In Part II of the blog post on occupational performance, ASI-trained therapist Tharina Annandale looks at how sensory preferences affect leisure choice, which also has a close link to mental health.
Occupational performance can be defined as different aspects of a person’s daily living, like work, social participation, play and leisure, and sleep (Strong, S. and Rebeiro Gruhl, K.,2011 pp. 31-33).
We can consider leisure to be an occupational performance area. An activity is regarded as leisure when it is experienced as rewarding or enjoyment is experienced during the activity. Different people pursue different leisure activities, depending on their personal “needs” or idea of enjoyment.
In the previous article on “sensory processing and occupational performance at work” the different sensory profiles (Dunn, 1999) were considered. Each individual has their own, unique sensory profile and there is always an unconscious experience of the sensory environment and sensory information during an activity. In the pursuit of enjoyment and meaning, an individual will always do whatever addresses their unconscious sensory need. Thus, all of us will have different interests in leisure activities. Some people will prefer leisure activities like bungee jumping and free-falling. Other people will prefer sedentary leisure activities, like building a puzzle or reading a book.
Some people are sensitive in their tactile (touch) systems and others are sensitive in their vestibular (balance and movement) system. Of course you get so many sensory profiles that it will be impossible for me to give an example of each one, but I will attempt to explain it with the following case study.
Let’s consider the following child: A fourteen year old boy that prefers playing violin and singing in the choir. He has never liked team sports or any form of contact sports at school. He prefers being alone during break time and is regarded as socially awkward. He has visited almost eight psychiatrists in his lifetime and one psychiatrist had diagnosed him with depression. Most of the other psychiatrists have told the family that “they need to stop fighting” at home, then everything will improve. Some have considered a diagnosis on the Autistic spectrum, but have not diagnosed him formally with Autism. During the boy’s baby years he did not like to be put in his pram and he preferred to sit and play. He got severe car sickness and had to sit in the front seat of the car at all times, otherwise he would even get car sick on the way to the local grocer. His parents have thought it good to enrol him in gymnastics and the boy has been doing trampolining since he was eight. However, the mother noted that in spite of the fact that a teacher recommended trampoline as a sport that the boy could participate in, because “a trampoline is good for children”, the boy is really irritated after he jumped on the trampoline, until seven in the evening. When the boy is finished at his “trampoline session” he goes out of his way to irritate his younger brother, his father and his mother. His mother explains that “he is in her space” and she only wants to “slow down” for the day.
Know, dear people, this is a typical example of two sensory profiles in conflict with each other and explains why the psychiatrists keep on saying “that the family needs to stop fighting”. Rightfully so, the family need to stop fighting, but what is behind the conflict? When we considered the fact that the boy started crying when he was put in his pram and that he gets car sick, the indication of a sensitive vestibular system is a possibility. The sensory profile indicated a severely sensitive vestibular system and this lead me to one question: “Was doing the trampoline the best leisure activity for this boy?”
Let’s have a look at trampoline as a sport- the following systems are involved when doing trampoline as a sport: Vestibular, proprioception, tactile and the visual system. At a closer look, it was established that the gymnast will have to make 180 degree and 360 degree (which is a full circle) turns during this sport. The position of the head is mostly upside down and the speed increases with each rotation. Was this the ideal leisure activity for this boy? The boy did not mind going, because “at least his parents will think that he is cool in something”.
However, the root of the conflict was analysed and an adjustment was made in terms of leisure activity and today this boy copes at school and at home. He does not experience any “sensory overload” anymore and changed his leisure activity to squash. Squash has less of a vestibular component, it is not a team sport and the proprioception that he gets from hitting the ball inhibits his tendency to experience vestibular information at a more intense level than other individuals. The mother reports that she has put the boy in a school with smaller classrooms and he has adjusted his daily program and his leisure activities to accommodate his sensory profile. The boy’s anti-depressants were stopped and he is socializing less awkwardlyJ. This is a very good example of someone with a Sensory Processing Disorder that could have been diagnosed with Autism and on chronic medication for “aggressive outbursts” “irritating others” and “fighting” at home. At this stage I would just like to make it clear that I am not saying that there should not be a diagnosis of Autism, but sometimes a very serious diagnosis is made that could have been different if sensory issues were sorted out.
Let’s have a look at other leisure activities and possible sensory profiles that might match the activities.
|Leisure activity||Main sensory systems involved||Matching sensory profile|
|Individuals that need a lot of proprioception to regulate. Sensory sensitive people and people with low postural control can benefit from this
|Proprioception and tactile
|Although this activity allows for proprioception at the shoulder joint, the auditory information might be too much for auditory sensitive individuals. Luckily it can be done with ear protection to keep the sound less intense.|
|This sport has a range of sensory experiences, depending on the position that the person plays. If he is in the scrum, the proprioception can either help with regulation or the tactile (fact that you have to touch each other) can be too intense in the case of someone with tactile sensitivity.|
|Long distance running
|Long distance running has proved to be a very “good” leisure activity for people that have low postural control and that struggle with tactile sensitivity. In some cases people struggle with poor motor planning, then long distance running is an activity that do not require extensive motor planning and can be used to improve self-concept.|
||Visual||When considering puzzle building, the person will have to be able to regulate visual information. If a person tends to be more sensitive in the visual system, sensory overload might be a risk factor.|
In the above examples you can see that there is literally a leisure activity that suits every sensory profile (Dunn, 1999). Leisure activities can either enhance occupational performance or can have a negative impact on occupational performance. Therefore, it is of utmost importance to allow children perform the leisure activities of their choice and to make sure that the leisure activity that they choose to do is not to impress a parent or any teacher. If a person does a leisure activity that they don’t enjoy, it can have a spiral effect on interpersonal relationships, work, self-care and even sleep.
It is important to be sensory sensible when choosing your leisure activity.
Today’s post was written by Riette Smit, an occupational therapist trained in ASI® , long term board member of SAISI and the 2017-2019 outgoing chairperson of SAISI.
As an occupational therapist I have often been faced with the question, “What makes our [occupational therapy] assessments different to assessments other therapists and teachers use?” Regarding sensory integration: What is the difference between tests such as the Sensory Processing Measure (SPM) and Sensory Integration and Praxis Tests (SIPT), and what distinguishes them from other tests measuring sensory integration function?
Some tests require training and a process of qualification for the therapist before she is a qualified test user. Other tests can be downloaded easily from the internet, without any prior training or learning attached to the test.
In any comparison of assessments it is important to establish whether the same parameters were measured, i.e. “to compare apples with apples.”
The value, usefulness and reliability of the interpretation of any assessment are greatly influenced by the statistical reliability of the collected data. This rests on four factors: standardization, reliability, validity and the adaption to the South African population.
