Occupational Therapy Mindfulness Strategies © copyright 2016 by John Pagano, Ph.D., OTR/L P. 1

John Pagano, Ph.D., OTR/Lwww.fabstrategies.org

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Best Clinical Resources P. 2

•  Brown, R. P. & Gerbarg, P. L. (2012). The healing power of breath. Boston, MA: Shambhala. www.breath-body-mind.com

•  Caldwell, B., Albert, C., Azeem, M. W., Beck, S., Cocoros, D., Cocoros, T., Montes, R., Reddy, B. (2014). Successful seclusion and restraint prevention efforts in child and adolescent programs. Journal of Adolescent Nursing and Mental Health Services, 52(11), 30-38.

•  Field, T. Touch Research Institute <www6.miami.edu/touch-research>•  Flook, L., Smalley, S., Kitil, M., Galla, B., Kaiser-Greenland, S., Locke, J., Ishijima, E., Kasari, C. (2010). Effects of

mindful awareness practices on executive functions in elementary school children. Journal of Applied School Psychology, 26(1), 70-95.

•  Frank, J. L., Bose, B., & Schrobenhauser-Clonan, A. (2014). Effectiveness of a school-based yoga program on adolescent mental health, stress coping strategies, and attitudes toward violence: Findings from a high-risk sample. Journal of Applied School Psychology, 30, 29-49.

•  Greenland, S.K. (2010). The Mindful Child. New York, NY: Free Press. <http://susankaisergreenland.com>. •  Kazdin, A.E. (2008). The Kazdin Method for parenting the defiant child. NY, NY: Mariner Books.•  Koester, C. (2012) Movement Based Learning. Braingym for special education.

<www.movementbasedlearning.com> •  Laugeson, E. A. (2014). The PEERS curriculum. www.semel.ucla.edu/peers •  Schaaf, R. C. & Mailloux, Z. (2015). Clinician's guide for implementing Ayres Sensory Integration: promoting

participation for children with autism. Bethesda, MD: AOTA Press.•  Schaaf, R. C., Benevides, T., Mailloux, Z., Faller, P., Hunt, J., van Hooydonk, E., … & Sendecki, J. (2014). An

intervention for sensory difficulties in children with Autism: A randomized trial. Journal of autism and developmental disorders, 44(7), 1493-1506.

•  Silva et al. (2009). QST program Sensory Massage.<www.qsti.org>•  Singh, N. N., Lancioni, G. E., Singh, A. D., Winton, A. S., Singh, A. N., & Singh, J. (2011). Adolescents with

Asperger syndrome can use a mindfulness-based strategy to control their aggressive behavior. Research in Autism Spectrum Disorders, 5(3), 1103-1109.

•  Thomas, M. (2012). The effect of different movement exercises on motor abilities. Advances in Physical Education, 2(4), 172-178.

•  Uhrich, T. A., & Swalm, R. L. (2007). Pilot study of a possible effect from a motor task on reading. Perceptual and Motor Skills, 104, 1035-1041.

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Mindfulness Research © Copyright 2016 by John Pagano, Ph.D., OTR/L

  Basic mindfulness activities improved executive functioning in elementary school students, with the greatest improvement seen in children with the initially worst attention and self-control difficulties (Flook et al., 2010)

  Mindfulness intervention with adolescents who had conduct disorder significantly reduced their anxiety, depression (Biegel et al., 2009) aggression, antisocial (Diamond & Lee, 2011; Singh et al., 2007) and self-injurious behaviors (Miller et al., 2007).

  Pediatric PTSD interventions that improved self-regulation included exercise, mindfulness, sensory enhanced yoga, and massage (Perry, 2009; Stoller et al., 2012)

  Yoga and meditation improved behavior in students with special needs (Koenig et al., 2012).

