‘sign posting’ advice to the Class Teacher about additional referrals that need to be made to outside agencies.
Occupational Therapy Approach at Rosehill School
Occupational Therapy intervention is delivered in a number of different ways to ensure maximum benefit to all pupils:
Whole School Universal via:
- Training to all teaching staff on a number of different topics, such as ‘Sensory Regulation’, ‘Handwriting Development’ and ‘Supporting Individuals with Feeding Difficulties’. This training occurs throughout the academic year.
- Practical whole class sessions where OTs model a therapeutic technique/strategy, such as ‘Sensory Circuits’, which teaching staff can then incorporate into the weekly timetable.
Individual Pupils via:
- All pupils admitted to Rosehill School have an initial assessment (observations of the pupil and discussions with staff) by one of the OTs, who then create a ‘Sensory Journal’. This provides a sensory profile for each child and identifies related participation challenges, with advice about how to promote their ‘just right’ sensory alert state, to support learning and engagement. The recommendations could include suggested activities to complete during a ‘sensory break’, or the provision of a garment, such as a ‘weighted jacket’, which can have a sensory regulating effect, or ear defenders, if a child is over-responsive to certain sounds. A goal is also set to give the pupil and staff a realistic outcome to work towards achieving, and to help review the effectiveness of the advice.
Teaching staff are able to request a review of the pupil’s ‘Sensory Journal’ at any time, for example, if there is a change in behaviour presentation or the effectiveness of the recommended strategies have changed.
As pupils progress through the school, we aspire for them to become less reliant on co-regulation, and to develop their ability to recognise when they are not in a ‘just right’ sensory alert state, and to use sensory strategies to regulate themselves more independently.
- For pupils experiencing more significant participation challenges, a more detailed occupational therapy assessment and direct work by OT with pupil and staff might be needed.
Types of intervention and advice
OTs advise on incorporating strategies into the school day for all pupils. This could be via the following:
- Sensory Circuits*.
- Assessing for and issuing sensory equipment for individual pupils, such as a ‘weighted lap pad’ or ‘body sock’.
- Recommending equipment for whole class or individual use, such as a ‘gym ball’ or ‘trampette’.
- ‘Sensory Diets’** for pupils who are identified as having specific sensory processing difficulties, typically around regulation, but to also help them with co-ordinating and organising themselves during daily activities.
- Advice on modifying the sensory environment for pupils who over or under respond to certain sensory input; for example, ear defenders to block out noise for someone over-responsive to certain auditory input, dimming lights to reduce glare for someone over-responsive to certain visual input, or increasing colour for someone under-responsive to certain visual input.
*Sensory circuits are a series of activities designed specifically to promote sensory regulation. They are a great way to energise or settle children into the day.
Each session includes three elements in the following order:
- Alerting activities (for example, spinning, bouncing on a gym ball, skipping, star jumps) to stimulate the body's central nervous system in preparation for learning.
- Organising activities (for example, balancing on a wobble board, log rolling, juggling), which demand brain and body to work together.
- Calming activities (heavy muscle work and deep pressure, for example, wall pushes, push ups, using weights) to give an awareness of their body in space and promote the ability to self-regulate sensory input.
Children/young people can be more regulated, calmer, focused and less anxious after these activities.
**A sensory diet is a specifically designed daily activity plan. It aims to include sensory activities throughout the child’s waking day in order to improve focus, attention and ensure the child is feeling “just right” (regulated) throughout the day. Just as the body needs the correct food evenly spaced throughout the day to maintain energy levels, the body can also need certain types of activities to keep its arousal level optimal. This can support the child/young person to focus on the task/learning, instead of being distracted by stimuli, such as their shirt label rubbing on their neck, a noise outside or being bumped in to in the corridor.
For further information about the OT service please contact:
Cheryl Steele email@example.com