Friday, 29 April 2016

Deep Pressure: Magic of Weighted Blanket!





                                                     
                                                  


John diagnosed Autistic at age of 6 years got admission in special needs school for progressive future. His parents did not inform school staff much about his maladaptive behaviours except being picky eater, impulsive and having tactile defensiveness. On first day to his school, he was introduced to classmates and support assistant (Ms. Johnson) by his class teacher (Ms. Winslet). As the day progressed, John seemed calm and settling within the classroom surrounded by some new friends.

During the lunch-time, Ms. Winslet told him about rules of eating in classroom and ensured that he is doing fine.  John without making any eye contact heard everything and absorbed all in (taking in too much information from new environment,resulting in sensory overloading) while eating his sandwich and nodded head.
All of a sudden, after fraction of seconds, everyone heard John shouting, being physically aggressive on child sitting next to him and crying without listening to anyone. He also bitten the support assistant who tried to stop him from hitting. Due to extreme kicking, hitting, pushing and biting behaviour (physical violence) he was restrained by two male staff members.

School OT intervened and he was taken to therapy room where she wrapped John in a weighted blanket (deep firm pressure) and rolled on floor until he calmed down.

Later, this little man mentioned that he got angry because child sitting next to him was eating crisps and making noise, that John didn’t like!!

Phew!! so, now we know why John behaved in such a manner.

Well, but what happened when he was wrapped in a weighted blanket? How so much angry young man (who needed male staff for restraining) calmed down so easily? Why didn’t he resist to weighted blanket?

This happened due to MAGIC of DEEP PRESSURE!!

Thursday, 14 April 2016

Tactile Defensiveness Vs Tactile Discrimination



Protective System (Dysfunction causes Tactile Defensiveness) 

Skin has an important function - protection. It acts as a physical barrier between us and the world. Our skin can feel too hot and cold sensations’ and respond accordingly, for example, on being pricked by a needle we are hurt and brain perceives pain sensation. For detailed description of Tactile Defensiveness click here

This system helps us in identifying light touch, crude touch, pain and
temperature which are protective in nature. When a needle is inserted in baby's buttocks for vaccination he feels uneasy and painful due to which he may cry aloud, this pain sensation happens due to protective touch system. Touch is the first sensation that starts developing in womb at five weeks. Protective system works phenomenally in a newborn, which helps him to react towards changes in temperature, come in contact with his or her mother and feel secure in her arms. It helps in sucking mother’s nipple to take the feed and feel her body’s warmth and cosiness. Due to this, children clasp fingers and toes when being touched.

When child tries to stand on his own feet however falls back due to lack of balance and postural control, he feels distressed and cries, since he feels pain in his buttocks or legs. The protective system supports child to sense the pain and discomfort. Similarly, dirty diapers make child uneasy and, colic pain (prominent from 0-6 Months) can cause too much of discomfort and distress.

Neuroscience Background:


According to A. Jean Ayres (1972), tactile defensiveness is the response that occurs, when Dorsal Column-Medial Lemniscus (DCML) Pathway fails to exert inhibitory influence over Anterolateral (AL) Pathway.This means that DCML system does not work properly and hence AL system predominates on it due to which child reacts adversely, negatively on being touched, hugged or kissed.
The child has difficulties in hair washing, tooth brushing and nail cutting or avoids being touched reflecting Tactile DefensivenessChild shows dislike towards parents or caregiver’s hugs, kisses or arm around the shoulder by either pushing or asking not to touch him.They don't like being messy or touching objects like glue, paints, shaving form or cream, shampoo, bubble bath.


Treatment Strategies:


Weighted Items: Wearing weighted vests, backpacks or hats can have calming effect in school. Great range of weighted items are available on Amazon such as ankle weights, lap weights shoulder and neck weights.

Heavy Work/Resistive activities: These activities have calming effect on brain. The muscles and ligaments work against the gravity proving deep-firm pressure to the body.

Brushing: Sensations received from clothes or their tags can be disrupting in nature. An Occupational Therapist (OT) may guide parents in administering the Wilbarger Brushing Protocol which reduces tactile defensiveness.It is designed a particular fashion to reduce tactile defenesivemess.The brushing is done in specific sequence at specific intervals throughout the day.  

Vibration: Vibrators can be useful around arms and legs however should be applied under supervision of Occupational Therapist who is Sensory Integration trained. It is another form of deep pressure that activates proprioceptors (receptors in muscles and ligaments). The adverse effects which will be immediately visible are dizziness, headache or nausea.
  

