Self-regulation is critical to a child’s learning and development. Self-regulation is a person’s ability to maintain their arousal level and a level of alertness that is appropriate for the demands of the environment. Children and adults use various strategies and techniques to maintain self-regulation throughout their daily lives. Many of these strategies are sensory based and help our nervous systems sustain physiological regulation in order to participate in social activities, daily living activities, and other age appropriate activities. Sensory processing is a key ingredient to a child’s self-regulation.

Sensory information that our bodies process includes:

• Proprioceptive input: Gives our bodies information of body position and where our body is in space.
• Vestibular input: Provides information to our body about movement and changes in head position.
• Tactile input: Sense of touch through our bodies, hands, and mouth; allowing us to interpret what we feel.
• Auditory input: Sense of hearing, allowing us to interpret what we hear.
• Visual input: Sense of vision, allowing us to interpret what we see.

Our bodies take in sensory information from the environment and process that information, resulting in a behavior in response to the environment. When children have difficulty processing sensory information or have difficulty adequately registering the sensory information, difficulties in self-regulation can result.

Just a few examples of how adults sustain regulation on a daily basis using sensory strategies include:

• Chewing gum to help sustain attention.
• Going out for a massage or engaging in physical exercise when feeling stressed.
• Lying under a heavy blanket when relaxing and falling asleep.
When a child has difficulty with self-regulation, it can impact the child’s ability to participate in school activities, in activities of daily living, social activities, etc. For example, if a child has difficulty sustaining an optimal level of arousal and is very active they will potentially have difficulty listening to classroom instruction, difficulty following the classroom routine, etc. Another example is a toddler who has difficulty tolerating transitions and difficulty self-soothing. This toddler may have difficulty utilizing tools or strategies to assist with self calming, like engaging in a calming movement activity, getting a hug for comfort, knowing what to expect through a visual schedule, etc.

Here are a few questions to consider when looking at a child’s functioning and determining whether difficulties with self-regulation may be contributing to your child’s learning potential:

• Does your child have difficulty staying seated or sitting still during tabletop tasks?
• Does your child have difficulty transitioning between activities?
• Does your child have difficulty sustaining attention to a conversation, activity, or task?
• Does your child have difficulty self-soothing when upset?
• Does your child have difficulty filtering excessive noise resulting in difficulty sustaining attention?
• Does your child have difficulty following multi-step directions or multi-step activities without requiring assistance?
• Does your child have a low activity level?
• Does your child seem to get lost while completing a task, delaying his/her ability to complete it in a timely manner?

These are only a few questions related to possible self-regulation difficulties. If difficulties with self-regulating is impacting daily life and your child’s ability to participate in age related activities to their fullest potential, an occupational therapy consultation or evaluation may be beneficial. Occupational therapy can assess a child’s individual sensory needs and self-regulation capacity to assist with increase in functional independence.

Here are a few examples of techniques that an occupational therapist could utilize to assist you and your child with their self-regulation:

• Create social stories: creating a story about the child and identifying their arousal level (our bodies move slow, just right, and fast).
• Creating a sensory diet that is specific to the child’s sensory system and needs, to help provide needed sensory input to maintain regulation.
• Increasing a child’s self-awareness and ability to identify their own arousal level.
• Providing sensory rich experiences for the child to engage in to increase opportunities for the child to receive the sensory input that they may need.
• Engaging in sensory based community activities that provide the sensory information that the individual child may benefit from.

Dr. Neeha Patel is a licensed occupational therapist who offers a holistic approach to therapy, drawing from evidenced-based practice techniques, sensory integration theory, neurodevelopmental treatment, family-centered care, and a play-based approach. She is Sensory Integration and Praxis Tests (SIPT) certified, and has extensive experience helping children from birth to 16 years old with sensory processing delays, fine and visual motor delays, social skills, pre-writing and handwriting skills, as well as in their primary activities of daily life. She has worked with varying diagnoses including autism spectrum disorders, learning disabilities, developmental delays, developmental coordination disorder, cerebral palsy, disruptive behavior disorder, and down syndrome. Neeha has special interest and completed her doctoral work in the area of cultural sensitivity when working with children and their families. Neeha offers home, school, or community visits in Brooklyn and Manhattan (Upper West Side, Midtown, Chelsea, Clinton, West Village, Soho, Tribeca, Union Square, Murray Hill, Gramercy Park, Upper East Side).

