Table of Contents

ILAUGH Social Thinking Program

The Wilbarger Protocol for Sensory Defensiveness (Autism/Asperger’s Digest)

Brushing Protocol Changes to Look for

Transitions

Speech Language Therapy Ideas for Home Use

Recommended Publications
Welcome
Welcome to the third edition of The Parents’ Place sponsored by The Therapy Place staff. This
newsletter is intended to provide parents and caregivers with some helpful information on various
topics regarding their children. In this issue topics covered will include: transitions, the ILAUGH
program, some helpful at home ideas for speech/language intervention and
The Wilbarger protocol.

Editor: Noelle Everts, MA CCC/SLP

ILAUGH Social Thinking Program

The Therapy Place is offering social cognitive assessments and intervention for children who
demonstrate social cognitive deficits. Social cognition is our innate ability to think through and
apply information to succeed in situations that require social knowledge. Social cognition is a form
of intelligence that is key to learning concepts and integrating information across the entire day: in
school, at home and in the community. Limited abilities for learning and/or applying socially
relevant information can be considered a social cognitive deficit.

What is the ILAUGH approach?

The ILAUGH approach, which was developed by Michelle Garcia Winner, explores a variety of
areas that contribute to social thinking and related skills. The ILAUGH acronym represents
elements of disability that contribute to social interaction skills, personal problem solving skills
and organizational skills.

Deficits in social cognition are difficult to reveal through traditional standardized assessment tools
as many children with social cognitive deficits fall in the “average range” on standardized
measures of expressive and receptive language. Yet, there’s “still something...”. These children
tend to have difficulty initiating (I), listening with their eyes and brain (L), thinking abstractly and
making inferences (A), understanding other’s perspective (U), getting the big picture (G) and
understanding humor in terms of the subtleties and timing (H). An ILAUGH assessment is
designed to assess a child’s individual strength and weaknesses in these areas. The ILAUGH
approach provides an innovative framework to examine a child’s social cognition through formal
and informal testing procedures and provides intervention designed to address a child’s social
cognitive deficits in a group format.

The ILAUGH approach is appropriate for children who are at least 7 years old and have
demonstrated average to above average cognitive skills. Those who may benefit from this
approach may include, but are not limited to, persons diagnosed with Asperger’s Syndrome, Non-
Verbal Learning Disability, High-Functioning Autism, Pervasive Developmental Disorder-Not
Otherwise Specified and attention Deficit Hyperactivity Disorder.

If you are interested in pursuing a social thinking assessment for your child or if you have any
questions, please contact The Therapy Place at (952) 885-0418. link: www.socialthinking.com

Ask the Expert: The Wilbarger Protocol for Sensory Defensiveness

Autism Asperger’s Digest magazine Sept-Oct 2004 issue

Ask the Experts

The Wilbarger Protocol for Sensory Defensiveness

By Ellen Yack, B.Sc., M.Ed., O.T., Shirley Sutton, B.Sc., O.T. & Paula Aquilla, B.Sc., O.T.

Q: My 5 year-old daughter was recently evaluated for sensory processing difficulties. One of the
treatments being suggested is the ‘brushing technique.’ What can you tell me about it?
The Wilbarger Protocol (Wilbarger, 1991) is a specific, professionally guided treatment regime
designed to reduce sensory defensiveness. The Wilbarger Protocol has its origins in sensory
integration theory, and it has evolved through clinical use. It involves deep-touch pressure
throughout the day. Patricia Wilbarger, M.Ed., OTR, FAOTA, an internationally recognized expert
who specializes in the assessment and treatment of sensory defensiveness, developed this
technique.

Ms. Wilbarger offers training courses where professionals can learn how to administer her
technique and has produced videotapes, audiotapes, and other publications. At these courses,
she also shares strategies for integrating the protocol into intervention plans and training parents,
teachers, and other caregivers.

There currently is a lack of documented research to substantiate this technique. However, the
protocol has been used by many occupational therapists who have noted positive results with a
variety of populations. Many parents of children with autism have reported that their children have
responded positively to this technique, including reduction in sensory defensiveness, as well as
improved behavior and interaction. Many adults with autism have also reported reduction in
sensory defensiveness, decreased anxiety, and increased comfort in the environment through the
use of this technique. We have observed significant behavioral changes in many of our clients
following the introduction of the Wilbarger Protocol.

