OT Parent Ed Series 2

OTParentEd Series 2
Jill Kurzner, Rebecca Renteria, Lauren Ritch, & Devin Stewart
1

Modules
2
Introduction ……………………..………………………………………………………..……...........….. 4
Module 1: Sensory Processing……………………………………………………................................... 5
Quiz……………………………..................…............................................................................ 17
Summary…………………………………………………………………………………..……18
Module 2: Milestones and ADLs……………………………………………………...........................…19
Quiz …………………………..................…............................................................................... 53
Summary ……………………………………………………………………………………… 54
Module 3: Strategies…………………………………………………………….……...........................…55
Quiz ……………………………………………………..............................................................87
Summary………………………………………………………………………..……………... 88
References………………………………………………………………....................................................89

1. Sensory
processing
2. Milestones
and daily
activities
3. Strategies
that can be
implemented
at home
Welcome
Occupational Therapy Parent Education Series 2
This presentation is comprised of three modules:
Autism spectrum disorder (ASD) can have a large impact on the everyday lives
of those diagnosed and their families (Case-Smith, & O'Brien, 2015). In this series, we hope to
relieve prevalent challenges by addressing common ASD experiences & offering
strategies to help in the home environment. Studies show that parent & caregiver
education can boost confidence, relieve emotional pressures, & create happier
experiences in the home (Ji, Sun, Yi & Tang, 2014).
3

Introduction
What is Autism?
•Autism is
neurological disorder
characterized by
repetitive, restrictive
behaviors and deficits
in social interaction
What are sensory
needs?
•The way a person to
notices and responds
to the sensory events
within daily life
What is OT?
• Occupational
therapists use
evidence-based
practice to assess and
determine how
impairment is
affecting a child's
daily life
(Case-Smith & O'Brien, 2015) (Case-Smith & O'Brien, 2015)(Dunn, 2008)
4

Sensory Processing
Module 1:
5

Sensory processing describes the way we interpret the
environment based on our senses. It involves the input
of sensory stimulation (such as the smell of chocolate)
and the output of a response.
To process all the senses around us, our brains have to
recognize, organize, and make decisions about what it is
we experience .
How we process this information can have a big impact
on our behavior and the way we react to our
environment.
What is sensory processing?
(Atchison, & Dirette, 2017)
6

Did you know we have more than 5 senses?
When we process our senses,
we react to stimuli that comes from:
Sound
Smell
Taste
Vestibular
Touch
Sight
Interoception
Proprioception
7

INTEROCEPTION
•Interoception is a sense that tells us how
the inside of our body is feeling (Morin,
2019).
•It lets us know, for example, when we are
hungry, in pain, cold or hot, in need of a
restroom, and if our heart is racing – it even
lets us detect our emotions (Morin, 2019).
•When we are aware of these sensations, we
can react appropriately. If we are hungry,
we may seek food; if we are cold, we might
grab a sweater.
•Children with impaired interoception have
difficulty responding to these needs
because their bodies may not accurately tell
them what their needs are.
VESTIBULAR
•The vestibular system helps us keep our
balance. It is formed by structures in the
ear that tell the brain where our head is
situated. This enables our posture and sight
to continually adjust so that we remain
stable (Lundy-Ekman, 2018).
•A working vestibular system lets us play on
swings and shake our heads “yes” without
experiencing vertigo.
•A child with an impaired vestibular system
may feel dizzy, lose equilibrium, or fall
quite often.
PROPRIOCEPTION
•Proprioception, also known as kinesthesia,
is knowing where our bodies are located
in space. It gives us the ability, for example,
to touch our nose with our finger while our
eyes are closed.
•It’s important for moving our bodies safely
and for understanding where we are
situated in relation to the world around us.
This keeps us from bumping into our
surroundings.
A closer look at our senses
8

Sensory processing can often be a difficult task for children with ASD.
Please click on the video below to learn more.
Sensory Processing Challenges
(Understood, 2018)
9

(Autism Speaks, 2020)
Hypersensitivity refers to over-
responsiveness to sensory stimulation.
This may feel distracting or
overwhelming. Have you ever taken a
bite of a lemon, winced at the sour
taste? Or been distracted by the feeling
of a tag in your shirt? For those with
hypersensitivity, many daily
experiences may feel this way.
Hyposensitivity refers to under-
responsiveness to sensory stimulation.
This can make the senses feel faint and
hard to recognize. Have you ever had a
diminished sense of smell or taste after
coming down with a cold? Similarly,
those with hyposensitivity may be less
aware of sensory experiences, and
therefore, crave more.
Hypersensitivity & Hyposensitivity
10

• Dunn’s sensory processing
framework is a reputable model
that categorizes people into 4
types of sensory patterns.
• These patterns are differentiated
by the amount of sensation one
can tolerate and how one reacts
to that sensation.
• Understanding children’s
behavior may become easier when
we first understand their sensory
experiences.
Dunn's Sensory Processing Framework: Sensory Patterns
(Ismael, Lawson, & Hartwell, 2018; Image Retrieved from Demopoulos, C. et al., 2014)
11