Part 1: The Visual, Auditory and Tactile Senses

As a new parent to an 9-month old boy, I busy myself reading child development books and checking online resources, to assure myself that he is meeting his developmental milestones each month. While we are playing and having fun, I am assessing his emerging gross and fine motor skills, listening to his burgeoning language, and marveling at his cognitive gains. As an Occupational Therapist (OT), I have been encouraged to see that the books and online articles often reference the sensory skills that are developing in our babies; skills which continue to develop in children until their early teenage years. In this entry, I will discuss ways to support your child’s visual, auditory and tactile skills from an OT perspective. These are ideas that are easy to implement at home, and which can be enjoyed by children who are typically developing as well as assist those who are experiencing delays.

VISUAL SYSTEM

Definition: Our visual system allows us both to see and to interpret what we see. Developmentally, it is important for recognizing people, shapes, colors, and eventually letters and numbers. Socially, it helps us to read body language and facial expressions. For example, we must use our vision to guide our movement through the world safely and effectively.

Infants: Provide the baby with high contrast black and white images, bright colors (especially red and yellow), simple geometric designs, mirrors, and slow-moving mobiles. One of baby’s favorite things to look at is the human face (especially mom and dad). Books with pictures of faces are often interesting to babies and will stimulate their vision. As your baby grows, you can help their vision mature by presenting slowly moving items so that they have to track the item as it moves throughout their field of vision (first try horizontal movements, then vertical, then circular).

Preschool: Help your child learn shapes, colors, and begin letter and number recognition through activities like puzzles, blocks, and books. Children gain valuable “practice” with their visual system through activities such as rolling a ball, stacking blocks, pointing to pictures in a book, coloring and cutting with scissors.

School age: Higher-level visual skills are developing at this age, including figure-ground, visual discrimination, and visual memory. Hidden picture books (figure-ground), matching worksheets (discrimination), and games like Memory are all great for this age group. In addition to the school tasks of reading and writing, children can work on their eye-hand coordination at this age through mazes, connect-the-dots, and word searches.
For more information about the development of vision, visit the website of the American Optometric Association. It provides great information about what changes occur at each age and stage and development: http://www.aoa.org/x9419.xml

AUDITORY SYSTEM

Definition: We use our auditory system (or sense of hearing) to identify both the quality and location of sounds in our environment. For example, our auditory sense alerts us so that we turn our heads when a car is approaching.

Infants: A baby is born with a very well-developed sense of hearing. Your baby can recognize (and prefers) the sound of parent’s voices. Talking to your baby is one of the best ways to help your baby’s auditory system develop. This can include your own singing, too! As young as one month, babies can remember sounds, such as a repeated lullaby. Parents should also talk to their babies as they go through their day, narrating what you are doing is a great way to introduce language. Babies respond to repetition, and to high frequency sounds (which is why many prefer female voices). As your baby begins to make her own sounds, repeat them back to her as this lays the foundation for the turn-taking of spoken language. Music, of course, is another strong auditory input that babies enjoy. This can be anything from classical music, to nursery rhymes and songs, to any music that mom and dad like! You can help your baby refine her sense of hearing by having her find (localize) a moving sound (slowly move a rattle or noisy toy). As your baby grows, introduce the following auditory/language concepts during play: animal sounds, names of colors, and counting (fingers, toes, blocks, etc.)

Preschool: Continue to explore music through playing simple instruments, learning finger songs, and singing. Playing with puppets and using different voices (high, low, silly, etc.) is a fun activity, and it also engages the child in pretend play. Have your child point to pictures in a book as you read it. Listen for and identify sounds in the environment (“that’s a car horn”, “hear the birds chirping”, etc.). Work on giving one-step, then two-step directions. As always, continue to talk to your child during your daily routines and continue to read books.

School age: At this age, you can help your child continually improve their auditory skills by giving him three- and four-step directions. Addressing the concept of voice volume may be an issue as children enter school, where they are asked to be quiet for long stretches of the day. Instead of expecting children to understand the term “inside voice”, a visual aid may be helpful. You can make a simple chart with the following information: 0 = silent, 1 = whisper, 2 = talking, 3 = yelling. Act out each volume with your child. Then, explain the rules of your home regarding when it’s OK to use each (i.e., yelling may be OK during play, or during an emergency; a whisper should be used at nighttime, etc.) One final piece of OT advice regarding school-age children and auditory input relates to that dreaded word…homework. My advice is to know how your child responds to noises and be aware how this impacts his/her focus during homework. Some children will require a quiet work space, away from distractions such as radio, TV, siblings, phone calls, or even a parent cooking dinner. However, other children thrive on “background noise” to help them. These kids may do well working at the kitchen table, or wearing headphones with music playing as they work.

