An interview with Laura Graham – Occupational Therapist.

Laura will be presenting her workshop at SEN Jigsaw on 6th June 2020 in Stoke on Trent. In the meantime, continuing on my own theme of anxiety, I wanted to chat to her about anxiety in young people. How it presents and what might be the underlying difficulties.

 Hi Laura tell us what you do.

Hi Georgina, I am an independent occupational therapist specialising in children and young people.  I have completed a post graduate diploma in sensory integration and a lot of my work is around the challenges that children and young people face when they have difficulties with sensory integration.  

As you know, I’m presently going on my path of discovery regarding anxiety and want to share how those experiences of anxiety also impact on our learners. As an OT, can you tell my readers how anxiety might present in individuals you meet?

That is a great question Georgina and one I spend time frequently discussing with parents and children.  I often meet families who are concerned about their child’s anxieties and often this can relate to difficulties with sensory processing or other conditions such as Developmental Coordination Disorder (Dyspraxia), Attention Deficit Disorder and Autism Spectrum Conditions.   Parents regularly contact me for advice and assessment when their child shows signs of anxiety such as school refusal, after school restraint collapse, self-harming behaviours and lower level signs of anxiety or dysregulation such as constantly fidgeting, chewing on non-edible objects, difficulty tolerating busy environments they used to be able to.   

Is anxiety a secondary presentation or can anxiety mimic or present as some SpLDs/SEN? 

In the children I support, I often must ask myself what came first the sensory processing difficulties or the anxiety? It is a bit like the chicken or the egg question.  With those who have diagnosis such Dyspraxia, ASC and ADD it is known that sensory processing difficulties can also be present, ergo we frequently see anxiety too.  If you feel uncertain about the sensory information you are receiving through the 8 senses, then the world can feel very unsafe.    When I deliver training to parents and school staff, I often use the example from Greenspan and Salmon in their book, The Challenging Child.  “Imagine driving a car that isn’t working well. When you step on the accelerator, the car sometimes lurches forward and sometimes doesn’t respond. When you blow the horn, its deafening. The brakes sometimes slow the car, but not always. The indicators work occasionally, the steering is erratic, and the speedo is inaccurate. You are engaged in a constant struggle to keep the car on the road.  Would you be able to concentrate on anything else?”      I think this is a really good example of how many children might feel but instead of the parts of the car not being reliable it is their sensory systems.  For example, a sound that many of us not even notice, can be overwhelming for a child with auditory defensiveness or the seams on a pair of socks can be intolerable for a child with tactile defensiveness, likewise standing in a queue for lunch with the jostling that occurs can be very overwhelming.                   

What age group might this cover?

These issues can be present from very young children, right through to adults.  You don’t grow out of many of the conditions that we have mentioned, you will always having Dyspraxia, ADD or ASC but what does change with the correct support and environment is how you cope with the associated sensory difficulties and related anxiety. 

Are there specific areas of difficulty which my readers may or may not have heard of where anxiety impacts individual related to Occupational Therapy?

Not everybody is aware of the 8 senses that we consider when we talk about sensory integration.  People are generally familiar with; Touch (tactile), Taste (gustatory), Smell (olfactory), Hearing (auditory) and Vision (visual) but are sometimes not aware of the hidden senses of Vestibular, Proprioception and Interoception.  These lesser known senses provide us with a constant stream of information about where our body is in space.  Proprioception is the sense of body position and force, it gives us information about where a specific body part is and when it is moving.  We can feel  where our arms, legs, head and body are without even seeing them because our proprioception tells us where they are.  The proprioceptive system is the sensory system which detects limb position.  It gives the awareness of where body parts are at any given moment, and determines the force needed to be exerted during an activity. The proprioceptive system is important for development of body scheme, body awareness and emotional security.   The proprioceptive system also has an important regulatory role in sensory processing as proprioceptive input can assist in controlling responses to sensory stimuli.  Proprioception can be calming for those who are easily overwhelmed by sensory stimulation and therefore some individuals may be observed to seek increased proprioceptive input to down regulate their nervous system.  The vestibular system is the sensory system that tells us where our head/body is in relation to gravity.  It is located within the inner ear.  Vestibular dysfunction can lead to difficulties experienced by an individual such as poor bilateral coordination, arousal state and emotional security.  The vestibular sense is vital for development of balance, coordination, eye control, attention, being secure with movement.   Directly or indirectly the vestibular system influences nearly everything we do.  It is the unifying system in our brain and that modifies, and coordinates information received by other systems.  The vestibular system primes the entire nervous system to function effectively by sending messages to higher centres of the brain.  When the influences of the vestibular system fail to reach their destinations, they cannot adequately contribute to sensory integration.  Common difficulties with vestibular sensory processing can be constantly seeking movement and taking risks or being fearful of movement including avoidance of using escalators or climbing and descending stairs or using playground equipment or sitting in a tilting dentist’s chair.   We often see signs of gravitational insecurity with children with vestibular processing issues and that can be extremely unnerving. Interoception is the sense that provides information about the internal functioning of our bodies, or to put it differently, how our body is feeling on the inside.  It allows us to feel lots of bodily sensations such as a rumbling stomach, a dry mouth, tight muscles, or fast beating heart. Good perception of these sensation enables us to experience and identify homeostatic emotions such as hunger, fullness, thirst, pain, temperature and need empty bowel and bladder along with the emotions of relaxation, sadness, frustration, anger, excitement and anxiety. At the most rudimentary level interoception allows us to respond to the question, “How am I feeling?” at any given moment. 