Characteristics:
• Tolerate great amounts of
sensation but do not
actively seek sensory
experiences
• Sensations that feel overt
for most generally go
unnoticed for these
individuals
• Persons
with low registration might
not feel a runny nose or
food stuck on their gums
How to Recognize
• Uninterested
• Difficult to engage
• Difficulty attending to
tasks
• Appear lethargic or
exhausted after activities
Cup Analogy:
• Bystanders are represented
by a large cup, which
means it takes a lot of
sensory input for them to
feel regulated. Because
they do not actively seek
this stimuli, however, their
cup is often underfilled.
Registration (Bystanders)
(Bradac, 2015)(Dunn, 2008)
(Ismael, Lawson, & Hartwell,2018)
(Image Retrieved from Google images, 2020)
12

Characteristics:
• Tolerate minimal
amounts of sensation
and do not actively seek
any more or any less
• Perceive sensations that
would typically go
unnoticed by others
• Sensors are easily
distracted, like to finish
tasks quickly, rarely try
new foods, and are
easily bored
How to Recognize
• Hyperactive
• Distracted
• Easily upset
Cup Analogy:
• Sensors are represented
by small overflowing
cups. Just as small
cups fill quickly and
with lesser amounts,
sensors have small
sensory thresholds.
Because sensors do not
actively respond to
sensations, it can
feel overwhelming like a
cup overflowing.
Sensory Sensitivity (Sensors)
(Bradac, 2015)(Dunn, 2008)
13

Characteristics:
• Generally crave more
sensory experiences
than others
• Have a high
tolerance for sensation
and actively seek more
• Sensory seeking
children often
bump into their
surroundings and like
the feeling of sand
running through
their fingers.
How to Recognize
• Fidgets in their seats
• Chews on objects
• Hangs onto others
• Jumps off furniture or
climbs on objects
around the house
Cup Analogy:
• A big cup with water
continuously pouring
into it represents a
seeker. Seekers need a
lot of sensory input,
but they need it all day.
They actively seek
more stimulation to
meet their needs, so
they continuously fill
up their cup.
Sensory Seekers (Seekers)
(Bradac, 2015)(Dunn, 2008)
14

Sensory Avoiders (Avoiders)
Characteristics:
• Generally want less
sensory experiences
than others
• Have a low tolerance for
sensation and actively
avoid more sensory
input by trying to limit
these experiences
• A sensory avoiding
child may feel agitated
by loud sounds and feel
a sense of calm while
wearing noise-
cancelling headphones
How to Recognize
• Seems withdrawn
• Unwilling to participate
in activities
• Irritable or aggressive
during independent
work because of
unpredictable sounds or
movements around
them
Cup Analogy:
• A small spilled cup
represents an avoider. A
small cup is quickly
filled. An avoider tries
to prevent stimuli that
will cause the cup to
overflow.
(Bradac, 2015)
(Dunn, 2008)
15

Parent Coaching:
Parent-child Interaction
• Adapting to the child's sensory needs
Family routines and context
•Ex: Creating visual schedules, Using a timer
Environment Modifications
•Ex: headphones, sunglasses, light covers,
soundproofing surfaces, swings
(Case-Smith, & O'Brien, 2015)
16

Module 1
Quiz!
1. What sense tells us when we are hungry?
Interoception
2. A child that climbs on objects unsafely is
showing what sensory type?
Sensory Seeking
3. A child is eating dinner at the table with their
family but only eats a little bit, because it hurts their
mouth. Child is willing to try what the parent is
asking of them but will not go beyond that. What
sensory processing type is this child?
Sensory Sensitivity
17

Sensory Processing Summary:
Sensory
processing is
the way we
interpret our
environments
through our
senses.
We have more than
just 5 senses, in fact
we have 8 that help us
navigate the world.
• Sight
• Smell
• Taste
• Touch
• Hearing
• Interoception
• Vestibular
• Proprioception
There are 4 types of
sensory processing
patterns that describe
how a person interacts
with their senses:
• Sensory Seeking
• Sensory Sensitivity
• Registration
• Sensory Avoiding
Each person has
their own sensory
processing patterns
• Please consult
with your OT
about
identification.
18

Milestones
Activities of Daily Living
Module 2:
19

Milestones and ADLs for children aged 6-12
Sleep Feeding Toileting Bathing Dressing Grooming
& Hygiene
Social
Participation
Play
20

Sleep
Ages 6-10
• Need 10-11 hours of sleep
• Should not be taking any naps
Ages 11-12
• Need 8.5-9.25 hours of sleep
• Should not be taking any naps
• Children with Autism Spectrum
Disorder (ASD) tend to have
problems with sleeping;
specifically a hard time falling
asleep and then staying asleep
• Children with ASD often wake
up early in the morning.
• Most sleep problems are related
to problems or a lack of routines,
especially bedtime routines.
21

Factors to Consider When A Child Has SLEEP
Problems Based on Their Age
CHILDREN 5-10 YEARS OLD
Bed Wetting (typical until age 7)
Medical Issues- tonsils enlarged, facial profile is convex, has cross bite, reflux or medical
procedure (ex: positioning, suction)
Unaware of social cues for calming down to go to sleep
Increased demands for schoolwork or other extracurricular activities
More interest in computers and internet
Caffeine consumption or eating close to bedtime
Electronic use in the bedroom or too close to bedtime (e.g., computers, televisions, tablets,
video games)
Erratic sleep schedule
Lack of understanding of the importance of healthy routines for sleep
22