  Focus on feet significantly improved behavior in adolescents with Prader-Willi Syndrome (Singh et al., 2008) and aggression in conduct disorder (Singh et al., 2007)

ZIP, TOUCH, NOSE BREATHE & BIRD P. 4© Copyright 2013 by John Pagano, Ph.D., OTR/L

SITTING UPRIGHT IN SEAT DO 3 REPETITIONS★ Zip FRONT & BACK OF, NOT TOUCHING BODYZIPPING YOUR TRUNK UPRIGHT AND YOUR LIPS★ SIGN LANGUAGE CHEER DO SIGN LANGUAGE CHEER★ BOTH HANDS TOUCH HEAD, SHOULDERS, STOMACH (OR

SUBSTITUTE) ★ NOSE BREATHE: TAKE 3 DEEP BREATHS IN STOMACH GOES OUT, FINGERS OPEN WIDE, OUT STOMACH GOES IN FIST THUMB, DOUBLY SLOW BREATH★ BIRD-TAKE 3 DEEP BREATHSWINGS UP BREATHE IN WINGS DOWN BREATHE OUT

MINDFUL CLOCK SITTING/STANDING, BODY AWARE P. 5© Copyright 2015 by John Pagano, Ph.D., OTR/L (Greenland, 2010; Koester, 2012)

★ MINDFUL CLOCK SITTINGTIC SWAY FORWARD TOC SWAY BACK LIKE A SWAY FORWARD CLOCK SWAY BACK ‘TILL WE SWAY FORWARD FIND OUR SWAY BACK CENTER MOVE CENTERTIC SWAY LEFT do a righting reaction (head and trunk flex uphill)TOC SWAY RIGHT do a righting reaction (head and trunk flex uphill)LIKE A (Sway Left) do a righting reaction (head and trunk flex uphill)CLOCK (Sway Right) do a righting reaction (head and trunk flex uphill)‘Till WE (Sway Left) do a righting reaction (head and trunk flex uphill)FIND OUR (Sway Right) do a righting reaction (head and trunk flex uphill)CENTER (Move Center)★ MINDFUL CLOCK STANDINGTIC SWAY FORWARD TOC SWAY BACK LIKE A SWAY FORWARD CLOCK SWAY BACK‘TIL WE SWAY FORWARD FIND OUR SWAY BACK CENTER MOVE CENTERTIC-SQUAT DOWNTOC-STAND ON TOESLIKE A-SQUAT DOWNCLOCK-STAND ON TOES‘Till WE-SQUAT DOWNFIND OUR-STAND ON TOESCENTER MOVE CENTER★  SENSORY: Front-Back-Top-Bottom-

TENSE & RELAX, CIRCLES, FEEL FEET P. 6© Copyright 2013 by John Pagano, Ph.D., OTR/L

★ TENSE & RELAX MUSCLES TENSE AFTER I SAY 1-2-3-GO IMMEDIATE RELAX TENSE PRUNE & GRAPEFRUIT DRINK FACE (3 X) ELEVATE BOTH SHOULDERS (3 X) MAKE FISTS TO SQUEEZE ORANGES INTO JUICE (3 X)

★ CIRCLES Neck, Shoulders, Hips-Circle then Infinity

★ FOCUS BOTTOM OF THE FEET /PALMS after press together (Singh et al., 2011)

Addendum www.fabstrategies.org © Copyright 2013 by John Pagano, Ph.D., OTR/L

•  Body scan-Gold bird, white light calms and energizes Like Focus on the bottom of feet/palms a body-based meditation practice

•  KINDNESS-Love, Met, Self; happy, healthy, at peace Metta Loving-Kindness Meditation adaptation

•  FREE CONNECTICUT CLASSES •  Centering Prayer www.co-ct.org/prayer-groups.html •  Buddhist Insight Meditation https://newhaveninsight.org/ •  Jon Kabat-Zinn Mindfulness Based Stress Reduction Clinic https://www.umassmed.edu/cfm

FLEX & EXTEND SHOULDER & ANKLE P. 7 & 4-4-6-2 Breathing

© Copyright 2015 by John Pagano, Ph.D., OTR/L !

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• Flex & Extend Shoulder & Ankle: Same side: Right shoulder-ankle simultaneously

Opposite-Right shoulder left ankle simultaneously Same half-Right shoulder, left ankle, and left shoulder half way up and down, by joining right shoulder • 4-4-6-2 Breathing: 4 seconds BREATHS IN 4 seconds HOLD BREATH 6 seconds BREATHE OUT 2 seconds HOLD BREATH (Brown & Gerbarg, 2012) !

Mindfulness & Coping Strategies P. 8 © copyright 2017 by John Pagano, Ph.D., OTR/L

•  Mindfulness is paying attention to what you are currently doing, which is important for all functional occupations and new learning. It can also be a valuable daily or crisis coping strategy.