Tactile Discrimination System (Dysfunction causes Tactile Discrimination difficulties)


This system is fast, efficient and its development is essential for dextrous tasks and In-Hand-Manipulation. Discriminative system is associated with function of discrimination, such as exploring the world and differentiate between different types of touches such as type of texture, and size of object. For example, consider how easily we can differentiating between different size coins in our pocket without looking at them. Opening or closing the lid of jar or doing small buttons without actually looking at shirt are examples of Tactile Discrimination and in hand Manipulation. He might not react at all towards injuries, may have lack of body awareness. 
This system also responds to vibration, touch pressure and deep pressure
information. As the child achieves developmental milestones they also develop a sense of touch discrimination. As the child grows older his abilities of discriminating tools objects and toys improve gradually. 
In a normal developmental process, as the child grows and he develops fine motor skills ability to discriminate different fabrics (soft blanket or stuff toy and wooden surface), sizes (small and large Lego pieces) develop. They enjoy jumping on soft mattress bed rather than playing on the wooden floor with carpet. 
So if the child’s cluster of behaviours such as being accident prone, dropping things from hand, difficulties in managing buttons, zippers, laces and ties, difficulties in handwriting it may be considered that these activities are linked to dysfunction in tactile discrimination.


Neuroscience Background:

Discriminative system is associated with function of tactile discrimination such as detection of size, form, texture as well as movement across the skin as evidenced by Fisher and Bundy (1991). The dorsal column medial leminiscus (DCML) pathway and associated receptors are responsible to respond to stimuli transmitting vibratory, touch pressure, discriminatory and deep pressure information meaning for appropriate functioning of Discriminative system DCML system is responsible.
When there is damage in DCML pathway, the sensory feedback to higher brain centres (cortex) is interrupted leading to deterioration of coordinated fine motor abilities of child.  This can be evidenced with empirical research work done by Cohen (1999), who concluded that injury to DCML can lead to decreased sensory feedback to the cortex causing uncoordinated fine motor skills. Therefore, child has difficulties in carrying out fine motor activities such as doing laces, buttons, fastening zippers.
                                                             


Thursday, 7 April 2016

7 ways to control Angry child!



            


            Parent’s voice of tone µ Child's Aggression

The above equation says it all, higher is the voice tone of an adult while dealing with the angry toddler or young child, greater will be his aggression. Calmness, patience and nonviolent environment are essential components to improve child’s behaviour. In simple terms,child's behaviour is (directly proportional) very much affected by parent's behaviour!

If the parent and child shout together then situation remains, the same without any enhancements. It will be like beating around the bush which has no outcome ever. Moreover, it affects child’s trustworthiness and emotional security (parent-child bonding) in the long term. 

It is important to understand that a child under the age of four or five years does not have any intention to harm anyone around him. He wants to explore the world through different body senses such as touching different textures (Examples-carpet, power plug points, keys of laptop, smartphone), observing contrasting colours and images to explore visuals (snatching phone or I-pad to see images or photos) and shouting as they enjoy their own voice but hitting, kicking or pinching parents or caregivers is not their agenda fundamentally. Even shouting or getting angry is not their first choice, it happens only when they have no other option to get their things done!

Biting usually happens due to tethering factor.

At this developmental stage attention seeking behaviour is prevalent which is misinterpreted as aggressive behaviour of toddlers or young ones. Study done by Auruhn Dhal in University of California also suggests, that the use of aggression by toddlers  or young ones is unprovoked. 
Children involve into explorative force to seek attention. Unprovoked acts presumably become less frequent from 18 months onwards as toddlers learn that their aggression harms' others or they become sensitive towards other’s distress. 
So it should be understood that children are not hitting, biting, pinching or kicking intentionally to upset parents, siblings or others but because of their own newness in the world. Children belonging to age group of 36 month or more, are likely to get aggressive.
If child is having frequent aggression issues and hits people around revengefully which   reflects in his temperament, then following strategies can be explored: -

A. Act quickly but CalmlyChild’s Anger + Violence Address problem calmly + Quickly:
When the child is aggressive it is important that, parents should demonstrate patience, calmness and normal voice of tone. Screaming, yelling or shouting will not resolve the issue instead will aggravate the aggression within child. Moreover, there will be mirroring of parent’s actions. Plus, stomping foot, slamming doors will aggravate the behaviour and cause emotional meltdown and mistrust.  
If parent resolves the issue in soft, non-violent way, child will probably follow the same example. He should be spoken about the issue softly but immediately. Parents must not waste time or follow "Let it go" approach considering that this is his first time or he is too young to understand. For example:The child hits his younger sibling without any reason, for the first time, so it should be addressed immediately. He needs to apologise and take time-out of 3 to 5 minutes to calm down and think about his mistake, Later, parents can discuss with him making him realise what wrong he has done. He should be aware of his actions and their consequences.
Keynote: Setting rules for actions and related consequences is important

B. Appreciate your child (good for 3-year-old or more): Leads to better Behaviour + raised Self-esteem: 
Praising plays an important role. Explain to him how much “Grown up” he is acting whenever he behaves in a desirable manner (communicating without being aggressive) instead of shouting, kicking, pinching or biting. It will be good to give him one or two smileys or thumbs-up on the behavioural chart for good deed or kindness act such as opening doors for others if the child is 5 years or older than that.
Hugs and kisses are good to calm down an angry child. According to Sensory Integration, hugs provide deep pressure to body which is a great way of relaxing the child.Use of weighted blankets or vests can also be helpful for ADHD,Sensory Processing Disorders, Autism Spectrum Disorder.Most of the times anger are co-morbid with these conditions.