CHILDREN 11-12 YEARS OLD
Increased demands of school, work, social life, or other activities
Anxiety or emotional event during the day
Caffeine consumption or eating close to bedtime
Electronic use in the bedroom or too close to bedtime (e.g., computers, televisions, tablets, video
games, smartphones)
Erratic sleep schedule especially weekend versus weekday nights
Internal clock of teens—like late nights and waking up later in the morning
Lack of understanding of importance for healthy routines for sleep
Factors to Consider When A Child Has SLEEP
Problems Based on Their Age
23

Tips to Improve Sleep
Create Bedtime Routines &
Habits
• Keep the routine & environment
the same each time the child goes
to sleep
• Keep the same schedule for
bedtime and wake-up time
during the week and weekend.
• Avoid activities prior to bed that
are upsetting or alerting to
children.
Modify Physical Aspects of
the Environment
• Limit the amount of auditory
stimulation during sleep that
arouses the child or teen
• Keep the temperature consistent.
• Reduce visual stimulation. Use
dim or frosted night lights if
needed.
• Consider the weight, texture, &
visual attractiveness of clothing
and bedding and the personal
preference of the child. (Case-Smith, & O'Brien, 2015)
24

Milestones
Feeding
By age 6-8, a child should be able to
– Finger Feed
– Scoops with a spoon or fork and
brings to mouth
– Uses a fork or spoon well
– Uses a knife to spread butter
– Drinks well from a regular cup
– Pours from a pitcher to cup
– Eat all textures of foods
– Eats mixed textures
– Eats foods from all food groups
– Gets on and off kitchen chairs safely
– Age 7 on: prepares cold snack
(cereal, etc.) independently.
(REAL, 2013)
(Image Retrieved from Microsoft PowerPoint, 2020)
25

At age 9 to 10, children
should additionally be able to
Use utensils to cut food
Use the microwave to prepare a
meal
Use kitchen utensils, such as
blender or toaster, to prepare meal
By 11 and 12, can also
Plan and prepare a light meal
for themselves
Uses stovetop safely
Prepares meal using the oven
safely
Uses kitchen knives safely to
prepare meal
(REAL,2013)
(Image taken from Microsoft PowerPoint, 2020)
Feeding
26

Complications
• Although by this age, child
should be independently
feeding themselves, it is often
reported that child with ASD
may engage in:
– Disruptive mealtime
behaviors
– Food selectivity
– Food refusal
– Mealtime rigidity
(Image Retrieved from https://www.pngkey.com/detail/u2q8y3u2q8a9i1r5_healthy-
food-png-image-with-transparent-background-healthy/, 2020)
27

As a parent...
• You might see your child
• Avoiding sticky, mushy or
slimy foods
• Avoid smelly foods
• Be a "picky eater"
• Will only eat certain foods
• Refuses to try new foods
• Avoid fruits or vegetables
Retrieved Photos from Microsoft PowerPoint
(Chistol et al., 2017)
28

Tips For Improving Feeding
29

•Toilet Trained – independently completes all toileting activities
Age 6-12
•Wiping with toilet tissue
•Feeling water spray as the toilet flushes
•The noise of the flushing water
Toileting considerations for a child with ASD:
Toileting
(REAL,2013)
30

Toileting
82% of parents of children with ASD reported having difficulties with
toileting.
Common Parent-Reported Toileting Issues
•"Has toilet accidents during the day"
•"parent/caregiver notices smears in underwear"
•" Refuses to use the bathroom when prompted by others"
•" The individual requires a lot of encouragement to use the bathroom"
•" The individual does not stop engaging in a preferred activity to use the bathroom"
•" Does not let parent/caregiver know when they have wet their clothes"
•" Does not independently perform most self-help tasks"
(Szyndler,2007)
(Leader, Francis, Mannion, & Chen,2018)
31

Change toilet paper or use
different material, such as
wet wipes or cloth.
Play soft music or toilet song
on tape player.
Discuss public restroom
expectations; have a social
story available to talk about
them
Tips for Improving Toileting
32

Bathing Skills by Age
Age 6
•Obtains soap & hygiene
products for bath/shower
• Gets in/out of shower or bath
safely
•Maintains a safe body position
while bathing
Age 7- 12
•Obtains soap & hygiene
products for bath/shower
• Gets in/out of shower or bath
safely
•Maintains a safe body position
while bathing
•Washes, rinses, & dries body
well
(REAL,2013)
33

Bathing
Requires:
• Toleration of water temperature
• The tactile experience of water moving over skin
• The smell of soaps and shampoos
• The feel of towels or washcloths.
Washing Hair
Requires:
• Leaning backward with one's eyes close (a scary motion for those with
vestibular difficulties)
Bathing Considerations
for Children with ASD
34

Bathing Tips/Tricks
• Deep pressure before and after
bathing
– Deep pressure on the head
before shampooing to prepare child
• Hand-held shower head with eye
guard to avoid getting soap in the
child's eyes
– Use a cup with water in it if
the shower water is too harsh or
hard to control
• Keep in mind all children have
unique sensory needs!
(Image Retrieved
from https://www.amazon.com/Adjustable-Shampoo-
Shower-Bathing-Protect/dp/B074CVHRFN, 2020)
(Image Retreieved
from https://www.autismeducates.com/2018/11/06/melt
downs/, 2020)
35

