This blog is a commentary on a recent article by Beth Ohannesson Sarah Schoen, Vanessa Mitchell B Parent perspectives on children with sensory over-responsivity. The article describes a study in which parents of children with sensory over responsivity and sensory meltdowns/ sensory over responsivity episodes described their childrens description of the episodes and the strategies that they used to manage them.

The parents were asked to discuss sensory meltdowns/ sensory over responsivity episodes with the children and to ask the children to  describe how it felt.

The children described an intense sensory episode as:

·         “It feels like knives are stabbing my bones,”

·         “My whole body hurts,”

·         “I'm so scared,”

·         “You're killing me,”

·         “It's painful.”

·         A full description was obtained from one child's report, which included him saying: It’s painful, not physically, but it’s just too much. Don’t touch me, but don’t leave me, because it’s just too much. I’m so scared. There’s so much pressure that I have to go onto the ground. If you come over to comfort me, it’s killing me. I’m already down on the ground and now you’re killing me.

Other children indicated sensory specific reactions that included the following:

·         “Sounds are too loud,”

·         “Smells are too strong,”

·         “It hurts my ears,”

·         “Textures are too rough,”

·         “It's completely overwhelming,”

·         “I hate the feeling,”

·         too many things are happening in my head and body at once, and it makes me mad.

The descriptions provided by the children resulted in a suggested change in the terminology or sensory meltdown/sensory over responsivity episode to better reflect the intensity of the experience. They proposed the term “sensory assault”. This term is more consistent with the literature linking physiological, neurologically driven adverse sensory experiences that activate autonomic nervous system fight, flight, or freeze response.

Julie and I and other OTs we have discussed this with, have heard similar descriptions from children and adults of the pain and distress of a Sensory Assault and the descriptions of overwhelming input.  We will be interested to see whether this term becomes utilised in the OT literature.

In another part of the study , the families were  asked to describe the strategies that they had used  for the Sensory Assaults. This included:

·         Stay with my child

·         Gentle hold to keep everyone safe

·         Give them proprioceptive input

·         Name their feelings

·         Other

·         Yell

·         Give them oral chewies or gum

·         Countdown 5,4,3, 2 , 1

·         Give consequences or withdraw a privilege

·         Give time out.

The study includes the percentages that these strategies were used in a table form.

The majority of  parents in the study were feeling frustrated that their efforts do not seem to help (n = 24, 66.7%) or feeling confused about how to help (n = 23, 63.6%). Parents also reported feeling hopeless about their efforts to help (n = 14, 38.9%) and angry at their child (n = 16, 44.4%). A minority (n = 11, 30.6%) of parents reported feeling confident when responding to their child during an SOR episode”.

It is interesting that none of the strategies were to reduce the overwhelming sensory input. At Sensory Modulation Brisbane, we recommend this as a first line strategy.

The full article is worth reading for the extra detail.  and would love to see further research interviewing and expanding on the points raised in the article.

 

Sensory Assault Strategies

Sensory Modulation Brisbane suggested the following process in responding to a sensory assault

If possible, make changes to any sensory input in the environment

·         Turn down lights (not complete darkness – just a lamp) and in particular fluorescent lights

·         Use nil odour , or a fan or move away from intense scents

·         Offer ear plugs, headphone to block sound or turn music down or move away from loud sounds.

·         Remove any item of clothing or any item that may have a problematic texture

·         Block any visual motion (eg cars, people walking by) by changing positioning or having someone else sitting or standing in the way of it.

Co-regulation

·         Keep conversation to a minimum eg 5 word sentences. Person may have difficulty with processing speech or with speaking. For this reason, we advise not discussing the situation until later during a calm time. If they would like to speak and are unable to, use another communication strategy. If they are unfamiliar with not being able to speak, provide reassurance that this is short term and can occur during high distress.

·         Provide a calming presence. Sit or stand beside the person quietly. Use strategies that you find calming for yourself.

·         If the person is headbanging, or at risk of harming themselves then it is worthwhile discussing specific strategies with an OT.

Other calming sensory input

Any calming sensory input that is introduced needs to have been trialled previously and the person indicated that they like this input. During a Sensory Assault it is possible that the person does not want the sensory item and this needs to be respected. Also it is not uncommon for someone who has had a sensory assault to be irritable because of the intensity of what they have experienced

Calming input that may be useful includes:

·         Backpack, bag, bag of rice on lap, blanket

·         Heat /cold items (persons preference for temperature intensity)

·         Drink of water. Small sips. May be hard to swallow*

·         Tilting head down

·         Rocking head and/or body rhythmically back and forth

·         Moving/wiggling fingers and toes very slowly and gently

·         Calming scent

·         Swing

·         Chewing items if they are not a risk if they are swallowed (*the person may have difficulty coordinating swallowing ).

·         Using a single word or sound with a calm and long breath

Touching

·         Some people like a strong hug, or touch.

·         Pets can sometimes provide calming touch.

·         Other people find that touch is too overwhelming during the experience. If you are unsure, it is preferable to not touch.

 

After the Sensory Assault

·         Compete a Sensory Audit of the sensory input present during the Sensory Assault. A pdf of a Sensory Audit is available. This audit includes checking whether the person is in pain.

·         Reflect/ or Ask the person who had the sensory assault to identify if they feel that any particular sensory input in the Sensory Assault was problematic. This is not possible with some people (eg due to age, cognition, dissociation etc) but is valuable information if available.

·         Record the possible problematic sensory input and notice themes over time (be a sensory detective)

·         Explore other options that may be useful during a sensory input and develop strategies to make sure that they are available eg sensory kit.

A sensory assault is a traumatic and distressing experience and individuals may express their distress through punching, headbanging, hair pulling, self harming, aggression, moaning. It is important to have a trauma informed perspective on this experience and to not engage in punishment or other behavioural responses. It may be useful to see an Occupational Therapist for more specific strategies

Training

The Sensory Modulation course describes sensory modulation strategies and the use of a sensory audit. The content can be generalised to apply to a range of situations. The course does not use the term Sensory Assault as it is new!

 

References

 

O’ Sullivan, J, Fitzgibbon, C (2017) Sensory Modulation Resource Manual

Beth Ohanneson, Sarah A. Schoen, Vanessa Mitchell (2023) Emerging Ideas. Parent perspectives on children with sensory over-responsivity Family Relations, Interdisciplinary Journal of Applied Family Science  https://doi.org/10.1111/fare.12843

https://onlinelibrary.wiley.com/doi/10.1111/fare.12843