Let’s have a look at the standardization of the Sensory Integration and Praxis Tests (SIPT) which is widely used by occupational therapists trained in Ayres Sensory Integration®. The SIPT represents a culmination of Dr. A Jean Ayres’s lifework. It is based on theoretical concepts and research that evolved over four decades. In the early 80’s extensive field and pilot tests were done in Southern California and Chicago. The SIPT’s primary purpose is to provide information on a child’s sensory integrative and praxis function. It provides an in-depth look at the child’s sensory systems functioning. The test contains 17 subtests and takes about 2 hours to complete. Therapists involved in the data collection process underwent training in the administration and scoring of the SIPT. The 1980 US Census was used to ensure appropriate representation of the US population in the normative sample. Variables considered were age, sex, ethnicity, and type of community. The final number of children tested (normative sample) was 1997 children. These children were selected from 9 geographic divisions.
Let’s have a look at the reliability of the SIPT. The reliability of a test indicates the extent to which the outcomes are consistent when the test is done more than once or in different testing situations. Test reliability also includes consideration of error related to lack of consistency in human performance and test imperfections. This means that trained SIPT therapists will get similar results when administering the SIPT.
Another important aspect we need to consider is the validity of a test. Validity is the extent to which a test measures what it claims to measure. It is very important for a test to be valid in order for the results to be accurately applied and interpret by the therapist. The SIPT has a very good validity within the subtests.
A very important consideration is how the test one is using, is adapted to the South African population. There are pertinent differences in some areas of development when we look at children globally. For example, South African children are found to have better developed motor skills than children in USA and Europe. To what extent are these factors accounted for in assessments? Research by Dr. Annamarie van Jaarsveld indicated which subtests within the SIPT needed to be adapted for the South African population.
In summary, when comparing assessments used by a variety of therapists and teachers, ask yourself the following questions:
a) Is this test standardized? On how many children was it standardized? Is that a good representation of children regarding age, sex, culture and demographics? Is training for the therapist required in administration and scoring of the test to interpret results successfully?
b) Is the test reliable? Will the outcome of the test be the same should it be done in different settings and by other trained therapists?
c) What is the validity of the test? Does it test what it says it will test?
These are questions any parent can ask to determine the efficiency of an assessment as well as the accuracy of test results.
- Mailloux, Z. (1990). An Overview of the Sensory Integration and Praxis Tests. American Journal of Occupational Therapy, 44, 589-594.
- Ayres, A.J. 2004. Sensory Integration and Praxis Test Manual, updated edition. Eighth printing. Western Psychological Services, Los Angeles
- Van Jaarsveld, A, Raubenheimer, J & Smith Roley, S. 2011. Patterns of Sensory Integration Dysfunctions in South African Children. In process of writing up.
Our blog post this week is written by occupational therapist and SAISI board member Tharina Annandale, who has a special interest working with adults with sensory integration and mental health difficulties.
Occupational therapy can be defined as the science addressing occupational performance through occupation (Strong S. and Rebeiro Gruhl, K, 2011 pp. 31-33).
Let’s have a closer look at what we can understand under occupational performance. Occupational performance can be defined as different aspects of a person’s daily living, like work, social participation, play and leisure and sleep (Strong, S. and Rebeiro Gruhl, K.,2011 pp. 31-33).
When we consider work as a occupation, the importance of it can not be understated. The lack of opportunity to work does not only have financial implications, but the psychological and social impact of not working can be equally devastating. Thus, supporting the importance of work in our daily lives. On average, people spend about 8 hours a day at work. Therefore we can conclude that we spend about 70% of our lives working. Work is also most typically distinguished from other areas of occupational performance, because of its role in facilitating identity and a sense of meaning in our everyday lives (Pitts, 2011). According to Pitts (2011), work has the following benefits:
- Employment imposes a time structure and routine
- Employment implies regularly shared experiences
- Employment links different goals of people
- Employment defines important aspects of personal aspects of personal status
- Employment enforces activity, demanding an action
As humans we function as holistic beings. The Person-Environment Occupation Model (Strong, S. and Rebeiro Gruhl, K., 2011 pp. 31-33) describes the interaction between the person, his/her environment and occupation. In this instance the “occupation performance” aspect will be “work” and therefore we will discuss the dynamic interaction of the person, work and his or her environment. Environments, occupations and people all have limiting factors. Factors that contribute to a decrease in productivity and therefore decrease in meaning within a certain role. Thus, we can assume that a change in one of the aspects (person, occupation and environment) can contribute to more productivity and efficiency within the workplace. Each individual (person) has individual qualities, which can compromise a work project or enable it. We can also assume that the environment will have a direct impact on the person and the performance of activities at work.
When we look at the individual or a person, the person will comprise of a spiritual, social and cultural being. Furthermore we can include the affective (what the person will feel), the cognitive (what the person is thinking or whether he/she is concentrating) and the physical (doing). The spiritual component will involve what gives the person “pleasure” or “meaning” in life. Each person will also have a sensory system. The sensory system will include the proprioceptive system (system that receives messages through the joints and muscle tension), the vestibular system (in the ear, contributes to balance and equilibrium), the tactile system (feeling something, located on the skin), the interoceptive system (feeling of being hungry or having to go to the bathroom), visual system, olfactory system (smell and taste) and auditory system (hearing).
Each person has an unique sensory system. Some of us have a high tolerance for loud sounds and other have a very low tolerance for loud sounds. No two people have exactly the same sensory profiles (Dunn, 1999). According to Dunn (1999) a person can fall into one of four sensory categories: sensory avoidant, sensory sensitive, sensory seeking or low registration. You can complete a sensory profile to find out more about your sensory system here. This will assist you in understanding your sensory profile much better and incorporate this in your work environment.
Have you stopped to consider your work environment? Consider the smells, noises, feeling of your desk or the cushion that you are sitting on. What is the distance between you and the person next to you? Are they in “your space”? Are you feeling tired or cold maybe? How do you feel at the end of the day? I will like to explain how the sensory aspects of the environment at work can affect your productivity or positive work experience through the following example of a mechanical engineering department:
The mechanical engineering department at a university will be planned as follows:
1) The engineer trainees are all working from cubicles that are not separated from each other
2) All the trainees have a computer with a sound system
3) The level where the cubicles are situated is looking out over the workshop area
Now, let’s have a look at all the sensory experiences of the trainees in the environments mentioned above.
1) The trainees will be able to touch each other and look on the computer screen of the trainee next to them. They will be able to hear the person next to them talk and they will be able to hear the sounds and smell the odours from the cubicle next to them.
2) The trainee will use his visual system to look on his computer screen, will hear his own computer or even talk on the phone. The trainee will experience touch when touching his/her desk and feel the heat or cold of his/her body. The trainee will also taste certain tastes in his/her mouth or smell different body odours in the environment.
3) The sound of the workshop will be totally overwhelming. The smells from the tools and the materials that they use will be in the air. People will be working in close proximity to each other.
Keeping in mind that each individual has an unique sensory profile, imagine the impact that an environment like the engineering department will have on each individual. People that are sensory sensitive will have tremendous difficulty coping and in the long term it could also contribute to anxiety or even a mood disorder; not even to mention the effect that it will have on productivity. As mentioned, all people have different sensory systems. While someone might seek noise due to a high auditory threshold, someone else might be auditory sensitive and even avoid “normal” noise levels.