The Wilbarger Protocol represents one of those difficulties in clinical practice where positive
results are observed in treatment regimes that have not yet been fully validated by scientific
research. However, because of the strength of anecdotal reporting and our own observations, we
feel we would be doing a disservice if we did not advise our clients about this technique. When
we discuss this option with our clients, we review why it is being recommended and provide them
with information on sensory defensiveness. We also inform them about the absence of research
in this area, and we make it clear that it is their decision if they want to include the technique in
their treatment regimes.

An occupational therapist who has been trained to use the technique, and who knows sensory
integration theory, needs to teach and supervise the Wilbarger Protocol. This statement cannot
be emphasized enough. If the technique is carried out with-out proper instruction, it could be
uncomfortable for the child and may lead to undesired results.

The first step of the Wilbarger Protocol involves providing deep pressure to the skin on the arms,
back, and legs through the use of a special surgical brush. Many people mistakenly call this
technique "brushing" because a surgical brush is used. The term "brushing" does not adequately
reflect the amount of pressure that is exerted against the skin with the movement of the brush. A
more appropriate analogy would be that it is like giving someone a deep massage using a
surgical brush. The use of the brush in a slow and methodical manner provides consistent deep-
pressure input to a wide area of the skin surface on the body. Ms. Wilbarger has found and has
recommended a specific surgical brush to be most effective. The face and stomach are never
brushed.

Following the “massage” stage, the child receives gentle compressions to the shoulders, elbows,
wrists/fingers, hips, knees/ankles, and sternum. These compressions provide substantial
proprioceptive input. Ms. Wilbarger feels that it is critical that joint compressions follow the use of
the surgical brush, and if there is no time to complete both steps, then compressions should not
be administered.

The complete routine should only take about three minutes. This technique can be incorporated
into a sensory diet schedule. The procedure is initially repeated every ninety minutes. After a
period of time, the frequency is reduced. Eventually the procedure can be stopped, but gains can
be maintained. Some children immediately enjoy this input, and others resist the first few
sessions. You may distract the child by singing or offering a mouth or fidget toy.
Some children really like the administration of this protocol and will seek out the brush and bring it
to their parents, teachers, or caregivers. Other children tolerate it with little reaction, and
occasionally a child is resistive. If the child continues to resist, and you see negative changes,
you must reconsider the use of the technique and contact the supervising therapist. This has
rarely occurred in our practice.

Sensory Diet
A sensory diet is a planned and scheduled activity program designed to meet a child’s specific
sensory needs. Wilbarger and Wilbarger (1991) developed the approach to provide the “just right”
combination of sensory input to achieve and maintain optimal levels of arousal and performance
in the nervous system. The ability to appropriately orient and respond to sensations can be
enhanced by a proper sensory diet. A sensory diet also helps reduce protective or sensory
defensive responses that can negatively affect social contact and interaction.

There are certain types of sensory activities that are similar to eating a “main course” and are
very powerful and satisfying. These activities provide movement, deep-touch pressure, and heavy
work. They are the powerhouses of any sensory diet, as they have the most significant and long-
lasting impact on the nervous system (Wilbarger, 1995; Hanschu, 1997.)

There are other types of activities that may be beneficial, but their impact is not as great. These
“sensory snacks,” or “mood makers,” are activities that last a shorter period of time and generally
include mouth, auditory, visual, or smell experiences.

A sensory diet is not simply indiscriminately adding more sensory stimulation into the child’s day.
Additional stimulation can sometimes intensify negative responses. The most successful sensory
diets include activities where the child is an active participant. Every child has unique sensory
needs, and his sensory diet must be customized for individual needs and responses.

=================================
This material was adapted from Chapter 5, “Strategies for Managing Challenging Behaviors” that
appears in the authors’ book, Building Bridges Through Sensory Integration.

