SELECTED ARTICLE
Author
Tatyana Elleseff MA CCC-SLP 
Article Title
Speech-Language Strategies for Multisensory Stimulation of Internationally Adopted Children 
Posted Date
1/11/2012 

This article was first published in January 2012 Issue of Adoption Today Magazine (pp. 40-43)

Recently I participated in a professional adoption email discussion regarding developmental stimulation of infants and toddlers in orphanages and it got me thinking about not just the importance of stimulation for institutionalized children but also about stimulation activities for post-institutionalized children. Orphanages have long been infamous for sensory deprivation as well as a host of other adversities. Even one month spent in an institutional environment can significantly disrupt functioning in a number of areas including health, language, cognition, and behavior (Johnson, et al 1992). But what of the children who spend several years in orphanages before their adoption takes place? After all, just because the children become adopted doesn’t mean that their problems magically disappear.

As a speech-language pathologist I work on improving or developing post-institutionalized children’s speech and language abilities, feeding and swallowing abilities as well as social pragmatic skills. But I also realize the importance of multisensory stimulation for these children and try to incorporate that into my speech and language therapy session activities.

So why is multisensory approach important? Well, let’s think about it for a moment. When babies are cared for by biological parents they receive natural multisensory stimulation. They are not just spoken to or gazed at, but they are also touched and hugged, as well as given natural opportunities to smell and taste different foods (or objects), as well as hear a variety of sounds. They get to explore their world via all their senses and not just a select few.

However, in an institutional environment each child’s sensory input is at risk of being significantly stunted. Infants lie day after day in a crib, without meaningfully interacting with their environment, they are touched only when changed and fed, and no one tends to them when they cry. The result: an increase in stress levels (Tarullo & Gunnar, 2006) as well as increased potential for developing sensory processing deficits.

Sensory processing refers to process by which our brain receives messages from our senses and turns them into appropriate responses. If these sensory signals don’t get processed appropriately then a child may present with sensory processing deficits characterized by hyper or hyposensitivity to sensory stimuli, affecting any or all of the senses (visual, auditory, olfactory, gustatory, vestibular and proprioceptive).

In the past a number of studies have described the advantages of multisensory stimulation for various at risk populations. For example, in 2003 a study published in Journal of Research in Nursing and Health described the advantages of multisensory stimulation for 2 week old Korean orphans who received auditory, tactile, and visual stimulation twice a day, 5 days a week, for 4 weeks. This resulted in significantly fewer illnesses as well as significant gains in weight, length and head circumference, after the 4-week intervention period and at 6 months of age. Another 2009 study by White Traut and colleagues published in the Journal of Obstetric, Gynecologic, & Neonatal Nursing, found that multi sensory stimulation consisting of auditory, tactile, visual, and vestibular intervention contributed to a reduction of infant stress reactivity (steady decline in cortisol levels). Moreover, multisensory stimulation is not just beneficial for young children. Other studies found benefits of multisensory stimulation for dementia (Milev et al, 2008) and coma patients (Doman & Wilkinson, 1993), indicating the usefulness of multisensory stimulation for a variety of at risk populations of different age groups.

While it is important to recognize that the assessment and treatment of sensory processing disorders falls under the auspices of an occupational therapist, there are still a number of ways in which other professionals (e.g., speech language therapists) and parents can incorporate multisensory stimulation into a variety of fun therapy sessions or carryover learning activities. However, before initiating any activities it is important to obtain a clearance from the child’s occupational therapist, particularly if the child presents with significant sensory issues. Also, make sure that the child doesn’t have any food allergies, or nutritional restrictions, which is especially important for newly adopted infants and young toddlers.

Multisensory stimulation for young children does not have to involve stimulation of all the senses at once. However, there are a number of activities which come quite close, especially when one combines “touch ‘n’ feel” books, musical puzzles as well as paper and edible crafts.

Here’s one of my favorite speech language therapy session activities for children 2-4 years of age. I use a board book called Percival Touch ‘n’ Feel Book to teach insect and animal related vocabulary words as well as talk about adjectives describing textures (furry, smooth, bumpy, sticky, etc). As I help the children navigate the book, they get to touch the pages and talk about various plant and animals parts such as furry caterpillar dots, shiny flower petals, bumpy frog skin, or sticky spider web. We also work on pronouncing these words (articulation therapy) and on combining the newly learned words into short sentences (language therapy), depending of course, on the child’s age, skills, and abilities. With this activity I often use animal and insect musical puzzles so the children can hear and then imitate select animal and insect noises.

Also, since all of Percival’s friends are garden insects and animals, it’s fairly easy to turn the book characters into paper crafts. Color paper templates are available from free websites such as www.dltk-kids.com, and range in complexity based on the child’s age (e.g., 2+, 3+ etc). While looking innocuously like simple paper cutouts, in reality these crafts are a linguistic treasure trove and can be used for teaching simple and complex directions (e.g., after you glue the frog’s arm, glue on his foot) as well as prepositional concepts (e.g., glue the eyes on top of the head; glue the mouth below the nose, etc).