When a person that is sensory sensitive is exposed to noise, they can easily become overstimulated. Symptoms that they might experience could be headaches, nausea, dizziness, yawning, lower concentration levels or a “foggy” brain. When people experience these symptoms, they are not as productive as they should be. This also influences the productivity of the company that they are working for. Unfortunately, in today’s world, everything is about money and time. People are expected be more productive and they should be able to work fast and effectively. If the environment is adapted to be a more sensory “friendly” environment, people will be more productive and companies will benefit in the process.
On the other hand…have you ever wondered why people choose certain jobs? Have you ever noticed that jobs tend to attract people with certain personalities or even certain sensory profiles? A person with a sensitive vestibular system will prefer a sedentary job, but someone with a vestibular system that has a high threshold might prefer a job that includes movement, like a soccer coach or even a gym instructor. These decisions might be made on a subconscious level, based on the subconscious need that people have for certain sensory information. Sensory thresholds can also vary according to the time of day, whether you had a good night’s sleep or whether you are consuming medication or even illegal substances at the time.
As an occupational therapist, I find it difficult to treat patients during the afternoons. I have a sensory sensitive system and depending on the noise levels or the amount of touch that I have been exposed to during the morning, my fatigue levels will vary. This influences my frustration levels and my level of productivity during the afternoon. The positive side to the story is that I have learnt to cope through “quiet time” or “time-out”, as some people call it. When I get home, I take a luke warm bath and this inhibits the symptoms of over-stimulation or sensory overload and helps me to cope for the rest of the evening. This re-establishes my energy levels and decreases my level of frustration. If I did not have the insight to manage my sensory systems, the worst might happen…unneccesary conflict situations, unproductivity, anxiety and burn-out.
Sometimes people are not well-matched with their jobs or work environment, and then tend to be unhappy at work. This can be addressed by educating people about their sensory profiles and ways that they can adapt to cope better on a sensory level. An occupational therapist that is trained in the use of sensory integration can be consulted to adjust the environment. Sometimes it is only simple things that need adjustment and in most cases people need knowledge about sensory processing and the reason behind “not coping” or poor productivity.
All of us want to be as productive as possible and experience meaning and pleasure at work. We have different interests, personalities, physical attributes and SENSORY SYSTEMS. It is up to us to make our work experience as positive as we can. I will like to end off with the following anonymous quote:
“Don’t be busy, be productive, be sensory sensible”
Welcome back to all our readers and wishes for a prosperous and sensory-inspired 2020! In today’s blog post we hear from a bunch of hard-working therapists who are bringing sensory integration to children in the Cape in a whole different way during the December break.
Just a month ago, KWELA camp, the brainchild of Nita Lombard and Suzanne Olivier, celebrated its 20th camp in December 2019. The Kids With Energy Love Activity anagram rang true at camp, with 5 jam-packed days of activity. Robyn Turnbull, a Sensory Integration therapist at Sensory Kidzone and the KWELA camp coordinator for 2019 shares her experiences and thoughts with us.
KWELA camp is a unique specialized experience designed for children from 6 to 10 years. This 5-day intensive camp utilizes a Sensory Integrative approach, life skills, social emotional facilitation, observations for diagnostic purposes as well as training students and young therapists.
Daily life skills sessions introduced the lessons for the day, followed by craft sessions, perceptual motor and sensory integration sessions where the lessons from life skills were further instilled. These lessons encouraged our campers to practice turn taking, respecting others’ wishes and accepting that one might make mistakes – and that it is fine to make mistakes! Nothing teaches you to appreciate this lesson more than falling out of a spandex bridge onto piles of squishy mattresses. Mistakes can be fun too.
The theme and lessons from the movie Aladdin guided the planning for the life skills throughout the camp, with individualism being the key theme for the children to embrace. And did they embrace it! The concert evening held on the 2nd last day of camp is always a highlight for children and facilitators alike. With the hall set up like a theatre, the children performed a skit put together with their life skills group and were invited to perform individual acts as well. We were treated to singing, puppet shows, and even break-dancing. The courage of these children is enough to make the strongest of therapists emotional.
The 2019 camp welcomed the inclusion of hippotherapy. Patricia Hart travelled herself, two horses, games and tack all the way from Hout Bay to share the beauty of horses with us, and their therapeutic movement. The wordless, non-confrontational being of the horses brought a calmness to camp and instilled this calmness in the children who needed it.
The sensory integration session was a highlight for all children at camp. The opportunity to enter that room and climb on those swings got the children quite excited. At the new venue we had an even larger space in which to design and build the sensory integration lab – and nothing inspires a sensory integration therapist more than a large space and infinite suspension points! To date, the 2019 sensory integration lab was the biggest with the most individual pieces of equipment used in each session.
A new leaf of Kwela camp was turned as the decision to host the first optional-sleepover camp was taken, guided by the concerned parents’ “what if..”’s and “(s)he has never slept away from home.” Therapists were ecstatic at the response of children who changed their minds to join their peers in sleeping over at camp; considering that we had no television, cellphone or computer games on offer. The impressive nature of the children to seek out challenges for themselves, push their social boundaries and step up to independence was awe-inspiring.
Climbing the ‘KWELA mountain’ of planning, challenging oneself and growing was well worth it when parents gave feedback to state that their children: “can’ t stop talking about the activities from camp”, or “did not want to come home”, or said “they want to come again next year”. What better way to empower the children than through play!
Therapists and students also climbed their own KWELA mountains throughout the journey of receiving thorough training in the concept of a therapeutic community and specifically applying principles of occupational performance within a framework of Occupational Therapy.
We acknowledge and appreciate SAISI sponsorship in support of KWELA camp.
We thank the team of Taaibosch camp in Durbanville for their adaptability, and their willingness to meet the high expectations of the therapists.
We congratulate the parents who allowed their children to sleep over for the first time.
We applaud the therapists who gave 100% to the children despite their own struggles with change, limited hours of sleep, and year-end burnout.
I applaud the vision of the camp. And the people who drive its success.
Written by Robyn Turnbull – Kwela Camp Coordinator 2019. Please visit their website here.
Two weeks ago, Sally Fraser-Mackenzie shared some Tips for Trips to make our holiday journeys a little easier. Today Dana Katz shares some ideas for travelling with children who have sensory processing difficulties which make those trips a little more challenging. Enjoy the journey!
Some of my favourite memories centre around family holidays. Holidays are fantastic but getting to your destination can sometimes be quite an interesting, if not stressful and harrowing ordeal! Those of us with children know this only too well!
Travelling in a car or on a plane for hours on end can be extremely challenging for all of us. Not to mention tiring and perhaps even anxiety provoking for some. Maintaining a regulated, ‘calm-alert’ state is challenging when we have to sit still, have limited space and need to keep quiet. Our bodies need sensory input to stay calm and regulated. As adults we are generally able to override our sensory needs using top down strategies, such as cognition. We are able to tell ourselves to sit still for a while longer or not to kick the seat in front of us or not to shout out in frustration.
