When Sounds Hurt My Body

The other day when we got home from some random outing, we walked in the door and the dog went nuts. He was jumping all over the house like he had just ingested a gallon of coffee, jumping on the couch, running to the other side, jumping down, running to one child, then the next, all while barking. Oliver was screaming from excitement at every time the dog barked, which then made the dog bark again, most likely to the obscene disciples that child can reach when shrieking. Killian was laughing and yelling, “Ah! Kizzy! Kizzy is jumping! He’s jumping,” over and over again. I could feel my anxiety rising and rising as I’m trying to get the dog to hold still, Killian to stop repeating himself, Oliver to stop shrieking, and I am failing at each one.

I was losing my ever-loving mind.

My anxiety gets triggered by lots of sounds happening all at once or having the same sound(s) repeated over and over again. I feel like I am falling and drowning. Everything is caving in on me and there is no escape.

I love music. Classic rock is amazing, however, most songs I have to turn off because the instrumental solos are stuck on repeat of just a few chords and seem to go on with no end in sight and I start feeling suffocated. Guns and Roses is a great band, but I can’t listen to them because this happens in nearly every song they made.

So, when all of this loud chaos was happening and I couldn’t get it to stop, I lost my temper and screamed at my kids to shut up. Shut up is a no-no phrase in our house. Killian looked at me and started crying and ran off, Oliver just stood there and the dog froze. as my husband calls it, I had used my “demon voice” aka the “Mom has finally lost her shit and now everyone is in trouble” voice.

I felt really bad for scarring Killian and I immediately said sorry and that mommy was going to go into a time-out for saying something naughty. Really, I just needed a break from everything. But I knew that if I told him that I was going in time-out, it would show him that even mommies make mistakes and do something naughty at times.

Later, after I had calmed down, I got to thinking about how I react to sensory overload and how Killian is affected by the same thing but on a greater level at times. For instance, his clothes HAVE to be Cat and Jack or he starts to melt down. A friend gave me some cargo pants that her son had outgrown and Killian fought tooth and nail about how it hurt his skin. He said that it was to heavy, the pants felt to big on his legs, the button hurt, and he HAD to take them off NOW! Having tags on clothes makes him itch. If he even gets 1 drop of water on his clothes, he HAS to take them off because he can not stand to have that on him. Cat and Jack are an amazing brand of kid’s clothing that is specifically designed for kids with special needs and sensory issues. Everything is smooth, tagless, have a stretchy band and drawstring option in pants, and adaptive.

Killian has sensory processing disorder which makes some of his senses more sensitive and others lacking. His body craves deep pressure stimulation. He loves big hugs because having his body squeezed tight is calming to him. It will be 90º and he is wrapping himself in a giant comforter so he has that compression around his entire body. He loves to run and crash into people or the couch, pillows, and blankets. But if you were to run your fingertips lightly up and down his arm he will pull away like he just got burned.

Sensory processing refers to the way the nervous system receives messages from the senses and turns them into responses. For those with Sensory Processing Disorder, sensory information goes into the brain but does not get organized into appropriate responses. Those with SPD perceive and/or respond to sensory information differently than most other people. Unlike people who have impaired sight or hearing, those with Sensory Processing Disorder do detect the sensory information; however, the sensory information gets “mixed up” in their brain and therefore the responses are inappropriate in the context in which they find themselves. SPD is a neurophysiologic condition in which sensory input either from the environment or from one’s body is poorly detected, modulated, or interpreted and/or to which atypical responses are observed.