BIOS
Ellen Yack has practiced occupational therapy since 1979 and is currently the Director of Ellen
Yack & Associates Pediatric Occupational Therapy, a private agency providing occupational
therapy services to children, adolescents, and their families in Toronto. Her areas of expertise
include sensory integration, autism, and learning disabilities.
Shirley Sutton has worked as an occupational therapist for children with special needs for more
than 25 years. She currently has a private practice in Collingwood, Ontario, and also works with
Children's Therapy Services of OSMH in Early Intervention.
Paula Aquilla is an occupational therapist who has worked with adults and children in clinical,
educational, home and community-based settings. She was the founding executive director of
Giant Steps in Toronto, and directs Aquilla Pediatric Occupational Therapy, also in Toronto,
serving families with children who have special needs.

=================================

Reprinted with permission from the Sept-Oct 2004 issue of the Autism Asperger’s Digest, a 52-
page bimonthly magazine devoted to autism spectrum disorders. For more info, visit
www.autismdigest.com or call Future Horizons at 800.489.0727.

Brushing Protocol Changes to Look For

Below are some changes that you may see while completing the Wilbarger Deep Pressure
Protocol. We encourage you to check in with your therapist throughout the intensive period to
discuss progress. Use the checklist below to help observe and identify the kind of changes you
are noticing. Changes can be simply that, not necessarily positive or negative. Change means
the program is working. Write down any questions that you have so we can address all of your
concerns. Frequent communication and your awareness of changes are crucial to the success of
this protocol. We are always available to provide support through this process.

Physical Changes Social/Emotional Changes Behavioral Changes

__improved sleep patterns
__increased tolerance of grooming tasks
__increased independence in self-cares
__improved gross motor skills
__improved eating habits
__less wiggling
__more physically active
__improvement in handwriting
__more touching, hugging
__more consistent energy level
__increased tolerance to clothing
__increased repertoire of foods
__improved disposition __more motivated
__less controlling __thinking before acting
__improved talking/communication __more open-minded
__improved tolerance of people __improved organization
__less overwhelmed __sequencing improves
__less anxious __improved focus
__more emotional __less sensitive to smells
__more needy __less sensitive to touch
__increased self-confidence/self esteem __less irritable
__less defensive __better at beginning or
__more responsible completing projects
__more patient __less rigid behavior
__more calm and relaxed __longer attention span
__improved mood __decreased hyperactivity
__more acting out __decrease impulsivity
__more affectionate __improved transitions
__decreased frustration tolerance __participation in more
__increased interactions with others activities
__improved eye contact __ more appropriate
interactions with peers

TRANSITIONS
Many children with special needs have difficulty with transitions. Transitions can be as small as
going from play time to dinner time or a significant transition like going to a non-preferred place
such as the dentist. Children who have sensory integration difficulties as well as poor spatial
orientation and organization tend to have a more difficult time with transitions than other children.
Establishing a routine can make a child feel more comfortable with transitions and give them an
understanding of what is expected at these times. The following are some suggestions of how to
ease transitions:

*Provide a visual schedule (pictures of the daily routine in sequence). As the

transition time approaches, refer back to the schedule. For example, you can
tell your child, “It’s almost time for...”

*Make transitions part of the routine. Teach the child to clean up or put away the
materials from the previous activity and then get the materials for the new
one. Those two responsibilities give them an opportunity to mentally shift.

*Oral-motor activities can help to improve focus, concentration and can calm
he nervous system. For example, sucking on a piece of hard candy, chewing
gum, blowing bubbles with theratubing, or chewing on a brainpower.

*Heavy work activities during transitions can assist to increase internal

organization. The child could carry something with weight to the next
activity acting as a “helper”, pulling or pushing a wagon or cart with items
for activity, or wearing wrist and/or ankle weights.

*Establish consistent routines within the home environment. Whenever

possible, do not rush through the transitions.

*Tapping into the imagination can turn anxious or hard transitions into fun.
The following activities are appropriate for approximate developmental ages
2-5 years old, with children who have developed imaginative or imitative
skills. This type of transition activity may be stressful for children who have
developed more rigid or concrete patterns with transitions.

*Have your child hold your hands behind you to “hop on the train... all
aboard!” Then make train sounds to get to the desired place.

*Sing “The Wheels On the Bus” and pretend to get on a bus to “drive”
to the desired place.