Alternatively, we are able to come up with other plans, that are acceptable to those around us, to get what we need to stay regulated. Children can’t do this as effectively without some help. It is far more challenging for them to use top down strategies to stay in control of their bodies. They need input through their sensory systems; touch, movement, vision, hearing and taste to help them to stay in a ‘just right’ state of arousal. If they do not get the input they need, they may become overloaded or dysregulated, and you might see some of the following behaviours:
Irritability, restlessness, avoidance behaviour (covering eyes or ears, hiding away), anxiety, increased sensitivity, distractibility, flight behaviours (running away), crying easily, before a full meltdown sets in. Try to be alert to changes in behaviour that might be signs that your child is becoming overloaded and intervene with regulating input before a meltdown occurs.
As an OT mom trained in Sensory Integration, I decided to tap into my SI basket of tricks, to try and keep my sensory seeking children happy and regulated on our long journeys.
Here are some of the ideas that have helped me:
Being prepared and preparing your children beforehand is super important. Using a visual schedule (especially for younger children or children prone to anxiety) to help them to understand timelines can be very valuable. You can plot the number of days before you leave with a picture of your destination at the end, plot the time on the journey, including rest stops when travelling by car, if you are flying: airport and aeroplane schedule from arrival at the airport, check in, meals to landing and collecting bags. The more they understand and are prepared for what is to come, the easier the journey will be.
Ensure that everyone (including Mom) has had a good night’s sleep before you leave. Being tired makes our nervous system more susceptible to sensory overload and resultant meltdowns.
Ensure that you have some regulating (sugar free) snacks, cold water and a few easy fidget toys in your bag at all times.
In the car:
- Plan regular stops at spots that have child friendly areas to run and play.
- Try to stop for meal breaks and not to eat meals in the car.
- Use sippy cups / water bottles that can’t spill and keep snack food to simple finger foods, not sticky, saucy snacks that can ooze and drip.
- Be aware of smells in the car – coffee, strong foods, these can also overload a sensitive system.
- Use weighted blankets / weighted teddies to help calm or help them to sleep longer.
- Block out overloading visual stimuli from the outside using a dark blanket / towel on the window (or some form of sun visor) so that the visual stimulus passing by doesn’t overload them.
- Be aware of the noises in the car – aircon, music, talking, radio etc…that might become irritating.
- Keep clothing soft and comfortable and unrestrictive. Try to eliminate zips, buttons and tight elastics.
- Have a box of fidgets available using your child’s sensory preferences or special toys that they enjoy; play dough on a lap tray, squeezy toys, filled balloons (helium quality) with; flour, rice, cous cous, little beads etc… and have mini textured stress balls to play with (or buy some)water and oil timers, mini lava lamps, snow globes / kaleidoscopes to look at etc…
- Mobiles / a balloon on a string attached to the back of the front seat can be fun.
- Blowing bubbles
- Books –
- Touch and feel books.
- Mellissa and Doug “Water Wow” books
- Dry wipe books
- White boards for drawing on
- Card picture books (not paper pages that can be torn by accident or in frustration)
- Spotting books
- Music and ‘dance’ – favourite music and nursery rhymes, a few musical instruments – shakers, castanets. Sing fun songs and do action songs together. NB: Don’t have music on the whole time, regular quiet time is very important.
- Provide regular snacks – chewy and crunchy are regulating, i.e. dried mango, savoury biscuits, rice cakes, fruit rolls, popcorn, biltong, favourite snacks (NB limit sugar intake).
- Suck activities: milk / tea / water bottles, drinking yoghurt through a straw, dummies, ‘Squishes’, to help keep them regulated.
- DVD’s / favourite cartoons / interactive Apps – for a short while or if you are desperate! Remember these are hard to take away once introduced.
- Audiobooks are always a winner!
- Blow Pens / “Sprayza Pens” (from Hamley’s) – to colour in pictures / shoot at targets on a page
- Scratch and sniff stickers
- Magnetic games
Ensure that all activities are easily accessible, so that you don’t have to dig around or struggle to get to them. Have a few plastic containers in the foot well filled with the things your child may need.
On the Aeroplane:
Prepare them before boarding
- Brushing and joint compression protocol
- Deep pressure massage / squashes
- Let him jump and run (up and down an incline would be best)
- Carry a heavy backpack / push the trolley etc…
- Board last
- Seat them last – let them move around for as long as possible
- Tie seatbelt quite tight
- Have a schedule of events from boarding to landing – try to find out from the airline and print visuals
- Can use ‘Rescue Pastilles’ to help with calming.
On the plane
You can use all the car ideas above on the aeroplane too. Here are some extra ‘aeroplane specific’ ideas!
- Ensure that they drink enough water.
- Have chewy sweets, gum to suck for take off / landing – if you have a baby, let them drink a bottle – to help equalize pressure in their ears.
- Have a few surprise treats packed that are new and novel, that can be used as incentives / reinforcers.
- Massage hands / feet to calm
- Squash him under a pillow or use a weighted blanket or weighted teddy
- Sit on a deflated beach ball / move ‘n sit cushion
- Bounce them on your lap while hugging tight
- Give regular (15 – 20min), varied calming sensory input while awake.
- Take him for short walks, play games, i.e. “Simon Says”, balancing on one foot, push ups, at the back of the plane / air hostess’s area …. find a spot that vibrates / shakes and let them sit there for a little while.
- Look out of windows etc…
- Plan a scavenger hunt and let him find things around the plane.
- Vibrating massagers (handheld) / toys / pens / toothbrush
I hope that some of these ideas will be helpful and will make travelling to your next holiday destination fun, happy and relatively stress free!
Dana is a mom to 2 sensory seeking kids and an SI OT with 20 years’ experience in paediatrics. She lives and works in Cape Town where she runs an inclusive preschool and an SI OT practice.
“The Show Must Go On” is a popular phrase we are all familiar with. The well-known hit song by Queen, “The show must go on”(1991) has a catchy melody, but when we listen closely to the lyrics, it is tainted with anguish and suffering.The phrase was first coined by a circus back in the late 1800’s. Although there is no record of which circus used it first, the phrase caught on and was used by other circuses. It was used by the ringmaster when there was an incident, such as an animal getting loose. It was an effort to keep patrons calm and reassured. “The show must go on“ was printed in the Evansville (IL) Daily Journal on September 12, 1866 and in The Morning Republican (Scranton, PA) on December 13, 1875. In the 1900’s, the term spread to all of show business as a catch phrase meaning keep the show going regardless of what interferes. The expression soon applied to any kind of “show,” even a political show. (Quora.com) “The show must go on” became a proverbial phrase widely used in quotes and in various contexts since the 1800’s, and is still current today in the 21st century.