To learn more about how your child’s hearing develops from in utero throughout childhood; visit the home of the American Speech-Language and Hearing Association: http://www.asha.org/public/

TACTILE SYSTEM

Definition: This is our sense of touch, which plays an important role in a child’s motor and social development. The tactile system provides information about the shape, size, and texture of objects. This information helps us to understand our surroundings, manipulate objects, and use tools proficiently. For example, you are using your tactile system when you reach into your pocket and find a quarter among several coins.

Infants: Touch helps promote parent-child attachment by giving your baby a sense of safety, security and love. Developing awareness of the nature and quality of a variety of tactile input also gives infant valuable information about the world around them, thus aiding their cognitive and fine/gross motor skills. Offer infants a variety of safe textures to explore (plastic or wooden toys, stuffed animals, soft blankets, “crinkly” toys, feely books, tactile mats, and tactile balls). Give her an infant massage (with or without lotion). Lightly rub her feet and clap her hands together. Expose her to different textures and sensations, such as a vibrating toy, a soft cloth, a feather, a scratchy piece of sandpaper or bumpy ball. Be sure to tell her what the textures are as you show them to her. Allow for some “naked time” every day, so that your child can feel textures on her arms, legs, back and belly. (If you are daring, you can go without a diaper for a while!) Also, be sure to have some supervised “tummy time” every day, so that your baby does not become too sensitive on her stomach (This position is necessary in order to prepare for crawling and develop upper body stability and strength).

Preschool: One activity preschoolers often enjoy is a sensory table (or at home, you can make a “sensory bin”). Fill a large plastic bin with a mixture of dried rice and beans, then you can hide small toys or “treasures”, puzzle pieces, or simply cups and spoons for empty-fill. Other fun suggestions include: modeling clay, Play-Doh, and finger paints. Don’t be afraid to let them get messy! They are working on developing their tactile awareness, as well as the small hand muscles needed for later activities such as handwriting. Finally, taking a nature walk to pick up and explore various outdoor items (leaves, rocks, petals, dirt, etc.) is a great way to enjoy a nice day, while promoting this important sense.

School age: The sense of touch is highly developed in this age. A few ways to challenge your older child to use and perfect this sense are: draw letters on his back with your finger and have him guess, fill a cloth bag with common objects and have him identify things (one at a time) without looking in the bag. Activities such as arts and crafts, stringing beads, and lacing cards can help children continually improved their tactile skills.

The neurological process that interprets sensations from the body and its environment is called Sensory Integration. The brain’s ability to process sensory information makes it possible to use the body effectively within any given environment.

The quick screening checklist below will help you assess your child’s sensory development. If you answer “yes” to one or more of these questions, your child may be experiencing difficulties with sensory integration:
• Was your child unusually fussy, difficult to console, or easily startled as an infant?
• Is your child over-sensitive to stimulation? Does he/she over-react to touch, taste, sounds, or odors?
• Does your child strongly dislike baths, haircuts, or nail cutting (screaming, crying, “melting down”)?
• Does your child use too much force when handling objects, coloring, writing, or interacting with siblings or pets?
• Does your child seem to have weak muscles? Does she tire easily? Does she prefer to lean on people or slump in a chair?
• Was your baby slow to roll over, creep, sit, stand, or walk, or to achieve other motor milestones?
• Is your child clumsy? (Does she fall frequently, bump into furniture or people, and have trouble judging position of body in relation to surrounding space).
• Does your child have difficulty following instructions or sequencing the steps for an activity?
• Does your child avoid playground activities, physical education class, and/or sports?
• Does he/she not enjoy age-appropriate motor activities such as jumping, swinging, climbing, drawing, cutting, assembling puzzles, or writing?

For further information on Sensory Integration and for children diagnosed (or suspected) of a Sensory Processing Disorder:

http://www.sensory-processing-disorder.com/index.html
http://www.spdfoundation.net/index.html
http://www.otawatertown.com/

Check out Kids Health website for further information on the development of senses, as well as other great information: http://kidshealth.org/parent/growth/index.html#cat166

If your child is experiencing difficulty with any of these areas of development, please contact your pediatrician and/or an Occupational Therapist to assess if there is an underlying problem. Children develop at their own pace, with a wide range of normal regarding skill acquisition. If he/she has difficulty in several areas of sensory development, it may indicate a Sensory Integration Dysfunction.

Stay tuned for Part Two of this discussion, which will address the ‘hidden’ senses that are developing in your child.

Lynn-Marie Herlihy is an Occupational Therapist in private practice in Park Slope, Brooklyn. She has over 12 years experience treating children from birth to school-age, with a variety of sensory and motor deficits, developmental delays, and learning issues. You can also visit her website at www.BrooklynOT.com.