Dressing
• Completes all
dressing skills
including fasteners
and belts
• Age 10 females can
take off and put on
sports bra and
front- or back-
latched bra
Age
6 -12
(REAL,2013)(Images Retrieved from Microsoft PowerPoint, 2020)
36

Dressing
(Case-Smith, & O'Brien,
2015; Roley et al., 2015)
What to
expect
for a
child
with
ASD
When we dress, we experience a lot sensations on the skin. Tags, fabrics, textures,
and tightness of clothing can overwhelm a child experiencing ASD
A child with ASD may have problems with the orientation of the clothing. For
example, the difference between the front and back of a shirt.
Environmental stimuli may cause distractions and make this task challenging.
Transitions and changes in routine can present difficulties with completing this
task in a timely manner.
37

Dressing: Parent Reports
(Naik & Vajaratkar, 2019)
“He does not like
tight fitting cloths
and cloths with tags.”
“He gives a hard time
while dressing him
up for school.”
“He cannot wear a
shirt by himself and
needs to be assisted
by someone, he can
wear pants by himself
but takes a lot of time
which makes him late
for school.”
38

Dressing Skills
Motor skills:
putting arms
and head
through shirt
holes
Fine motor:
buttoning,
shoe-tying,
and zipping
Balance:
standing on
one leg to
put on pants
Cognition:
appropriate
choices for
the weather
Sequencing:
under
garments
then over
garments
Sensory
Processing:
tight or loose
clothes
39

Dressing: Tips and Tricks for Fasteners
Fasteners include buttons, snaps, shoelaces,
zippers, Velcro and buckles. Managing clothing
fasteners can be
tricky because there are more fine motor
skills necessary.
Here are some tips to practice that will lead
your child to become more independent:
1. Demonstrate. Allow your child to watch you do
it. Be sure that they look at your hands and
fingers.
2. Break down the task into small steps and
complete the tricky steps slowly
3. Practice, practice, practice. Alot extra
practice time and practice at different times in the
day
(Meadows, 2016)
(Images Retrieved from Microsoft PowerPoint, 2020)
40

Grooming: Hair
Age 6-8
• Brushes hair (not
including
tangles)
• Styles hair
•Tolerates haircuts
& trims
Age 9- 12
• Independent in
Brushing hair &
manages tangles
• Styles hair
•Tolerates haircuts
& trims
(REAL,2013)
41

AGE6-12
- Access the sink
- Washes, rinses &
dries hands well
AGE6-12
- Access the sink &
obtain all supplies
- Washes, rinses, &
dries face well
- Completes nose
care well
Personal Hygiene
(REAL,2013)
WASHING HANDS: WASHING FACE:
42

Oral Hygiene
& Brushing
Teeth
Maintaining oral hygiene can be challenging for
children experiencing ASD. Often times, sensory
and motor sensitivities make brushing teeth feel
unpleasant.
• Children with hypo sensitivities are often less
aware of what is occurring inside the
mouth, and this may lead to stress or anxious
behaviors
• Children with hyper sensitivities are often
overly aware of the sensations inside the
mouth, leading to feelings of discomfort or pain
(Christina, 2020)
43

Oral Hygiene &
Brushing Teeth
If your child is demonstrating
difficulty with tooth brushing,
simple modifications may ease
the process and accommodate
to your child’s sensory needs.
44

Oral Hygiene
& Brushing
Teeth
(Different Not Less, 2016)
45

Oral Hygiene & Brushing Teeth: Tips and Tools
Does your child: Tips to consider: Take a look!
Thrive with routine? • Create a schedule for brushing teeth at
least 2x day
Feel upset by loud sounds and
bright lights?
• Adaptive toothbrushes have wider
handles that are easier to grasp.
Dislike the taste of toothpaste? • Toothpaste comes in a variety
of flavors, and your child might find a
preference for one.
• Try Oranurse, an unflavored
toothpaste (that won't foam either!)
(Image Retrieved from Amazon.com: big grip
toothbrush, n.d.)
(Image Retrieved from oraNurse, 2016)
(Christina, 2020; oraNurse, 2016)
46

Oral Hygiene & Brushing Teeth: Tips and Tools
(Christina, 2020; oraNurse, 2016)
Does your child: Tips to consider: Take a look!
Have sensitivities to touch? • Try using a toothbrush
with extra soft bristles. Touching
the bristles to the lips first
may ease the transition to
putting it on the teeth and gums.
Feel upset by loud sounds and
bright lights?
• Keep the toothbrushing
environment quiet and dim the
lights.
(Image Retrieved
from oraNurse, 2016)
47

Oral Hygiene
& Brushing Teeth:
More tips and tools
• Create (or print out) a vision board so your
child can follow along with the steps!
• Set a timer so your child will know when the
activity will be complete. This may help them
perform toothbrushing with more ease and
comfort.
• Try brushing your own teeth at the same time as
your child so they can model your behavior.
• Use rewards to reinforce positive behaviors.
Praising children for completing daily tooth
brushing may encourage them to increase this
activity with less difficulty.
(Christina, 2020;Autism Speaks, 2018)
48