My circus, my monkeys, my responsibility
I was assisting backstage at my 7-year old daughter’s ballet show, when I felt the reality of the cost for the “show to go on”. The cost in this context does not refer to the sacrifices in terms of time or money, but the sensory and emotional strain on children and their parents, the impact on relationships and family life, and even the way how (we think) other people perceive us, can influence our decisions and behaviour.
As I sat there watching the hungry, thirsty, tired, excited ballerinas, bouncing in the heat backstage with flashing lights and loud music, waiting for over two hours before it was their turn to go on, the penny dropped. It was a sensory disaster, and we chose to take part in this show. Proverbially speaking, this was my circus, and I was responsible for these little monkeys. Life can be a bit like a theater performance sometimes, and the things we have to handle and cope with “backstage” so that the “show can go on”, can be debilitating and exhausting. I had to ask myself, are all the hours of preparation and emotional turmoil really worth the few minutes on stage?
The sensory struggle is real
Weeks before the show the schedule was finalised, amidst the end-of-year rush, with extra rehearsals on Saturdays. In the week of the show building up to the weekend, there were two additional compulsory dress rehearsals at the theater in the city center. Then the highlight of the year’s hard work: three scheduled theater performances, one on Friday evening, and two on Saturday, with a photo shoot in between. This implied that the ballerinas had to be fully dressed in their costumes for all the performances, with perfect hair and make-up. As a mother, I felt frustrated as my daughter so desperately wanted to dress-up and take part in the show, but at the same time it was a complete sensory nightmare and our relationship was suffering. Routines and habits were disrupted, and we just survived from moment to moment with less than optimal sleep and food. At times I felt a bit helpless as I could see how everything escalated, but did not know how to do it differently. We were late for the 10h30 rehearsals as the tears, anticipation and resistance already started when she woke up at 6h00. I was not allowed to open the curtains, the elastic of the skirt was too tight, the leotard pinched her skin, the strings in the ballet shoes could not be tucked away properly, the soles of the shoes were too dirty, the tights were too itchy, the hair bun was too big/small, the colour of the elastic was not right, the hair clips were pokey, the hair products smelled bad, she wanted to do her own make-up as I was not doing it right, breakfast was not right, and she did not need the toilet (which implied undressing and dressing when we arrived at the rehearsals, already late). Needless to say, this was a challenging and exhausting time, and yet, regardless of the struggles, we managed to find a way to pitch for the rehearsals, even if it meant arriving a few minutes late without tights and a perfect hair bun. She persevered and learnt that if she wanted to take part in the show (which she insisted she did), she had to deal with the demands that go with it.
As I was sitting in the end-of the month, black Friday city-center traffic on the way to the first performance at the theater, the words of Dr Ayres dawned on me “when the flow of sensation is disorganised, life can be like a rush-hour traffic jam”.1,2 I felt relieved that there were words and an explanation for what we were experiencing and a weight lifted off my shoulders as I understood better, and knew there was something we could do to cope better. This is probably what was happening to some degree in the brain stem of every ballerina and parent: a complete sensory overload resulting in frustration and various survival mode behaviours.3 As an OT trained in sensory integration, it took a while for my brain to kick into gear as I (an adult and parent) was also trying to cope with my own sensory issues like the loud music, the heat, dealing with my daughter’s emotions, as well as my own, and making sure everything was packed and ready so she can show up, despite the traffic.
As with life, the show had to “go on”, despite all the difficulties and challenges. However, the one thing that could not be ignored, punished, bribed or avoided, was that the sensory issues and struggles were real. VERY REAL. And if they were not acknowledged and dealt with at the right time and in the right way, became worse and we got stuck in the proverbial sensory traffic jam, and ended up in tears and smudged make-up.
The difference with life is, even though we have a choice, some things are compulsory, like we have to eat, get dressed, get enough sleep, and hopefully enjoy the activities we choose to participate in. Some of those things we can control e.g. what we eat, what we we wear, what time we go to bed and what we choose to participate in. On the other hand, some things we have to handle as they come e.g. the unpredictable responses of others, unexpected changes in our plans, and the “volume and intensity” of life.
Keeping the context in mind
In life, the “show” can be anything from keeping it together at school during the day (especially assessments), or with friends at a birthday party, a school prize giving evening, year-end party, or simply just dealing with the sensory and praxis demands of simple every-day things.It also happened that my daughter’s class was being renovated two weeks before the holiday, and they had to be divided into the other classes with children they may or may not know. In hindsight, of course, I could recognise that all of the above happened to my daughter in the weeks before the show, contributing to the after-school and Saturday morning meltdowns.
Strategies for coping and conquering “backstage”
We all have different coping mechanisms, and should have compassion and empathy for everyone’s perspective and experience. We have to familiarise ourselves with the challenges that go with the rules and expectations of the show or game e.g. dress code, make-up, and try to identify “backstage” coping mechanisms that are crucial for keeping things together e.g. getting enough sleep, taking sensory breaks (time away or out of the situation), healthy snacks (chewy and crunchy), taking those itchy stockings off, and letting their hair down (literally and figuratively speaking) to allow for recovery time between the shows in order to go on. The insight and sensory strategies were not nice to haves, they were critical for our survival during a challenging event. We are so often not aware of the blood, sweat and tears behind the scenes for someone to just keep things together in ordinary everyday events. In the end, what matters is that we did not sacrifice our relationships for the sake of the “show to go on”, but that we supported and encouraged each other, and experienced joy and satisfaction in what we accomplished together, with a bit of help of friends and family.
For my daughter, the victory dance at the finale and the smile at the end when the curtains went down, was priceless. She did it, and she loved it, which made it all worthwhile. She did not only take part in the show with a smile on her face, she also endured all the backstage challenges and conquered many unseen backstage mountains that were not part of the show. That in itself, was a victory. We can learn from our children that it is not just about the show that “must go on”, it is about accomplishing something, despite the challenges, and feeling good about it afterwards.
December holidays and Christmas season
Everyone is looking forward to a much-needed break. Now it is our responsibility to find a balance between the things we do for fun so that we can also relax during the holidays, and not a need a holiday to recover from the holiday. We have to give ourselves permission to slow down, rest, ask for help and let our hair down when we need to. We have to implement strategies so everyone can be OK during the holidays and Christmas season such as anticipating meltdowns and be prepared, whether it is for a long drive, long rainy days, hot and windy days on the beach, noisy restaurants, dinner parties, or festivities at busy public places. We have to be sensitive to and have compassion for our children’s sensory needs, as well as our spouses’ and our own, especially in a time when our habits and routines are disrupted. Let’s respect each other’s experiences, that it is REAL to them, choose our activities and company so that we can be energised at the beginning of the new year, that the “show can go on” without too many sacrifices and that we can enjoy the time together. Happy holidays everyone!
- Ayres AJ. Sensory integration and learning disorders: Western Psychological Services; 1972.
- Ayres AJ, Robbins J. Sensory integration and the child: Understanding hidden sensory challenges: Western Psychological Services; 2005.