I recently was introduced to a wonderful YouTube activist who is shedding a much-needed light on Autism and other disabilities from a first person point of view. Her name is Agony Autie and she created a fantastic video about Sensory Processing Disorder . In the video she explains some of her triggers and what it feels like to her. Having your senses overloaded faster and easier than “normal” people can be very traumatic and confusing. I’m sure it can even become embarrassing for some. We don’t live in a sensory friendly world. We are having our sensory systems stimulated at all times of the day. From having the sound of an airplane flying overhead at the same time as the cracking of car tires over gravel, distant laughter, a nearby conversation, music playing on the speakers, the smell of coffee from the cafe’, onions from the restaurant next door, fries from another restaurant across the street, the warm sun mixed with the cool breeze on your skin. All of these things that I am currently being exposed to as I sit outside of Starbuck and write. Things that have no effect on me because I am naturally able to process the sensory input that I am receiving into categories of “important/needed/relative” and “unimportant/background/junk” files. I can have all of these sensory inputs attack my system and they get filtered through without any negative reactionary discord.

Those with SPD are unable to filter those olfactory augmentations. The brain becomes overloaded and everything is too much to handle. Some may cover their ears, close their eyes, or even curl up into a ball in order to block out the world around them that is causing so much harm to them. Agony Autie explains that some of these sensory inputs may have a very physical reaction to the person even if they are not tactile in nature. For instance, hearing specific words or sounds may cause your body to cringe and feel distressed. Or looking at a pattern may cause your eyes to swirl and your head begin to pound.

Something to help those with SPD is to create a sensory backpack that is filled with items to help block out the offensive stimuli and give them something else to replace it with. For instance, if the child (or adult) is easily offset by sounds, include a pair of noise canceling headphones in the backpack for them. If moving colors tend to calm them, include a liquid motion bubbler for them to focus on. Because Killian craves the deep pressure and physical resistance I put a couple of therabands in his backpack. Oliver puts EVERYTHING in his mouth, she he has a chewy necklace that he can chew on instead of licking every possible surface of the grocery store.

Unfortunately, we can not prevent stimuli from occurring, but we can warn the child about what to expect and be prepared for when it becomes too much to bear. Teaching them to recognize when the triggers are beginning to affect them negatively and how to safely and effectively let you or someone else know that they need help becoming regulated again. Once you start seeing the tell-tale signs that your child is becoming agitated, bring out the sensory backpack and ask them what hurts, or select something for them if they are unable to communicate with you.

There are two types of sensory processing challenges, and many kids experience a mix of the two. One is oversensitivity (hypersensitivity). This leads to sensory avoiding—kids avoid sensory input because it’s too overwhelming. The other is undersensitivity (hyposensitivity). This causes kids to be sensory seeking—they look for more sensory stimulation. Often, kids with sensory processing issues are oversensitive. They try to avoid sensations they find intolerable. But some kids seek more sensory input, not less. They may want to touch things and feel physical contact and pressure. They may also be undersensitive to pain and have an unusually high tolerance for it. That’s why they may prefer playing rough and not understand if they’re hurting someone. Some kids may be both sensory avoiding and sensory seeking. They may be oversensitive to some sensations, and undersensitive to others. A child’s reactions can also change from one day to the next, or even throughout the day, depending on the environment or situation.

Kids who are sensory avoiding may react to a wide range of triggers. These can include loud sounds, uncomfortable clothing, crowded spaces, or certain food smells or textures, among others. Whatever the trigger, the reaction can sometimes be extreme. Sensory overload can lead to sensory meltdowns. These are very different from tantrums because they’re out of the child’s control. Kids who are undersensitive to sensory input have the opposite situation. They often have a need for movement. And they may seek out input like spicy or sour tastes and physical contact and pressure.

Sensory processing issues aren’t a diagnosis on their own. But they often co-occur with two conditions: ADHD and Autism. Kids don’t have to have ADHD or Autism to have sensory processing issues, however. Some of the signs of ADHD may look similar to the signs of sensory processing issues. Kids with either of these conditions might need to be in constant motion, for instance. But the reasons would be different. Like kids with ADHD, kids with sensory processing issues may also experience anxiety. And while ADHD and autism often co-occur with sensory issues, they do not cause them.