Social Participation and Play
• Social play
• Play includes talking and joking
• Peer play predominates at school and home
• Plays with consistent friends
• Cooperative, less egocentric
• Tries to please others
• Has best friend
• Is part of cliques
• Is less impulsive & is able to regulate behavior
• Has competitive relationships
49

Play
Play is "any
spontaneous or
organized activity that
provides enjoyment,
entertainment,
amusement or
diversion"
Through play,
children learn a wide
range of skills,
develop interests that
will influence later life
choices, and establish
interpersonal and
communication
abilities.
(Parham & Fazio,2008)
50

Play
• Computer games, card games that require
problem solving and abstract thinking
Games with rules
• Have collections
• May have hobbies
Crafts and hobbies
• Cooperative and competitive play in
groups or teams of children
• Winning and skills are emphasized
Organized sports
(Case-Smith, & O'Brien, 2015) (Images Retrieved from Microsoft PowerPoint, 2020)
51

Play: Tips
Use video modeling
•To improve:
•play and interactions
•play initiation
•independence in toy play
Involve peers in activities
Be smiling, inviting, and playful
•Children with ASD are more likely to approach you.
Imitate the child with ASD
•This can improve eye contact, responsiveness, and play skills.
Incorporate preferred sensory toys and activities
(Case-Smith, & O'Brien, 2015)(Images Retrieved from Microsoft PowerPoint, 2020)
52

Module 2 :
Quiz
1. A child aged 6-10 should get ____ hours of
sleep per night with no naps, and a child
aged 11-12 should get ____ hours a sleep
with no naps?
10-11 hours; 8.5-9.25 hours
2. True or False. A child aged 6-12, should
tolerate haircuts and trims.
True
3. What kind of activities does play include
for children aged 6-12?
Games with rules, crafts & hobbies, and
Organized sports
53

• Children in this age group typically:
– Do not take naps and should be sleeping
approximately 8-11 hours per night.
– Use of a fork and spoon well, can spread butter
with a knife and drinks from a cup
– Is toilet trained
– Safely maneuvers shower or bathtub and helps
in the washing process
– Can independently dress themselves
– Independently brushes hair and tolerates hair
cuts
– Washes hands and face independently
– Brushes teeth well
– Engages in social participation and play
activities
Summary
54

• Helps teach, improve, maintain & generalize a range of skills
• Used for children across the full spectrum of ASD (mild to severe)
• Children from pre-school to high school benefit from the use of visual schedules.
Evidence-Based Practice Strategies Overview
Emotional Regulation
• Creates positive experiences, meaningful participation in occupations and decreases maladaptive
behaviors
• Balance between child-led emotion following and prompting to allow exploration of feelings
• Range of techniques depending on developmental stage
Routines
• Create a sense of security and predictability
• Promote activity participation and completion
• Inhibit maladaptive behavior
• Allowing slight modifications teaches flexibility
Visual Schedules (Knight, Sartini, & Spriggs,2015).
(Ting & Weiss, 2017)
(Marcus Autism Center, 2020; Nebraska Autism Spectrum Disorders Network, 2020)
56

Sensory Supports for Low Registration
(Dunn, 2008)
• Chores
• Carry
groceries
• Push a basket
of laundry
• Army crawl or
bear crawl
• Carry books
• Dancing
• Doing
homework
while
standing
• Bouncing on
a yoga ball
• Essential oils
• Scented candles
Heavy work Rocking chairs or
bean bags
Smell Bright lights Movement Lively music
57

AccessorizeMovement
Play
outside in
dirt, grass
or water
Heavy
work
Allow
frequent
sensory
breaks
Crunchy or
chewy
snacks
Sensory Supports for Sensory Seeking
• Yoga
• Trampoline
• Bear crawl on the
grass
• Monkey bars
• Swimming
• Sand boxes
• Build sandcastles
• Water table
• Dig
• Play cars in the dirt
• Log rolls
• Carry groceries
• Chores (vacuum, clean
counters)
• Carry heavy objects
• Playdough
• Obstacle course
• Veggie chips
• Crackers
• Carrots
• Fruit snacks or
dried fruit
• Granola bars
• Beef jerky
• Breaks outside
• Slime
• Fidget toys
• Dancing or walks
• Textured bracelets
• Chewy
stick/necklace
• Headbands
• Water bead squish
ball
• Stress ball
• Weighted blanket
(Dunn, 2008)
58

Sensory Supports for Sensory
Sensitivity
Limit
Limit loud noises
• Noise cancelling
headphones
• Earmuffs
• Ear plugs
• Sound absorbing
decorations
Create
Create a routine
• Visual schedule
• Serve food in a
compartment plate
• Create a quiet space
Pressure
Form fitting clothes
• Evenly distributes
pressure on skin
• Avoid tight clothes
• Avoid baggy clothes
• Cut tags off or buy tag
less clothes
• Weighted blankets or
aninmals
(Dunn, 2008)
59

