Ayres Sensory Integration (ASI) is a well-established, evidence based therapeutic approach. It was developed by Dr. A. Jean Ayres, an occupational therapist, psychologist, and neuroscientist. Sensory integration theory provides evidence from science about the ability to receive, sort, process, and make use of the information originating from the body and the environment and perceived by our 8 senses. This sensory information goes to the brain, where it is organized and interpreted. As a result, we form a plan of action that allows us to have an adaptive response appropriate for the demands of the environment. Ayres Sensory Integration® intervention is provided within the context of professional practice. It is designed to improve sensory perceptual abilities, self-regulation, motor skills, and praxis. The benefits are seen with improved behaviour, learning, and social participation. CST can offer Sensory Integration within the home or school environment through the provision of specialist equipment, or within our Sensory Integration Clinic, Midland’s Child and Family Therapy Clinic, in collaboration with the childs caregivers.
Jean Ayres defined sensory integration as:
“The neurological process that organises sensation from one’s own body and from the environment and makes it possible to use the body effectively with the environment”
DIR Floortime Model
DIR®/Floortime® is a relationship-based therapy for children with autism. The parent gets down on the floor with the child to play and interact with the child at their level. It is based on a developmental theory that says that all children need to reach certain milestones so they can keep developing emotionally and intellectually.
We are working collaboratively with Jo Cormack, a ‘picky eating’ and food anxiety specialist. Jo is a qualified and registered counsellor with a Masters in counselling from the University of Nottingham. She is a doctoral researcher at Bishop Grosseteste University, Lincoln, researching parental feeding practices. Jo uses her counselling training and expertise in feeding dynamics to help children who are anxious eaters, and to support families in developing positive feeding relationships. Jo helps parents and professionals understand the psychology of eating, teaching them how to empower children to become more confident eaters and enabling the whole family to feel good about mealtimes.
As part of our collaboration with Jo, we are able to offer joint Occupational Therapy and Feeding Support Packages. All sessions are video calls via a telehealth platform, some involving you (parent or carer), and some involving you and your child. For further information on the packages available please contact email@example.com.
Theraplay is led by a Theraplay Practitioner who supports playful and caring child-adult interactions that foster joyful shared experiences. These activities work on building attunement and increasing understanding of each other, supporting the development of healthy attachment. Interactions are personal, physical and fun.
Theraplay interactions have four key areas of focus, core to healthy parent-child relationships
Visual Motor Integration and Visual Perception
Signs of visual perception or motor dysfunction depend on which of the following visual problems a child has:
Discrimination. E.g. confusion of “u” and “n” or “p,” “q,” and “b.”
Figure-ground discrimination e.g. picking out a shape, letter, or number from the background of a page.
Sequencing. e.g. skipping words or lines when reading.
Visual-motor integration. Difficulties with eye-hand coordination e.g. handwriting
Memory. E.g. remembering what they’ve seen.
Spatial. E.g. they may bump into objects and people as a result.
Closure. E.g. trouble filling in the missing pieces of an object of image if they can only see part of it.
Equipment and Adaptations
An Occupational Therapist will help a child to minimise their difficulties and improve their ability to learn, socialise and play. For example, we can assess and advise on ways to support your child’s disability in the home. For example, we can assess and advice on:
Equipment to assist daily activities e.g. specialist beds, toilet frames, shower/toilet seats, changing benches.
Moving and handling assessment and advice. For example, hoists/slings and a moving and handling plan addressing the specific needs of the child.
Minor adaptations e.g. grab rails, ramps and door widening.
Major adaptations e.g. stair lifts, through floor lifts, level access showers.
Zones of Regulation
The Zone of Regulation (‘The Zones’) programme is about self-regulation. If we can recognize when we are becoming less regulated, we are able to do something about it to manage our feelings and get ourselves to a healthy place. The Zones is a systematic, cognitive behavioural approach used to teach self-regulation. It supports children to become more aware of and independent in controlling their emotions and impulses, managing their sensory needs, and improving their ability to problem solve conflicts.
“If your body is like a car engine, sometimes it runs on high, sometimes it runs on low, and sometimes it runs just right!” Ref: Alert Program
The Alert Program® helps children express their inner experience of self-regulation (how alert they feel) and put into place simple strategies that can change our levels of alertness throughout the day. This can improve how easy we find it to get out of bed, work, play, learn, relax, socialize, and go to bed.
Dialectical Behavior Therapy (DBT)
DBT is a specific type of cognitive-behavioral psychotherapy used for the treatment of mental health disorders. It is Support-oriented, Cognitive-based and Collaborative in approach.
Children’s Yoga. Individual and in Groups
We can offer individual and group yoga. Children’s yoga helps to improve a whole host of areas such as improving posture, flexibility, strength, balance, coordination and motor skills. It can teach breathing techniques to increase energy and decrease anxiety, as well as helping teach relaxation and stress management. Outcomes can be an improvement in grades and reading skills, improved sleep, and increase in regulation.
The focus of Occupational Therapists with children is to improve function, whether that be with handwriting, scissor skills, throwing and catching a ball, dressing and self-care, accessing play with others, or sitting at a desk to learn. We can offer individual and group work to improve children’s functional skills and work on set goals.