There are a few tests professionals can use to identify sensory processing issues. These include Sensory Integration and Praxis Tests (SIPT) and the Sensory Processing Measure (SPM) checklist. In general, though, the behaviors kids show are very visible and evident. It’s important to observe your child and take notes to share with professionals who might identify your child’s challenges. Occupational therapists (OTs) are often qualified to identify and create treatment plans for sensory challenges in kids. Other professionals may be able to identify sensory processing issues, too.

There are no medications for sensory processing issues. But there are professionals that can help your child learn strategies to cope with sensory challenges.

OTs often work with kids with sensory issues. They help kids find ways to be less overwhelmed by sensory input. You may have heard of a treatment known as sensory integration therapy, but more often therapists might create what’s called a sensory diet. This is a tailored plan of physical activities. It helps kids learn to calm themselves and regulate their behavior and emotions. And that makes them more open to learning and socializing. Some of these activities are heavy work, a type of activity that pushes or pulls against the body.

Here are some things that might be included in a sensory diet:

  • Jumping jacks
  • Rolling on a therapy ball
  • Push-ups
  • Hopping up and down
  • Climbing ladders and going down slides

Child psychologists also work with kids who have sensory processing issues. They can use cognitive behavioral therapy to help kids talk through their feelings and frustrations caused by their challenges.

At school, your child might be able to get accommodations through a 504 plan. (If your child has an IEP for another issue, it could include accommodations for sensory issues, too.) The teacher may also give your child informal supports.

Classroom accommodations to help kids with sensory processing issues might include:

  • Allowing your child to use a fidget.
  • Providing a quiet space or earplugs for noise sensitivity.
  • Telling your child ahead of time about a change in routine.
  • Seating your child away from doors, windows or buzzing lights.
  • Allowing your child to take exercise breaks to self-regulate.

Right now, one of our main goals in OT, speech, and behavioral therapy is to get Killian to recognize on his own when his senses are feeling overloaded and how to ask for a break or signal to us that his brain needs a break to decompress if he is unable to verbally communicate those needs. I hope that we are able to come up with a solution before he begins Kindergarten so we can add it to the IEP for all of his instructors to be able to know and use when school begins to tax his little body and brain.

If you are needing help creating a sensory backpack or coming up with sensory friendly games and/or toys, Pintrest and a ton of amazing ideas. It’s where I went when creating Killian’s. Also, speak with your child’s therapist about seeing if their health insurance would cover the cost to provide you and your child with these tools. I recently learned that his does (though it can be a lot of paperwork and wait time).

-The Lazy Mama

The ABC’s of ABA

We got the referral for Killian to start ABA Therapy. The only problem? I had no clue what that even was. I have a friend who is an ABA Therapist and she briefly explained it but I still didn’t fully understand what it was. All I really got was the it is a positive behavior therapy to help alter the negative behaviors that my child has like his aggression, temper, and inability to follow simple instructions without having hand-over-hand guidance.

So, I decided to do my favorite thing and research. Then share with you what I have learned and tell you the most important piece of information that a therapist feels parents need to know.

Ready? Let’s go!

What is ABA Therapy?

Applied Behavior Analysis (ABA) is a type of therapy that focuses on improving specific behaviors, such as social skills, communication, reading, and academics as well as adaptive learning skills, such as fine motor dexterity, hygiene, grooming, domestic capabilities, punctuality, and job competence. ABA is effective for children and adults with psychological disorders in a variety of settings, including schools, workplaces, homes, and clinics. It has also been shown that consistent ABA can significantly improve behaviors and skills and decrease the need for special services. ABA therapy applies our understanding of how behavior works to real situations. The goal is to increase behaviors that are helpful and decrease behaviors that are harmful or negatively affect learning. The methods of behavior analysis have been used and studied for decades. They have helped many kinds of learners gain different skills, from healthier lifestyles to learning a new language. Therapists have used ABA to help children with Autism and related developmental disorders since the 1960s.

How does ABA Therapy work?