(The National Autistic Society, 2014)
60

Sensory
Supports
for Sensory
Avoiders
(Dunn, 2008)
61

Sleep: Home-Based Tools
• Creating Bedtime Routines & Habits
• Create quiet time before bedtime for
calming activities such as reading.
• (no electronics, television, eating, or
exercising right before bed.)
• Use checklists, visual schedules, or social
stories to help create a functional routine.
• On the next few slides you will find a few
examples of these strategies you can use at
home.
Z
Z
Z
(Case-Smith, & O'Brien, 2015).
62

Sleep: Home-Based Tools
Bedtime Checklist:
Brush Teeth
Use the Bathroom
Wash Hands
Wash Face
Put Pajamas On
Read a Story/Book
Get in Bed
Go to Sleep
* Print to use with your child or just use as an example!
63

Sleep:
Home-Based
Tools
Bedtime Routine
Visual Schedule
(Images Retrieved from: http://clipart-library.com, 2020)
* Print to use with your
child or just use as an
example!
(Autism Speaks,2020)
64

Feeding: Home-Based Tools
65

Limit snacking so
child is hungry
during mealtimes
•Limit excessive liquids
outside of mealtime
•Promotes hunger cues
Get creative
with food!
•Allow child to explore
food before having to
try eating it
Gradual new
food exposure
•Pair non-preferred food
with preferred foods
For low registration
children, cold
temperature or
bold flavors to
increase awareness
Feeding
(Case-Smith, & O'Brien, 2015).(Images Retrieved from Microsoft PowerPoint, 2020)
66

Toileting: Home-Based Tools
Have a visual
routine on the wall
(objects, pictures,
or action words).
Use the same
routine & rituals
for toileting
Use timer &
instruct child to
stay "seated" until
timer rings
A few strategies to improve toileting:
On the next few slides you will find a few examples of these
strategies you can use at home.
67

Toileting: Home-Based Tools
Visual
Schedule
for
Toileting
* Print to use with your
child or just use as an
example!
(Image Retrieved from Google images, 2020).
68

• Work on Desensitization for Bathing
–Scrub with washcloth or bath brush on a toy  child’s
hands
–Try a different soaps & lotion for bathing
–Allow child to play with shaving cream or bathing foam on
a wall
–Apply lotion after bath time (massage)
(Miller-Kuhaneck,2020)
Bathing: Home-Based Tools
69

Grooming: Home-Based Tools
Hair care varies for every child. Hair type, self-expression,
and individuality contributes to many styles and grooming
needs.
• For the hypersensitive child:
• Try using a hairbrush with soft rounded bristles
• De-tangling spray may ease knots
• For the hyposensitive child:
• Try using a hairbrush with an electric massager
• Brush with firm comfortable strokes (Bright Autism, 2018)
70

Prepping for a Haircut: Home-Based Tools
• Create a social story that explains what your child will
expect
• Schedule haircut appointments during quieter hours
• Let the hairdresser know ahead of time about any
discomfort your child may experience
• Have a reward ready for your child after the haircut is
complete
• Provide photographs of other children receiving haircuts
(Case-Smith & O'Brien, 2015; Autism Speaks, 2018)
71

Personal Hygiene: Home-Based Tools
Washing your hands is the best
way to protect your child and
your family from getting sick.
It is important to
go over
the thorough
steps of hand
washing.
Be sure to scrub
your hands for
at
least 20 seconds
Get creative
using a timer, a
video or favorite
song
(CDC, 2020)
72

Personal Hygiene: Home-Based Tools
This hand washing strip is a
great visual tool to establish a
hand washing routine in the
home!
• Print out the pattern on
thick paper and/or
laminate
• Teach and review each step
with your child. Repetition
and routines are key
73
Turn on Water. Wet Hands. Put soap on hands
and rub together.
Rinse Hands Turn off water Dry Hands.

Dressing: Home-Based Tools
Remove tags
Elastic
shoelaces
Comfortable
clothes
Dressing
routine
Sequencing
cards
Visual aids
74

Dressing: Home-Based Tools
This video shows some
tips and 3 different
ways you can practice
shoe tying with your
child
Standard method, double
"bunny ear" method, and
a modified way, easiest
for children with fine
motor difficulties.
(Associates in Pediatric Therapy, 2018)
75

The National Museum of Dentistry
provides helpful toothbrushing tips for families of
children with autism spectrum disorder.
They provide sequencing cards to help children follow the steps
to brushing their teeth. Interacting with these cards may make
brushing more fun and easier to tolerate.
Please find the cards on the following slides!
The Museum suggests:
• Cutting them out
• Arranging them in sequential order
• Removing each card when the step is complete
For more information, click here: https://vkc.mc.vanderbilt.edu/assets/files/resources/healthy-smiles-for-autism.pdf
Oral Hygiene & Brushing Teeth: Home-Based Tools
(The Dr. Samuel D. Harris National Museum of Dentistry, n.d.)
76

Print and Cut
the following:
Steps 1, 2, 3
Steps 4, 5, 6
(Images Retrieved From The Dr. Samuel D. Harris National Museum of Dentistry, n.d.)
77

Print and Cut
the following:
Steps 7, 8, 9
Steps 10, 11, 12
78

Print and Cut
the following:
Steps 13, 14, 15
For more information, and to find sequencing
cards for flossing, click on the following link:
https://vkc.mc.vanderbilt.edu/assets/files/resou
rces/healthy-smiles-for-autism.pdf
79