*Pretend to be an animal. Pick an animal to represent and crawl,

slither, hop, or prowl with the corresponding animal sound. This
activity is not only fun, but when a child is moving like an animal,
the movements provide great proprioceptive input (information to
the muscles and joints) which can be organizing for a child.

*Write the names of favorite songs or nursery rhymes on popsicle

sticks and store them in a cup. Your child can pick the song to sing
while getting started transitioning to the next activity. Being able to
choose one aspect of a transition can give a sense of control to a
child, thus making a transition easier.

*Guess how many steps or hops it will take to get to the desired
location. Then count while taking steps with a normal stride, “giant”
steps, or “baby” steps.

*The following is a list of materials parents and professionals have used to

make transitions easier. The parent still controls the situation, but the child has the
idea that they maintain some sort of control.

* Dice: The child is given a die (one that goes up three only is ideal!)
and asked to roll it. The number he/she gets can be the number of
minutes left to play a game or do an activity or the number of turns
they have left in a game for example. The die gives them a sense of
“control” as they are doing the shaking and rolling! If you are out
in public and need a way to help them transition, a die is easy to
keep in your pocket or purse.

* Hourglass timer: This is another way to set limits for a game or

activity. There is a visual component with this type of timer so the
child is aware of how much time is left and they can watch the sand
drain to the other end. This type of timer allows the timer to be “the one” to
tell the child when time is up and not the parent! The child can flip the timer to
begin the time (giving them some control). This type of timer is also made
small enough to carry in your pocket out into the community (when you are
at the park, McDonald’s Play Land etc...).

* Egg Timer: This type of timer allows the parent to set the time,
and the child is able to listen for the “ding” and know it’s time to be
done with and activity.

* Wrist Watch: A wrist watch with an alarm is a good way to prepare

an older child for when an activity is over or when it’s time to go
home. The alarm can be set 10 or 5 minutes before the end of the
activity and when it goes off, a verbal reminder that they have “just
a few minutes left” before it’s “time to clean up” or “go home” is
another way to help prepare a child for change.
 * The child’s age: Use the child’s age to help set limits and/or
transition. “You’re 5 years old, so you have 5 more minutes (or 5
more turns) before it’s time to clean up.”

Speech/Language Therapy Ideas for Home Use

Expressive Language:
Take the time with your child to engage in simple nursery rhymes and songs.
While reading books together, talk about the pictures, label items, ask questions to your child re:
the story or the pictures.
Have your child help with household chores. Encourage him/her to tell of the necessary steps.
Have your child view a book and have them tell you the story (it doesn’t matter if they can read,
as long as they tell a cohesive, appropriate tale of what they see).
After watching a video discuss with your child what you just watched. (With a VCR, you can
watch a short portion, talk about it, and the rewind to check for accuracy).
Encourage your child to talk on the phone with grandparents, aunts, uncles, cousins, etc.

Receptive Language:
Play games with your child such as “Simon Says” and “Twister” to encourage listening and
direction following skills.
Set up obstacle courses around the house such as “First, crawl under the coffee table. Next, jump
over the pillow. Last stand beside the couch”. This works on direction following and spatial
concepts.
Work on sorting of various items. Sort by color, size, shape, use, etc.
Place varies item in a brown lunch bag:toy animals, a ball, a plastic a fork, a crayon, etc. Have
your child feel and describe what s/he feels. S/He can guess what it is.
Work on basic yes/no questions. “Is ice cream hot?” “Does a dog meow?” “Does grandma go to
school?”
Play a describing game with your child. Use several descriptive adjectives and have them try to
guess what you are thinking of.

Recommended Publications
*Autism Asperger’s Digest
This magazine is a bimonthly publication of Future Horizons, Inc. It contains information on
autism and asperger’s from sources around the world presented in an easy to read format.
Articles are written by noted autism experts. This magazine is full of helpful information and
insightful stories. To subscribe: 1-800-489-0727. www.autismdigest.com

*S.I. Focus
This magazine is published quarterly. Founded by Kathleen Morris, a speech pathologist. This
magazine contains many information and stories and articles. The editor-in-chief is Carol
Kranowitz, the author of the well known book, “The Out-Of-Sync Child”. To subscribe: 1-214-
341-9999. www.SIfocus.com