Sensory Attachment Intervention
The goal of Sensory Attachment Intervention (SAI) is to develop the child’s capacity to self-regulate and co-regulate with others. Direct sessions facilitate the modulation of excitatory and inhibitory sensory and emotional inputs, through provision of up regulating and down regulating sensory activities, and by providing the ‘Just Right’ challenge. This supports the development of new emotional and sensory associations, through use-dependent learning. Intervention involves Parent-Child Engagement Sessions and facilitates mutually shared, positive experiences (Breathnach 2016). Sensory Attachment Intervention takes into account the Neurosequential Model of Therapeutics, with children’s physical and sensory needs being addressed before targeting higher cortical process e.g. talking based therapy. The treatment process can sometimes include time to consider the attachment patterns of the family, utilising assessment tools such as the Meaning of The Child (MoTC) to establish this.Adverse Childhood Experiences (ACES) can alter a child’s developmental trajectory and affect physiology. For children whose brains are still rapidly developing, frequent exposure to highly stressful experiences can result in long-lasting, negative impact, profoundly affecting the development of the brain and cause lifelong harm to children’s physical, mental, and emotional health. For infants and toddlers who are exposed to persistent stress, these kinds of adverse childhood experiences can cause changes in brain structure, potentially harming their physical, emotional, and educational development far into the future. However, ACES do not have to determine the destiny of a child who experiences them, and concrete steps can be taken to help children heal. Healthy parent-child relationships, or other supportive relationships, can serve as a protective buffer, and help children foster resilience and thrive (Burke Harris, 2018).Sensory Attachment Intervention, as well as Sensory Integration, uses play and the child’s motivation for exploration as a key approach to treatment.
“Scientists have recently determined that it takes approximately 400 repetitions to create a new synapse in the brain- unless it is done with play, in which case it takes between 10 and 20 repetitions” Dr K. Purvis
The Just Right State Children’s Programme and The Just Right State / SAI for CAMHS and Forensics.
The Just Right State programme uses sensory activities and foods to help children learn how to self-regulate their emotional states and behaviour. It introduces the Scared Gang, cartoon characters that represents different survival and attachment patterns of behaviour. The cartoon characters and stories gently touch on strategies that may support them to feel “just right”. The aim of the programme is for children to become more emotionally aware of themselves and of others. They learn to use simple tools which aid self-regulation and achieve the ‘just right state’. This can support areas of difficulty, such as academic learning, making friends, or getting a good night’s sleep.
The Just Right State Parent’s Programme
The focus of the parent’s programme is supporting parents to regulate their child from sensory and attachment perspectives. It increases parents’ awareness of their own engagement patterns and how this can impact on their child’s emotional states. It also addresses the underlying reasons for behaviours. They learn about the different levels of self- regulation (physiological, sensory, emotional, and cognitive); the regulating effects of food and activities; and how to create an enriched environment that is tailor made both for them and their child’s sensory-attachment needs. Ref: Breathnach
We can support you and your children with achieving goals that are important to them; whether that’s learning to ride a bike, improve their handwriting, wash and dress themselves or learn to throw and catch a ball. Occupational Therapists look at why a child may be struggling with these tasks e.g. visual perceptual difficulties, poor core stability or poor coordination, and we work to develop these areas.
SOS Approach to Feeding
SOS Feeding stands for ‘Sequential Oral Sensory’. This is an approach to feeding therapy that utilizes a systematic approach to address both the sensory processing and the oral motor skills a child needs to eat a wide variety of food groups and textures.
Listening based therapies support overall sensory development, through the use of music that has been specifically adapted to stimulate the auditory (hearing) and brain pathways.
Listening based therapies can support development of attention, concentration, social communication, coordination, over responsive sensory behaviours and emotional well-being. Programmes often involve listening to music via headphones daily for a set period of time. Listening based therapies should always be delivered and overseen by a qualified Therapist who is trained in the specific Listening based programme.
The Listening Program
Safe and Sound Protocol
Trauma Informed Yoga
Yoga-based treatment sessions that are informed by sensory attachment theory and trauma informed principles. Yoga is increasingly being recommended by experts as being beneficial to those who have difficulties due to sensory processing disorder or resulting from trauma experiences. Yoga-based sessions are suitable for children, teens and adults of all abilities. Sessions may be facilitated for individuals or small groups. We use a mixture of yoga with mindfulness, bodyfulness, and sensory-attachment strategies. The yoga-based programme is created and delivered by specialist therapists.
Interoception is the ability to notice and connect bodily sensations with emotions. It is an important factor in the development of effective self-regulation skills. It is the ‘how do I feel sense?’ that tells us about the internal state of our body. It can help to identify body sensations e.g. a dry mouth or a racing heart. Those with poor interoceptive awareness may struggle to recognise when they are hungry, full, hot, cold, in pain, need the toilet or thirsty.
Interoceptive differences are very common for individuals with autism, developmental trauma, sensory processing disorder, anxiety and depression.
The Interoception Curriculum, developed by Kelly Mahler helps to improve interoception over time, with the right instruction and supports.
Fine and Gross Motor Programmes
We have individual and group programmes to work on developing a child’s fine and gross motor skills. Programme is designed to improve a child’s hand function, shoulder stability, coordination and postural stability and balance. They are aimed at children exhibiting poor motor skills e.g. tendencies to trip or bump into things, difficulties with PE, poor handwriting skills, problems with dressing, using cutlery, concentration and low self-esteem.
Astronaut Training is designed to develop optimal vestibular function, an essential foundation for all sensory processing and movement control. The vestibular system works to keep us informed regarding where we are in time and space and how, when, and where our body moves. It is also responsible for balancing and modulating the other senses, including vision and hearing.
M.O.R.E. is an acronym for Motor components, Oral organization, Respiratory demands, and Eye contact and control. It utilises elements of toys and items that facilitate integration of the mouth with sensory and postural development, as well as working on self-regulation and attention.
Attachment Lead for Schools
Trained and registered via TouchBase, Attachment Leads are trained to be attachment aware and trauma responsive. We can support all children and young people to be fully included in school, college and their communities, making the most of all the educative opportunities on offer.