Supporting Socialization: Home-Based Tools
Socializing can be difficult for children with ASD. Many children want to make
friends but will need extra support to form friendships. To build upon their
social skills, create opportunities to engage with peers. Here are a few examples
of steps to take:
Tools and Strategies
Peer Modeling
and Role
Playing
Emotional
Regulation
Scales
Positive
Reinforcement
Invite a Peer to
Play in the
Home
Independent
Leisure
Activities
Recreational
Activities
Social Skills
Groups
Peer
Mentoring
Groups
(Case-Smith, & O'Brien, 2015; Sarah Dooley Center for Autism , 2016)
80

SOCIAL STORIES
are personalized, concise stories that help children with
ASD feel more comfortable in social situations (Aldabas,
2019). Please click on the video below to learn more!
(Autism Association of Western Australia, 2020)
81

HOW TO CREATE A SOCIAL STORY
Include:
An introduction, body, and conclusion
• Decide the purpose of the story (i.e. coping with
distressing situations)
• Explain who, what, where, and when
• Personalize with pictures of your child and familiar
environments
• Contact your OT to help construct your own social
story
82

Play: Home-Based Tools
(“Sensory Integration Therapy (SIT) and Autism: Research and Practice,” 2018)
For children with ASD, communication and sensory
processing challenges may impact their level of social
participation and play.
The next slide lists some activities that may cater to their
sensory needs and encourage play and
social involvement.
(Center for Pediatric Therapy, 2020)
83

PLAYDOH
PUZZLES
TWISTER
SWINGS
• A child with vestibular (balance) and proprioceptive
(knowing the body’s location) difficulties may benefit
from Twister
• It can exercise gross motor skills, which are large
movements of the body
• A child seeking sensory input may enjoy the texture of playdough
• Some children may find playdoh calming
• It can improve fine motor skills such as precise movements of the
fingers
• Puzzles can help relax the body of an overstimulated child
• Puzzles utilize visual-perceptual processing, the connection
of the eyes and brain
• They can strengthen fine motor skills and hand grips
• Slow front-to-back or side-to-side swinging may calm a
child
• Fast swinging with shifts in direction and speed may
stimulate a child
Sensory Toys
& Activities
(Morin, 2020; Ashburner, Rodger, Ziviani, & Hinder, 2014, p. 34)
84

Support Child Self-Regulation
Children with Autism & Sensory Processing
Disorders may have a hard time dealing with
certain environmental stimuli. This challenge
can cause the child to have anxiety and can
result in unwanted behaviors such as:
• Aggression towards others
• Hyperactivity
• Violence
• Self-injurious behaviors
• Withdrawal from the situation
Environmental Modification to
support your child's self-regulation
Create
zones for
specific
activities
(quiet work,
messy
work)
Reduce
visual
stimulation
(curtains on
windows,
remove
décor from
walls)
Use dimmer
switches for
the lights
Minimize
ambient
noise (add
carpet, turn
off
appliances)
85

"Remember that if you want to take the best possible care of your child,
you must first take the best possible care of yourself" (AutismSpeaks, 2020)
Parent Coping Strategies
(Center for Pediatric Therapy, 2020)
Personal "Me
Time"
Social Support
Relaxation and
Meditation
Professional
Help
Positive
Reframing
Stay Informed
ASD Community
Resources
Accept Emotions
Acknowledge
Success
(Image Retrieved from Microsoft PowerPoint,2020) (AutismSpeaks, 2020; Case-Smith, & O'Brien, 2015; Remedy Health Media, 2020)
86

Module
3 Quiz!
1. True or False: Setting routines and using visual aids may
have a positive effect on sleeping, dressing, hygiene, and
social participation.
True
2. What are four approaches to help with eating and
mealtimes?
• Positive reinforcement
• Gradual new food exposure
• Offering choices
• Consistent mealtime locations
3. True or False: Swings can have a calming or
stimulating effect depending on the way they are used.
True
87

Module 3: Summary
Collaborate with your OT on home-based tools that are
right for your child.
• Home-based tools implemented by the parent
promotes the transfer of skills from the clinic to the
home.
• Different sensory pattern needs can be met by different
strategies.
• Visuals, social stories, and routines can be customized
to your child's specific needs.
• A child with ASD can more easily regulate with
environmental modifications.
• Parents of children with ASD can use coping strategies.
• A parent can play a powerful role in their child's
success.
88