So far we have combined the tactile with the auditory and the visual but we are still missing the stimulation of a few other senses such as the olfactory and the gustatory. For these we need a bit more creativity, and that’s where edible crafts come in (inspired by Janell Cannon’s ‘Crickwing’). The child and I begin by constructing and gluing together a large paper flower and dabbing it’s petals with various food extracts (almond, vanilla, raspberry, lemon, root beer, banana, cherry, coconut, etc). Then, using the paper flower as a model, we make an edible flower using various foods. Pretzel sticks serve as stems, snap peas become leaves while mango, tomato, apple, peach and orange slices can serve as petals. After our food craft is finished the child (and all other therapy participants) are encouraged to take it apart and eat it. The edible flower is not just useful to stimulate the visual, tactile, gustatory, and olfactory senses but it also encourages picky eaters to trial new foods with a variety of textures and tastes, as well as serves to develop symbolic play and early abstract thinking skills.

I find multisensory stimulation to be a fun and interactive way to increase the child’s learning potential, decrease stress levels, as well as increase retention of relevant concepts. It is also quite easy to find multisensory stimulation ideas to supplement learning and educational activities for children of various age groups. All one has to do is to type in a relevant search query on “Google”. I found a great blog post entitled “5 recycled multisensory learning games” by simply typing in “multisensory activities by age” (see full citation below).

It is also important to emphasize that multisensory activities are not just used with younger children; they can be useful for adopted school-age children as well (including middle school and high school aged kids), especially because these children spent far more time in institutional environments then their younger counterparts. In the past, I have incorporated multisensory activities into thematic language and vocabulary units for older children (see resources below) while working on the topics such as the senses (e.g., edible tasting plate), nutrition (e.g., edible food pyramid), the human body (e.g., computer games such as whack a bone by anatomy arcade), or even biology (building plant and animal cell structures out of jello and candy). From my personal clinical experience I have noticed that when I utilized the multisensory approach to learning vs. auditory and visual approaches alone (such as paper based or computer based tasks only), the children evidenced greater task participation, were able to understand the material much faster and were still able to recall learned information appropriately several therapy sessions later.

Multi-sensory activities are a therapeutic, fun, and informative way to enhance the adopted child’s school and learning activities for greater information retention. Parents and professionals are encouraged to learn more about multisensory stimulation ideas as well as others terms discussed in this article by visiting the relevant national associations, foundations, websites or blogs listed in the “resources” session of this article. There are many routes available to pursue when it comes to application and usage of multisensory stimulation. However, the first step in finding out whether multisensory stimulation is appropriate for the child you are working with is parental and professional education!

References:

  • Doman, G & Wilkinson, R (1993) The effects of intense multi-sensory stimulation on coma arousal and recovery. Neuropsychological Rehabilitation. 3 (2): 203-212.
  • Johnson, D. E et al (1992) The health of children adopted from Romania. Journal of the American Medical Association. 268(24): 3446-3450
  • Ti, K, Shin YH, & White-Traut, RC (2003), Multisensory intervention improves physical growth and illness rates in Korean orphaned newborn infants. Research in Nursing Health. 26 (6): 424-33.
  • Milev et al (2008) Multisensory Stimulation for Elderly With Dementia: A 24-Week Single-Blind Randomized Controlled Pilot Study. American Journal of Alzheimer’s Disease and Other Dementias. 23 (4): 372-376.
  • Tarullo, A & Gunnar, M (2006). Child Maltreatment and Developing HPA Axis. Hormones and Behavior 50, 632-639.
  • White Traut (1999) Developmental Intervention for Preterm Infants Diagnosed with Periventricular Leukomalacia. Research in Nursing Health. 22: 131-143.
  • White Traut et al (2009) Salivary Cortisol and Behavioral State Responses of Healthy Newborn Infants to Tactile-Only and Multisensory Interventions. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 38(1): 22–34
Resources:
  • American Occupational Therapy Association (AOTA) http://www.aota.org/
  • American Speech-Language-Hearing Association (ASHA) http://www.asha.org/
  • Anatomy Arcade: http://www.anatomyarcade.com/
  • Cannon, Janell (2000) Crickwing. Harcourt Children’s Press.
  • DLTK Printable Crafts for Kids www.dltk-kids.com
  • Enchanted Learning: http://www.enchantedlearning.com/crafts/halloween/pastaskeleton/ How to make a pasta skeleton;
  • Enchanted Learning: http://www.enchantedlearning.com/crafts/edible/ Edible Crafts
  • Percival Touch ‘n’ Feel Book (2005). Bendon Publishing International
  • Sensory Processing Disorders Foundation Website http://www.sinetwork.org/index.html
  • Sensory Processing Disorder Blog http://www.sensory-processing-disorder.com/index.html
  • Wendy Z Learning Resources. 5 recycled multisensory learning games. Retrieved October 30th 2011. (http://wendyzshandsonlearning.blogspot.com/2009/06/5-recycled-multisensory-learning-games.html)
References
Tatyana Elleseff MA CCC-SLP is a bilingual speech pathologist with a private practice (Smart Speech Therapy LLC) and a full-time hospital affiliation (UMDNJ) in Central, NJ. She received her MA from NYU and her Bilingual Extension Certification from Columbia University. She is licensed by the state of NJ and holds a Certificate of Clinical Competence from ASHA. She specializes in working with bilingual, multicultural, internationally and domestically adopted as well as at-risk children with complex medical, psychiatric, developmental, neurogenic, and acquired communication disorders. For more information see Tatyana’s blog and website: www.smartspeechtherapy.com/blog/ or call her at 917-916-7487 
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