- Bear MF, Connors BW, Paradiso MA. Neuroscience : Exploring the brain. 3rd ed. ed. Philadelphia, PA :: Lippincott Williams & Wilkins; 2007.
Thank you to Stefanie Kruger for her beautiful metaphor shared in this post. Stefanie is an OT trained in Ayres Sensory Integration, SAISI Board Member and lecturer on the SASIC courses.
As we head into the holiday season, with many families planning their annual holiday, Sally Fraser-Mackenzie (OT, passionate road-tripper and mother of two busy boys) gives us some do’s and don’ts to prepare as we set out eagerly for our various destinations, so that we don’t arrive battered and bruised but ready for some real R&R.
General Principles of Travelling with small children:
- Plan petrol and loo stops carefully – fill up with petrol before the trip. Synchronize sleep time away from stops for food, loo, road work areas (road blocks and stop-and-go’s).
- Leave early – all family members are generally better in the morning, rather than the afternoon.
- Try and drive away from the sun – west in the morning and east in the afternoon.
- Stop for a long healthy, hearty breakfast. Preferably somewhere where there is a large area to run, trampolines, or a touch farm.
- Alternate which side of the car the child sits on if possible, so that the seat belt doesn’t keep pressing on the same side of their body for such a long time.
- Peg the seat belt higher up so it doesn’t squash their shoulder and irritate them.
- Line the car seat with a soft blanket, sheepskin, or pillow (those kids car seats can be really hard).
- Use some form of sun visors if necessary, even if just a towelling nappy in the window.
- Always have 2 or 3 towelling nappies available in the car. (Sun visors, plate to catch crumbs for Dad’s sandwiches, vomit cloth, soaking up toilet accident, wiping up yogurt, tug of war, cleaning the windscreen, wiping anxiety sweat from your brow!)
- At road blocks, if possible, get out, move, visit your neighbours… make friends…
- Monitor the children carefully. Change activity BEFORE they get irritated and “go over the edge”. Keep them regulated and settled. Do not, DO NOT let them get beyond themselves and unable to calm. (I speak from the bad kind of experience…)
- Approach the trip as an adventure, and something positive and exciting. Don’t let the kids get wind that you are terrified! (It does get better with age!)
What NOT to do:
- Activities with small parts (potential for: choking hazards; lost forever; jam up the air-vent/seat belt)
- Sticky juices (stick to water).
- Yogurt (gets everywhere)
- Sugary snacks (if your child responds badly to sugar).
- Sugary snacks (if you do regular long trips).
GOOD Activities to do:
- Having boxes or bags of various activities to pull out at different stages.
- Box of fiddles: bubblewrap, scooby wire, pipecleaners, elastic bands, Prestik.
- ZipLoc Bag (sealed with tape) or something stronger filled with rice and small objects (beads, plastic bugs, paperclips, matches, etc), then child must find the objects. Some children will tend to make holes and push small bits through and make wonderful mess.
- Balloons on sticks. Balloons off sticks. Balloons on a string.
- Squashy squeezy stress balls – Commercially available or you can stuff balloons with play dough, rice, seeds, maizena, flour, sand, cotton wool. Can put another balloon around the first for extra strength.
- Shop at Crazy Stores (Or Mr Price Home) before trip for bits and bobs – bringing out a novel toy may save the day. Keep a few surprises.
- Buy them a new small toy animal, vehicle, man to play make believe with, make a story with.
- Books – touchy feely ones are always good.
- Music – sing-a-long songs, action songs, bring out a few musical instruments – shakers, castinets. (Don’t have music on the whole time. Put it on in bursts, have it loud, enjoy it, then turn it off).
- Wrapping up all these kinds of things you would give them anyway (snack, toy, book), then when they have to find e.g. a windmill, then they can open one thing.
- Sticker books
- Snacks – popcorn, chewing gum, carrots, pickles, cucumber, dried mango, savoury biscuits, rice cakes, fruit rolls, liquorice, wine gums, jelly babies (try and keep sugary snacks as last resort).
- Thread an Otee/Cherrio necklace, then eat one by one.
- Magnetic drawing boards
- Blow activities: noiseless whistles, mouth organs
- Suck activities: long straw with a Yogisip
- Weighted blankets to help calm them, or help them sleep longer
- Attach a polystyrene bag on their laps as a work station so they have something to put their sticker book on.
- Simple games – “I spy” with colours
For the older ones:
- DVD’s (works particularly well for children who don’t have TV at home, like mine – as it is such a treat! – we did a 900km trip through the Karoo (7 movies) and they didn’t even ask when are we going to get there!)
- Ipods (especially if your kids are different ages, and have different needs)
- Audio books
- Verbal Games – I spy, find the next red car, etc.
- Magnetic board games – noughts and crosses
- Activity pads with wipe off markers
- Etch a Sketch
- Library books they haven’t seen before
- Where’s Wally, or puzzle books
- Sing-a-long Music (Queen played very loudly is a firm favourite in our car, and James Taylor!)
To Prevent car sickness and vomitting –
- Don’t let them scream so much they vomit. Stop the car. Get out, have a break, anywhere. It is worth it! (I know)
- Ginger helps – Ginger teas, ginger biscuits, candied ginger.
- Ice blocks held in the palm of the hand or rubbed on soles of the feet.
- Suck an ice block (don’t choke on it).
- Heavy pressure to the head – Joint compressions through the neck.
- Let the child sit on a booster seat in front to watch the road. Or in the middle at the back.
- Choose your activities so child is not looking down.
- Play lots of “I spy” and talking about the environment, and listen to music.
- Sea bands – available from pharmacies.
And lastly – if these don’t work – maybe consider a staycation 🙂
With thanks to Jenni Saunders, Kate Bailey, Michelle Luyt, Ray-Anne Cook and Janet Michaelides – some creative and inspirational mothers and therapists!
Friends and readers, parents and therapists, we’re almost there. You’ve almost made it through the chaos of end-of-year functions and concerts, shows of all of the extra-mural activities, exams for the older ones and big stage debuts for your babies. Relaxation is knocking on the door. Yet we are aware that for some parents with children with different sensory needs, a long holiday with lots of festivities can lie like a dormant volcanic mountain in front of you. How can we increase the chance of family fun? How can we make sure that’s something fun for all our kiddies – the seekers and the sensitive ones in the family?
Holidays, and especially summer Christmas holidays find us in a range of locations.. from the beach, to busy mall and even long days at home. Below are some ideas of how you can use the wealth of sensory invitations available to you during this time.
If you’re luck enough to find yourself at the beach:
- For some heavy work, let the child dig the deepest hole he can. Then bury him and let him try and get himself out.
- Lie on your back in the sand and make sand angels by making sweeping movements with your arms and legs.
- Pull the child across the sand while he sits or lies on a body board. Let the children take turns pulling each other.
- Hide treasures in the sand for her to find.
- Do handstands, somersaults on the sand.
- Play Frisbee or beach cricket.
2. The Garden
- Hang from the branches. Try and swing from one branch to another.
