The following is an excerpt from Sensory Diet Concept for use with Individuals with Smith-Magenis Syndrome (SMS) and Use of the Sensory Diet Template, by Tracy Murnan Stackhouse (speaker for Session D: The Power of the Sensory Diet Concept). The article in its entirety can be found here.

What Is a Sensory Diet?

A sensory diet is a treatment strategy used within the framework of occupational therapy to address two particular problems: sensory defensiveness and difficulties maintaining appropriate states of arousal. Sensory defensiveness is the tendency to respond in a negative or avoidant manner to sensory input; even normal sensations such as the feeling of clothing on the skin, water at bathtime or lights in a gymnasium can be sources of negative overstimulation. When this presents in a pattern of over-responsivity coupled with behavioral response of avoidance or agitation, it is called sensory defensiveness.

Arousal difficulties refer to the tendency of a person’s nervous system to maintain an optimum level of activation for the context/task at hand; if it is time to sleep, optimal arousal is low to match the sleep state.  Alternatively, if the task is a college lecture, then arousal should be alert and focused without a lot of body activity, in contrast to the alert, focused and active body used during a sporting activity. Because individuals with SMS often struggle with meeting their sensory needs and with poor arousal modulation, the sensory diet approach is ideally suited to address these particular needs.

The concept of the sensory diet was originated by Patricia Wilbarger, MA, OTR. It is an occupational therapy intervention strategy which consists of a carefully planned program of specific sensory-motor activities that is scheduled according to each child's individual needs (Wilbarger & Wilbarger, 2002). It also takes into consideration each family’s schedule, preferences, and resources.

A sensory diet can help maintain an age-appropriate level of attention for optimal function as well as be used to reduce sensory defensiveness. Like a diet designed to meet an individual's nutritional needs, a sensory diet consists of specific elements designed to meet the child's sensory integration needs. The sensory diet is based on the notion that controlled sensory input can affect one's functional abilities. Martin (1991) states in Principles of Neuroscience:

 “Sensory systems are not only our means for perceiving the external world, but are also essential to maintaining arousal, forming our body image and regulating movement.” 

A Sensory Diet can be used in 2 primary ways:

–  To Decrease/Treat Sensory Defensiveness

–  To Maintain an Optimal State of Arousal across Time

The OT devising the sensory diet should be certain to focus or parse the focus of the sensory diet to meet the individual goals. 

Wilbarger & Wilbarger's (2000) comprehensive approach to treating sensory defensiveness includes education and awareness, a sensory diet, and other professional treatment techniques. One such technique is called either the “Wilbarger Protocol” or “Therapressure” technique, which uses deep pressure to certain parts of the body, followed a series of joint compressions that provide the sensory input of proprioception. Proprioception refers to sensory input that activates muscle and joint receptors, providing information to the brain about those muscles and joints (what are they doing, how are they moving). Most important from an arousal standpoint, proprioceptive input releases chemicals in the brain that foster organized modulation or arousal functions.

The Wilbargers also suggest a specific protocol, called the Wilbarger Oral Tactile Technique, which addresses oral sensory defensiveness. Oral sensory defensiveness manifests in aversive, negative responses to oral sensations and is usually seen in feeding and speech-related behavioral concerns. Either Therapressure or the Oral Tactile Technique are used in combination with an overall sensory diet. The sensory diet provides the structure which coordinates sensory motor activity into the life routine of the individual for whom it is designed. It is critical that these protocols not be used in isolation and that the overall program be initiated and monitored by an appropriately trained occupational therapist.

A sensory diet is best designed by the family and therapist together. The therapist utilizes direct treatment time to learn the individual child’s “formula” for attaining and maintaining appropriate sensory reactivity and arousal modulation. The therapist takes this information, and together with what she or he knows about the family’s schedule and resources, designs a schedule of sensory supports that comprises the sensory diet.

Note: The complete article includes such topics as:

Creating Powerful and Precise Sensory Diets

• Typical elements of a sensory diet
• Sensory diet activities
• Individualizing a sensory diet
• How to structure a sensory diet
• Suggested routines for SMS
• Sensory diet data sheets and templates

Imagine how you feel when you shop in a hot, loud, over-crowded, not so nice smelling mall, while wearing an itchy wool coat at the end of preparing for and hosting a busy holiday party. That is how day to day activities for some children with sensory processing disorder feel. So when they are exposed to the same stimuli that would overload just about anyone, the effects are compounded. This can be lead to ‘sensory overload.’ It is no wonder that temper tantrums, emotional outbursts, difficulty with self calming, destructibility, and an inability to stand in lines are common scenes with many children at malls.

When the question is asked, is it sensory or is it behavior? Reframe the question by asking are there sensory issues driving the behavior? However, use caution, because some behaviors may be learned as a way to avoid or get something, or communicate wants and needs. It is important to learn how to be proactive when offering calming strategies (e.g. giving bear hugs when when your child begins to look disregulated) as opposed to reinforcing negative behavior (e.g. offering a bear hug after he or she hits you).

Keep these strategies in mind when shopping this holiday season, but use them only as tolerated by your child:

1. Find spots in the mall where you and your child can regroup (e.g. quiet hallways without a lot of decorations).
2. Incorporate some deep pressure hugs throughout your shopping day.
3. Have some calming ‘mouth tools’ available (e.g. grab a snack or meal, sip on a water bottlle, bring a child safe chew toy)
4. Take time to smell the flowers…I mean candles in the quiet candle stores with soft music.
5. Give your child some closely supervised movement breaks out of the shopping cart. Even when you are in a hurry and don’t feel you have the time, you may save time in the long run by preventing an outburst later.
6. Give your child some safe ‘hand fidgets’ to fiddle with while riding in a cart or waiting. If they are old enough and able to do so, or allow your child to help you push the cart or carry bags.
7. Put on some snug fitting under garments that offer firm, maintained touch pressure and ‘breathe’ with your child.
8. Shop at less crowded times of the day or season as you are able, and take several short shopping trips over several days, rather than trying to squeeze it all into a couple of long trips.
9. Allow your child to choose and where his or her favorite comfortable clothes and socks.
10. If you are fortunate enough to have some help, bring along an extra hand. Your child may be held by grandma or walk around with her while looking at some pretty decorations, while you stand in the long check out line.

Happy Holidays!
Susan Swindeman, OTR

Adapted from Tools for Tots: Sensory Strategies for Toddlers and Preschoolers
Henry, Kane-Wineland, Swindeman, 2009

This post appeared originally on Susan Swindeman's blog. Susan is co-presenting Session L: Tools for Tots.