In OT think about client preferences and developmental levels to choose among mindfulness options: •  Weight lifting, Isometrics, Cardio exercise •  Crafts & Fine Motor Hobbies •  Movement/Dance/Stretching •  Yoga, Brain Gym, Bal-A-Vis-X •  Progressive Relaxation •  Mindfulness/Meditation •  Self-Massage, Therapyball, Sensory Activities •  Massage

SENSORY DISCRIMINATION DISORDERS !© Copyright 2016 by John Pagano, Ph.D., OTR/L!

1. Sensory Discrimination Disorders-difficulty distinguishing, interpreting, and organizing sensory information for functional use, contributing to disorganization and school difficulties. Sensory Discrimination Disorders can be for tactile, proprioceptive, vestibular and interoception sensory input e.g., hunger (Miller & Collins, 2012; Miller et al., 2007; Watling et al., 2011)

Tx-Light touch, deep pressure touch, Awareness of front-back, top-bottom of body through movement, obstacle courses, touch. Core input.

BACK X & SPINE CRAWL P. 10 X MARKS THE SPOT X on entire back

WITH A DOT DOT DOT 3 dots with your fist

AND A LINE LINE LINE 3 horizontal lines

AND A QUESTION MARK ? on entire back

“CRACK AN EGG ON YOUR HEAD fist egg

LET THE YOKE RUN DOWN” finger yoke (2 X)

CREEPY CRAWLIES UP YOUR SPINE

spine crawl with knuckles both sides spine

CREEPY CRAWLIES DOWN

palms down both sides spine

SENSORY BASED MOTOR DISORDERS !© Copyright 2013 by John Pagano, Ph.D., OTR/L!

2. Sensory Based Motor Disorders A. Dyspraxia-sensory integration difficulties resulting in problems planning and doing non-habitual skilled motor tasks (Schaaf & Mailloux, 2015). More common in PDD, predicting difficulties in social, imitation (Dzuik et al., 2007), sensory processing, language, & behavior skills (Lane et al., 2010). Sig greater SI and praxis problems in Sx (Chan et al., 2009) and Child neglect (Bauer et al., 2009). Praxis:

a.  Ideation-Know what want to do

b.  Motor Planning-Steps/sequence

c.  Execution-Act B. Postural Disorders- Dynamic balance difficulties (seen in sensory motor “soft signs”)

HOT CROSS BUNS ACTIVITY P. 12 !(Meta-cognition: Sensory Discrimination, Sensory Based Motor) !

BODILY-KINESTHETIC, INTERPERSONAL, AUDITORY, VISUAL & MUSICAL INTELLIGENCE!© Copyright 2014 by John Pagano, Ph.D., OTR/L!

!•  HOT (HIGH NOTE HIGH FIVE)

•  CROSS (LOW NOTE LOW FIVE)

•  BUNS (MEDIUM, HORIZONTAL FIST)

•  ONE A PENNY TWO A PENNY

(NO RESPONSE)

•  HOT (HIGH NOTE HIGH FIVE)

•  CROSS (LOW NOTE LOW FIVE)

•  BUNS (MEDIUM, HORIZONTAL FIST)

3.  Sensory Modulation Disorders-Difficulty regulating sensory retion to respond to take in functionally important environmental information and screen out functionally irrelevant input. 2-5 year olds with PDD had significantly greater hyper-reactivity, hypo-reactivity, and self-regulation difficulties (Ben-Sasson et al., 2007; Silva & Schalock, 2011). Assessed by Sensory Processing Measure: Preschool (2-5 yrs.), Home or Classroom (5-12 years) or Sensory Profile.

a. Sensory Overresponsivity- Sensory Sensitive/Hyper-reactivity) react more to sensory. More than half of youth with Autism Spectrum Disorders showed auditory and tactile overresponsivity related to decreased amygdala & sensory cortex habituation(Green et al., 2015)b. Sensory Underresponsivity- (Low Registration/Hypo-reactivity) do not notice sensory input, habituate quicklyc. Sensory Seeking- actively seek out sensory inputd. Sensory Avoiding- actively avoid sensory input(Watling et al., 2011; Schaaf & Mailloux, 2015)

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