Applied Behavior Analysis involves many techniques for understanding and changing behavior. ABA is a flexible treatment. It can be adapted to meet the needs of each unique person and can be provided in many different locations such as in the home, at school, and in the community. ABA teaches skills that are useful in everyday life and involves either one-on-one teaching or group instructions.

ABA therapy involves multiple treatment steps that help children overcome challenging behaviors and develop socially significant skills.

Overcoming challenging behavior

  • Functional Behavior Assessment (FBA): An FBA is one of the first assessments conducted in ABA Therapy when a child engages in challenging behavior. It is a comprehensive set of assessment procedures to help understand why problem behavior occurs so that the therapist can best provide intervention services. FBA involves an indirect assessment, direct observational data collection and sometimes a systematic, structured assessment called a functional analysis. The results can reveal a cause and effect relationship between a problem behavior and what is maintaining it.
  • Defining a plan: After assessing challenging behavior, specialists develop a collaborative function-based treatment plan with parents to reach a set goal. The team discusses the best therapeutic methods and measurements of success to try under the ABA plan.

Developing new skills

  • Systematic instructional procedures: Specialists are trained in the most-effective ways to teach children with Autism. Some of these methods include discrete trial training (or breaking down a task into small, achievable pieces), positive reinforcement, repetition, and altering antecedent stimuli. These strategies help children with Autism learn.
  • Ongoing assessment: ABA Therapy does not end when a goal is met. An effective behavior specialist will continue to support their client, revisiting instruction when needed. The goal is to help the child continually experience success with their learned skill, in different settings and as they grow.

With the right interventions through ABA therapy, children can improve their behaviors and reach their full potential.

When is ABA recommended?

ABA is commonly practiced as a therapeutic intervention for individuals with Autism. According to the Center for Autism, ABA helps the autistic client improve social interactions, learn new skills, and maintain positive behaviors. ABA also helps transfer skills and behavior from one situation to another, controlling situations where negative behaviors arise and minimizing negative behaviors. With Autism, ABA is most successful when intensely applied for more than 20 hours a week and prior to the age of 4. ABA can also help aging adults cope with the losses that come with age, like memory, strength, and relationships. For young and old, ABA can help individuals manage some of the lifestyle challenges that accompany many mental and physical health conditions.

Positive reinforcement is the key!

Positive reinforcement is one of the main strategies used in ABA. When a behavior is followed by something that is valued (a reward), a person is more likely to repeat that behavior. Over time, this encourages positive behavior change. First, the therapist identifies a goal behavior. Each time the person uses the behavior or skill successfully, they get a reward. The reward is meaningful to the individual – examples include praise, a toy or book, watching a video, access to playground or other location, and more. Positive rewards encourage the person to continue using the skill. Over time this leads to meaningful behavior change.

So where do the ABC’s come in to play? Well here they are!

Antecedent, Behavior, and Consequence

Understanding antecedents (what happens before a behavior occurs) and consequences (what happens after the behavior) is another important part of any ABA program.

The following three steps – the “A-B-Cs” – help us teach and understand behavior:

  1. An antecedent: this is what occurs right before the target behavior. It can be verbal, such as a command or request. It can also be physical, such a toy or object, or a light, sound, or something else in the environment. An antecedent may come from the environment, from another person, or be internal (such as a thought or feeling).
  2. A resulting behavior: this is the person’s response or lack of response to the antecedent. It can be an action, a verbal response, or something else.
  3. A consequence: this is what comes directly after the behavior. It can include positive reinforcement of the desired behavior, or no reaction for incorrect/inappropriate responses.

Looking at A-B-Cs helps us understand:

  1. Why a behavior may be happening
  2. How different consequences could affect whether the behavior is likely to happen again

EXAMPLE:

  • Antecedent: The teacher says “It’s time to clean up your toys” at the end of the day.
  • Behavior: The student yells “no!”
  • Consequence: The teacher removes the toys and says “Okay, toys are all done.”

How could ABA help the student learn a more appropriate behavior in this situation?