- Try and hang upside down.
- Make a swing from an old tyre, rope or plank and hang it from a tree. Try and make yourself go by bending and straightening your legs.
- Hang under a branch, holding on with arms and legs like a monkey.
- Make a trapeze out of an old broom handle. Swing from the tree and jump onto the grass.
- Practice wheelbarrow walking with brothers and sisters. Have a race when you’re getting good!
- Make a wobbly balance beam by placing a long plank over a log. Try and walk from one end to the other.
- Tie a rope with knots from the tree and let your child practice climbing up into the tree.
- Make an obstacle course using any garden objects e.g. logs, tyres, play equipment.
- Swim, swim, swim
3. Shopping malls
Shopping centres are loud and busy places, especially at Christmas time. This can be a daunting time for the children and their parents. If you are prepared and understand your child’s needs, meltdowns can be avoided.
- Limit the length of shopping trips. Big shopping centres are filled with various visual, auditory and movement experiences, and your child can very quickly become over-stimulated. Rather take shorter trips to smaller, outdoor centres.
- Plan regular breaks. Bathroom breaks and something to eat.
- Choose restaurants with play areas such as Spur / Papacinos. Let your child climb on the equipment and jump on the trampoline.
- When at a restaurant, choose something calming like a double thick milkshake for your child to suck through a straw.
- Make games while shopping, such as spotting the first letter of your child’s name in the shop names. Spot colours or shapes if your child is younger.
- Give your child a piggy back ride when they are tired of walking or riding backwards in the trolley. Let your child sit in the front of the trolley facing forwards.
- Opt for smaller / outdoor centres rather than the big ones!
- Involve your child in choosing the presents for others, paying etc
4. A Rainy day at home
With the drought of the last few years we are so grateful for any rain, and sometimes it feels like just watching a storm is enough of a sensory experience that the kids aren’t used to. Jumping in puddles can be so much fun, and they probably won’t even get cold. Have a lovely warm bath ready for when they’ve had enough. If your child doesn’t like the squishy mud, get a pair of rain boots so that they can still take part in the fun.
Crafts are also a lovely way to keep little hands busy. There are so many ideas on mommy blogs and Pinterest so choose to your hearts content and according to the little ones’ skills.
- Make Christmas decorations that allow simple cutting practice. Use the green samples for paint colours from your local hardware store to cut out triangles for Christmas trees.
- Thread red and white beads onto pipe cleaners, then bend into the shape of a candy cane.
- Trace shapes for decorations against the wall.
- Make a “pomander” by sticking cloves into an orange and looping a ribbon through to hang in your wardrobe.
- Use finger paints and thumb prints to make a reindeer, Santa’s hat, snow flakes and a tree to use on cards for the family.
- Make decorations for the tree with salt dough, baking it to dry once you have finished creating them, Paint as desired.
- Make an interesting Christmas card by poking holes along the line of a colouring picture and threading red and green cotton through the holes.
- Place paper in a shallow cardboard box. Dip marbles in paint and tip the box in different directions to make marble trails. Use as wrapping paper.
- Practice tying bows on presents.
Movement songs: Try these with the kids!
(Tune: Hokey Pokey)
You put your antlers in.
You put your antlers out.
You put your antlers in,
and you shake them all about.
You do the reindeer pokey
and you turn yourself around.
That’s what it’s all about!
We Wish You a Merry Christmas
We wish you a Merry Christmas (Sign Language for Merry Christmas – see below),
We wish you a Merry Christmas (Sign Language for Merry Christmas),
We wish you a Merry Christmas (Sign Language for Merry Christmas),
And a Happy New Year.
Now let’s all do a little clapping (clap),
Now let’s all do a little clapping(clap),
Now let’s all do a little clapping (clap),
And spread Christmas cheer (raise arms and make sprinkling action with fingers)
Now let’s all do a little jumping (jump),
Now let’s all do a little jumping(jump),
Now let’s all do a little jumping (jump)
And spread Christmas cheer (raise arms and make sprinkling action with fingers)
Now let’s all do a little waving (wave),
Now let’s all do a little waving(wave),
Now let’s all do a little waving(wave),
And spread Christmas cheer (raise arms and make sprinkling action with fingers)
Sign language for Merry Christmas can be found here.
- Rough-housing, rough and tumble play.
- Make an oversized noughts and crosses board on the floor.
- Make a crash pad of cushions and pillows.
- Create a hideaway tent out of towels and sheets as a secret and quiet place for an over-stimulated child. Have a password for adults who want to enter.
- Hide objects in a pillow case and have your child identify them.
- Lay a rope on the floor. Walk on the rope, cross feet over, jump over the rope etc
- Play “flashlight tag” by lying in the dark and chasing each others’ “torch dots” on the ceiling.
- Play broken telephone. Sit in a circle and whisper a message in the first person’s ear. Pass the message around the circle and see if the last person can repeat it correctly.
- Start your own band. Fill 7 glasses with different amounts of water and add a little food colouring. Play your own music with a teaspoon.
- Put on old lipstick and “kiss” the mirror. Use a koki to make butterflies and other insects from the patterns.
- Jump on old bubble wrap from presents and see who can make the loudest noise. The bigger the bubbles the better. Else cut thin strips of bubble wrap and see who can pop all their bubbles first.
- Go ice-skating.
- Plant a seed and watch it grow. Give the child the responsibility of watering the plant at a certain time every day.
- Make pizzas with ready-made bread dough and let the children knead the dough.
5. Christmas food
Make Christmas cookies with a variety of cookie cutters. Try to remember the steps of the recipe. Let the child roll the dough with a rolling pin.
The following recipe may be helpful:
225 g flour
½ tsp baking powder
100 g margarine
40 g icing sugar
2 egg yolks
1 tsp vanilla essence
Mix dry ingredients. Add margarine and rub it in with your fingertips. Stir in icing sugar. Stir in egg yolks and vanilla. Roll out dough and cut out shapes. Bake for 15 min at 180 ̊. Decorate as desired.
Happy holidays everyone! Please let us know which activities your little ones liked best!
[This article was written by Karen Powell. Karen is a member of SAISI Board and has a private practice for assisting babies and toddlers in Pretoria East].
Just a few weeks ago Hong Kong hosted ISIC 2019 and today Ray-Anne Cook shares her wonderful experience with us. Ray Anne is so well known in local and international SI circles for her passion and enthusiasm for all she does. She is a long-standing and senior member of the SAISI Board since 1991, the international liason for SAISI at congresses along with Annamarie van Jaarsveld, runs a private practice in Durbanville, and I am sure you will feel her passion for the subject in her writing.
South Africa hosted the first International Sensory Integration Congress in 2018, so with much anticipation we awaited the next ISIC congress in Hong Kong to meet our colleagues/friends again.
Our excitement was dampened with news of the riots in Hong Kong but nothing was going to stop me having the privilege of being part of this international ASI® community. The excitement grew as colleagues posted they had landed in Hong Kong, and as we walked into the lobby of the hotel we saw and greeted one another like long lost friends eager to catch up on the latest news.
