Question
What are some sensory strategies OTs can use with clients during meltdowns?
Answer
First, we want to understand the avoidance. Is it a behavioral avoidance or is it a sensory avoidance? Do they see the sensory strategies as a threat? Or do they not want to take your advice on something? Typically, I use the manipulation method (sounds bad). However, I want them to think it is their own idea. Having them have as much choice in the process as possible is important. I might offer lots of different options. I might educate less and just have them think it is something cool in their interest area. For example, let's say we make a fidget. I might not tell them what it is and let them just think they are making a toy. Eventually I would tell them how it could help. I have some kids who get very distressed by this because they know that you are giving them a solution to a problem and they cannot really admit to the problem. The problem is a threat. Thus, I really like to use more cognitive behavioral with those kids coupled with sensory.
If it is significant and I think it is beyond their capacity, I am going to try to get reduced homework as a temporary solution. Then, I am going to have them do just a little bit. The environment is also very important. Do they need a little decompression prior? Do they need background noise? Sometimes we think that having the sterile, quite area is ideal, but some of these kids need background noise. I need background noise. I cannot work without Spotify or Pandora because I am very distracted by noises in the halls, the air conditioner, the clock going, etc. I also want to give some kind of an immediate reward for doing the activity, that has a lot of meaning. Over time, I am going to start making them have to work a little harder. But if it is a pretty significant situation, I am going to go the 504 route. Typically the schools are pretty good about that. Alternative seating can also make a huge difference. Let them pick what they want to sit on. Do they need a sensory reward after? Do they need proprioception? Again it is thinking about what do I need to calm and alert them? However if they are seriously distressed by the homework and seeing it as a threat, I need to have them reframe the homework into something positive. I need to untrain or retraining the brain. The schools are starting to respect the sensory aspect now that the DSM has sensory for autism. I am noticing it is starting to trickle out and people are starting to notice that the functional behavior plans do not always work. They have to do something different.
The big thing is getting teachers to reframe their perspective and helping them to realize that meltdowns usually have something to do with the environment. I like to use a collaborative consultation model with teachers. I like to take the path of least resistance. I ask them if they prefer we gave them something for the child, or would they like to change something in their environment that works for everyone, including that child. Typically, they say they want something for the child, and then when they see that it works for the child, they then ask for something environmental. If the culprit is auditory then the use of headphones is very helpful. A quiet tent area is also very helpful. Resistive or proprioceptive activities throughout the day, coupled with movement breaks, are other great strategies. Will the teacher do some kind of movement breaks for everybody? Can they do something resistive with the kid like TheraBand on the chair? Could it be something heavy for the lap? Even chair push-ups are a great simple activity. I would like to emphasize the quiet safety area because I think it makes a huge difference for the kids to know they have a space to go to. I like to push that if I feel that the teacher is open to it. Many of these teachers are really just beside themselves on what to do and they want help.