  • Antecedent: The teacher says “time to clean up” at the end of the day.
  • Behavior: The student is reminded to ask, “Can I have 2 more minutes?”
  • Consequence: The teacher says, “Yes, you may have 2 more minutes!”

What does an ABA program involve?

Good ABA programs for Autism are not “one size fits all.” ABA should not be viewed as a canned set of drills. Rather, each program is written to meet the needs of the individual learner.

The goal of any ABA program is to help each person work on skills that will help them become more independent and successful in the short-term as well as in the future.

Planning and ongoing assessment

A qualified and trained behavior analyst (BCBA) designs and directly oversees the program. They customize the ABA program to each learner’s skills, needs, interests, preferences and family situation.

The BCBA will start by doing a detailed assessment of each person’s skills and preferences. They will use this to write specific treatment goals. Family goals and preferences may be included, too.

Treatment goals are written based on the age and ability level of the person with ASD. Goals can include many different skill areas, such as:

  • Communication and language
  • Social skills
  • Self-care (such as showering and toileting)
  • Play and leisure
  • Motor skills
  • Learning and academic skills

The instruction plan breaks down each of these skills into small, concrete steps. The therapist teaches each step one by one, from simple (like imitating single sounds) to more complex (like carrying on a conversation).

The BCBA and therapists measure progress by collecting data in each therapy session. Data helps them to monitor the person’s progress toward goals on an ongoing basis.

The behavior analyst regularly meets with family members and program staff to review information about progress. They can then plan ahead and adjust teaching plans and goals as needed.

Who provides ABA services?

A board-certified behavior analyst (BCBA) provides ABA therapy services. To become a BCBA, the following is needed:

  • Earn a master’s degree or PhD in psychology or behavior analysis
  • Pass a national certification exam
  • Seek a state license to practice (in some states)

ABA therapy programs also involve therapists, or registered behavior technicians (RBTs). These therapists are trained and supervised by the BCBA. They work directly with children and adults with autism to practice skills and work toward the individual goals written by the BCBA. You may hear them referred to by a few different names: behavioral therapists, line therapists, behavior tech, etc.

What is the evidence that ABA works?

ABA is considered an evidence-based best practice treatment by the US Surgeon General and by the American Psychological Association.

“Evidence based” means that ABA has passed scientific tests of its usefulness, quality, and effectiveness. ABA therapy includes many different techniques. All of these techniques focus on antecedents (what happens before a behavior occurs) and on consequences (what happens after the behavior).

More than 20 studies have established that intensive and long-term therapy using ABA principles improves outcomes for many but not all children with autism. “Intensive” and “long term” refer to programs that provide 25 to 40 hours a week of therapy for 1 to 3 years. These studies show gains in intellectual functioning, language development, daily living skills and social functioning. Studies with adults, though fewer in number, show similar benefits.

Here is a List of questions that I found online to use as a tool for finding the best ABA team for you and your child.

  1. How many BCBAs do you have on staff?
  2. Are they licensed with the BACB and through the state?
  3. How many behavioral therapists do you have?
  4. How many therapists will be working with my child?
  5. What sort of training do your therapists receive? How often?
  6. How much direct supervision do therapists receive from BCBAs weekly?
  7. How do you manage safety concerns?
  8. What does a typical ABA session look like?
  9. Do you offer home-based or clinic-based therapy?
  10. How do you determine goals for my child? Do you consider input from parents?
  11. How often do you re-evaluate goals?
  12. How is progress evaluated?
  13. How many hours per week can you provide?
  14. Do you have a wait list?
  15. What type of insurance do you accept?

Killian is currently on the waitlist for an ABA program that is connected through the same behavioral therapy office that he goes to every Friday morning. They will be able to work closely with his current therapist to make sure that he receives the best care possible and that everyone is working on the same goals and in the same way in order to offer the proper support. I personally can not wait for him to start and see what kind of positive differences we can achieve.

-The Lazy Mama