References:
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• Ashburner, J. K., Rodger, S. A., Ziviani, J. M., & Hinder, E. A. (2014). Optimizing participation of children with autism spectrum disorder experiencing sensory challenges: A clinical reasoning
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• Atchison, B. & Dirette, D. (2017). Conditions in occupational therapy (5th ed.). Effect on occupational performance. Philadelphia, PA: Lippincott Williams & Wilkins. ISBN: 978149633221
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Journal of Occupational Therapy, 73, 7301205070. https://doi.org/10.5014/ajot.2019.024612
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• Autism Speaks. (2018, August 30). Preparing for a Haircut. Retrieved from https://www.autismspeaks.org/tool-kit-excerpt/preparing-haircut
• Autism Speaks (2020). Sensory Issues. Retrieved from https://www.autismspeaks.org/sensory-issues
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• Bradac, J. (2015, Aug 14). Sensory Overview – Cup Analogy [Video]. YouTube. https://youtu.be/ZmAgTzFJW0Q
• Bright Autism . (2018, June 14). Developing a Tolerance for Hair Brushing – Autism and Sensory Processing Disorder. Retrieved from https://brightautism.org/blogs/news/developing-a-tolerance-for-
hair-brushing-autism-and-sensory-processing-disorder?_pos=4&_sid=a821cf21c&_ss=r
• Case-Smith, J., & O'Brien, J. (2015). Occupational therapy for children and adolescents: 7th edition. St. Louis, MI: ELSEVIER.
• Chistol, L. T., Bandini, L. G., Must, A., Phillips, S., Cermak, S. A., & Curtin, C. (2018). Sensory sensitivity and food selectivity in children with autism spectrum disorder. Journal of Autism and
Developmental Disorders, 48(2), 583-591. doi:http://dx.doi.org/10.1007/s10803-017-3340-9
• Christina. (2020, January 23). Tackling Toothbrushing: 15 Sensory Tips. Retrieved May 5, 2020, from https://blog.sensorytheraplaybox.com/2016/07/16/tackling-toothbrushing-tips-for-helping-children-
with-autism-brush-their-teeth/
• Demopoulos, C. Arroyo, M., Dunn, W., Strominger, Z., Sherr, E., & Marco, E. J. (2014). Quadrants of the Sensory Profile. [Photograph]. Retrieved from https://images.app.goo.gl/b7Fhe9genqoBnqRZ7
• Different Not Less. (2016, November 10). Dental Care for Children with Autism. Retrieved May 20, 2020, from https://www.youtube.com/watch?v=ca9EvKBHTB0
• Dunn, W. (2008). Sensory processing: Identifying patterns and support strategies. In K.D. Buron & P. Wolfberg (Eds.) Learners on the autism spectrum: Preparing highly qualified educators. Autism
Asperger Publishing Co.
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References
• Ismael, N., Lawson, L. M., & Hartwell, J. (2018). Relationship between sensory processing and participation in daily occupations for children with autism spectrum disorder: A systematic review of studies
that used Dunn’s sensory processing framework. The American Journal of Occupational Therapy, 72(3), 1-9,1A-4A. doi: http://dx.doi.org/10.5014/ajot.2018.024075
• Knight, V., Sartini, E., & Spriggs, A. (2015). Evaluating Visual Activity Schedules as Evidence-Based Practice for Individuals with Autism Spectrum Disorders. Journal of Autism & Developmental
Disorders, 45(1), 157–178. https://doi.org/10.1007/s10803-014-2201-z
• Lundy-Ekman, L. (2017). Neuroscience: Fundamentals for Rehabilitation. 5th ed. Elsevier. ISBN: 978-0-323-47841-0
• Marcus Autism Center. (2020). Establishing Routines at Home. Retrieved June 18, 2020, from https://www.marcus.org/autism-resources/autism-tips-and-resources/establishing-routines-at-home
• Meadows, A. (2016). Clothing fasteners and fine motor skill development. Retrieved 9 June 2020, from https://kidsplayspace.com.au/clothing-fasteners-and-fine-motor-skill-development/
• Miller-Kuhaneck , H. (2020). Home Activities. Sensory Processing Disorder - STAR Institute, www.spdstar.org/basic/home-activities-0.
• Miller- Kuhaneck, H., & Watling, R. (2018). Parental or teacher education and coaching to support function and participation of children and youth with sensory processing and sensory integration
challenges: A systematic review. American Journal of Occupational Therapy. 2017;72(1):7201190030. https://doi.org/10.5014/ajot.2018.029017
• Morin, A. (2019, October 16). Interoception and Sensory Processing Issues: What You Need to Know. Retrieved May 2020, from https://www.understood.org/en/learning-thinking-differences/child-
learning-disabilities/sensory-processing-issues/interoception-and-sensory-processing-issues-what-you-need-to-know
• Morin, A. (2020, May 13). 8 Sensory-Friendly Indoor Games and Activities.
• Nebraska Autism Spectrum Disorders Network. (2020). Rules and Routines | Nebraska Autism Spectrum Disorders Network | Nebraska. Retrieved June 18, 2020, from
https://www.unl.edu/asdnetwork/virtual-strategies/rules-and-routines Retrieved June 2, 2020, from https://www.understood.org/en/learning-thinking-differences/child-learning-disabilities/sensory-
processing-issues/8-sensory-friendly-indoor-games-and-activities
• oraNurse. (2016). Unflavoured Toothpaste. Retrieved May 21, 2020, from http://www.oranurse.co.uk/unflavoured-toothpaste.html
• Remedy Health Media. (2020, February 5). Coping with Stress While Caring for a Child with Autism. Retrieved from https://www.psycom.net/coping-with-stress-while-caring-for-a-child-with-autism/
• Roll, K. (2013). The Roll Evaluation of Activities of Life (REAL™).
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friends/
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from https://vkc.mc.vanderbilt.edu/assets/files/resources/healthy-smiles-for-autism.pdf
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doi:http://dx.doi.org/10.1007/s10803-016-3009-9
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