The theme of the congress was “An International Journey of Innovation, Identification and Intervention in ASI®”.
Innovation has the wisdom and theory from Ayres Sensory Integration® supporting “play” to enhance participation and health for all children. Dr Anita Bundy expanded further in her keynote presentation on “The art of sensory integration “, that therapy is more than just a science.
Identification included the recent research and advancement to promote a comprehensive evaluation and early identification of children with SI dysfunction and Zoe Mailloux updated us on the EASI test.
Intervention in ASI® includes research on intervention adhering to the ASI Fidelity Measure. Prof Shelley Lane took us further on this topic in her keynote presentation of where ASI® is in the current conversations about sensory integration.
Over 20 countries were represented with about 200 participants, expanding and sharing about ASI® in other countries, both successes and challenges.
When there were South Africans speaking I got even more excited. My chest was bursting with pride when Dr Annamarie van Jaarsveld, Gina Rencken and Shanna Louwrens presented their papers. Go South Africa!
ISIC Hong Kong was a sensory experience of note and being a sensory seeker, I was in my element, volunteering for an experiment in Stephan Chan’s presentation on the application of real-time electro-dermal activities in sensory integration assessment. The Gala Dinner continued this experience with the food being a visual feast with amongst others the fried chicken head, and the tactile and olfactory senses with the flavours, textures and tastes of all the ethnic cuisine from Hong Kong.
To end the sensational evening: having to describe to everyone my auditory experience of listening to Sensofoam in a shooter glass! Wow! Each ear heard a different sound!.
And the riots? Hong Kong was so organized with regular updates of where the riots were. Typical – my husband and I walked into the rioters late one night whilst trying to find our way home in this huge concrete jungle and the rioters politely let us pass!!
ISIC Hong Kong 2019 was an experience and to end it we did our sightseeing with Annamarie and her husband: the light show, cable car trips etc – memories to treasure.
Are you joining us in the next ISIC 2020 California to celebrate Ayres 100th Birthday?
South African therapists are so glad to be given a chance to be part of the International Normative Data Collection (INDC) for the Evaluation of Ayres’ Sensory Integration (EASI)- a test that will eventually replace the Sensory Integration and Praxis Tests (SIPT) which are currently the gold standard for evaluating sensory integration dysfunction. However, collecting data and establishing norms and diagnostic patterns from children across the world is no mean feat and has its challenges, as Sally Fraser-Mackenzie shares with us in this week’s humourous and frank account of her experiences. Sally we salute you for your perseverance!
The online training for learning the new Evaluation of Ayres Sensory Integration (EASI), soon to hit South Africa was excellent, what a breeze! And so interesting in terms of what they have kept and thrown out from the SIPT. It was lovely to see our old clinical observations integrated into it all as well. So here goes with the South African Normative Data Collection! And that is about where the wheels started coming off, and massive challenges meeting us.
As Normative Data Collectors, it is amazing to feel part of 72 country wide collecting this information. It really gives you a feel of the complexities of how the norms for any tests are gathered. So testing five children didn’t seem like such a gargantuan task. As my Afrikaans isn’t very good, certainly not good enough to dive in and test 5 Afrikaans children with a new test I wasn’t very familiar with, I got allocated English children, and in doing so, a school nearby, one where my child is attending. A big government school with 35 kids per class, 2 English streams per grade, which makes 70 English children per grade. Then I got allocated my Male/Female; Black/White/Indian/Coloured; 6yr/7yr/8yr case requirements. How hard can it be to find ONE 7 year old BLACK GIRL who is (1) willing, (2) seems neurotypical, (3) who has neurotypical siblings, (4) whose parents can manage the fairly dense information package and (5) whose parents give permission. It turned out to be a 1/70 experience!!! Yes, I could find ONLY one per grade – just enough in each grade to limp through. How was this possible? As I discovered, the questionnaires were just too much for some parents and disappeared into the ether, despite much following up through the poor harassed teachers (by me). Some parents refused without reason – a bit of a blow, but fair enough. One teacher assured me that the chosen boy was White, but when I looked at the form, the very white blond mother had written Indian in the block, as the father is Indian. The teacher did not want to tell the boy I now couldn’t test him, especially based on race (she had already got him all excited about being tested!) and asked me nicely if I wouldn’t mind just testing him and then not entering the data (just a few hours of my time for political correctness….!!), I promised I would give him a gift to apologise and no, I was unable to do it.
Then there was the case of the teachers promising me that there is lots of space to test, but when I arrived, there was no space. You have to book the space, and even then, the “space” was a small store room with a large table and no chairs. So the initial two assessments I did, were in a corridor which was sporadically busy with classes walking through, and kids coming and having a fascinated look.
The following week, the next two were in the storeroom. At least it was quiet, but juggling all that EASI stuff and equipment was a challenge. One child was a quarter of the way through and mentioned he had done similar stuff with his OT – stop right there! Oops, teacher knew nothing about it, but it was in fact ticked by the parent and I hadn’t checked the form in that much detail. It had been years ago. Find a new kid for next week!
The final child was found by pressurising the teacher until she was sick of me, and I had no option at this time of the year, there were no male black 6yr olds in the 70 Gr 1’s who didn’t have learning issues, so I had to look at Gr R just before they turned 7. The teacher’s assistant was on maternity leave and her son was in that class. After 3 weeks of pestering, the permission form was returned so I had the go ahead.
Being fortunate to now have an entire classroom at the preschool, I arrived an hour early and set up the whole EASI, as different stations around the room. I knew that the test itself would take much less time if it was like this, and easier for the child and myself. Then I waited. The class begins at 8. The child wasn’t there….. At 8:10, the mother sent the teacher a message to say “There was a tyre accident”. Assuming that meant some sort of traffic accident, I offered without hesitation, to go and fetch the child from the townships. Luckily for me in Knysna, the townships are not that far away. I phoned the mother and she couldn’t explain directions to me, but apologised as she’d forgotten I was coming today and said “no it wasn’t a traffic accident”, but that he didn’t want to come to school. Confused but determined, I tenaciously headed into the townships to track this boy down! I drove around for some time, phoning her regularly to discuss various landmarks, water towers, churches, and asking other people I came across to speak to her and discuss where she was, which was the most successful strategy. I found them eventually, the boy was well, and it turned out that the previous day at aftercare, he had been playing on the tyres (hence tyre accident) and a boy had kicked him in his private parts, and he hadn’t felt like coming to school. So, we drove back to school, and I conducted my 5th and final EASI successfully and smoothly.
Supplying gifts to all the children and all 5 teachers (since they were all different) was a necessary part of the process, and although very time and cost ineffective for me, it was well worth it! I’ve felt part of a bigger process and will understand and feel invested in the EASI assessment knowing that those 5 children made up the norms we will use for decades to come.
[Sally Fraser-Mackenzie has been serving on SAISI’s board for many years. She runs a private practice in Knysna, Western Cape.]