Can you briefly tell us how these difficulties might present and how they can sometimes be misunderstood?

Join us and see Laura live at SEN Jigsaw 2020

As we all process sensory information differently it can be very difficult to imagine or empathise about how someone else is feeling anxious or overwhelmed by sensory information.  Often, I observe individuals and hypothesis that they are over responsive to auditory input or are auditory defensive (unable to tolerate loud or unexpected sounds).  These same individuals however can frequently be the loudest children in a class.  This is because if they are constantly talking, humming, singing or narrating the goings on they are attempting to block out the unpleasant noises.    Other misunderstandings can occur around the tactile sense.  An individual might suffer a fall on the playground and hardly react and yet the same individual might be brushed past in the lunch queue and the response is very over the top, this is due to poor tactile processing.    We also see that many individuals who present with over responsive profiles can be quite controlling in their behaviours as they are anxious and want to avoid possible contact with the sensations that they might find overwhelming.  I have known individuals to have a toileting accident just before a trip to the supermarket in order to get out of going into a loud, bright, noisy and sometime smelly shop.  I have also met those who will work very slowly in order to be told they are missing playtime to catch up their work as they find the movement and noise on the playground too much.   I am saddened if I hear people saying that these behaviours are chosen, the level of anxiety that can be caused due to poor sensory processing is significant and almost never a chosen behaviour.


Could you give our parents and education professionals your top tips to support individuals with anxiety-based difficulties?


If you suspect that a child has anxiety-based difficulties possibility relating to their sensory integration abilities, then my advice first of all is to look at the environment with your sensory googles on.  I often say that I am a sensory detective, looking for the subtle signs that an individual is overwhelmed or anxious. I also have to remember that sensory input that I or others might be able to cope with another person might find intolerable.    I look for signs such as chewing non-edible objects, fidgeting, stamping on their own feet under the table or constantly moving their feet.   I observe them in a range of environments, classroom, dinner hall, playground and home to see if the behaviours are the same across all environments or if certain environments exacerbate them.

Thank you, Laura, I am sure that’s given many of my readers, parents and professionals a valuable insight. Your workshop will compliment Libby Hill’s workshop on ASD in girls. Our delegates will have a wonderful opportunity to learn from all our professionals.

Contact Laura HERE

Can you point readers to any good reads?

The books that I frequently recommend are:

  • The out of sync child – Carol Kranowitz.
  • Living Sensationally – understanding your senses – Winnie Dunn
  • Answers to questions teachers ask about sensory integration: forms, checklists and practical tools for teachers – Carol Kranowitz, Stacey Szklut, Lynn Balzer-Martin and Sheldonzabeth Harber.
  • The Sensory Team Handbook: a hands on tool to help young people make sense of their senses and take charge of their sensory processing – Nancy Mucklow
  • Too loud too bright too fast too tight – what to do if you are sensory defensive in an over stimulating world. Sharon Heller

You’ll be hosting a workshop at SEN Jigsaw Conference 2020 can you briefly tell my readers what tips they can expect to take away from your workshop.

Yes, I am really looking forward to returning to the conference this year.  My title for this year’s workshop is “Sensory processing in the classroom and beyond.” I will be focusing on exploring the eight senses and how an individual can be under or over responsive in them and what it can look like in school and at home.   I will discuss some strategies to support an individual experiencing sensory challenges from sensory break ideas, equipment and reasonable adjustments.

Tickets for SEN Jigsaw Conference 2020 can be found here. Parents and professionals will receive a warm and friendly welcome. Will you be joining us?