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The ALERT Program

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Mars Why

on 28 February 2012

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Transcript of The ALERT Program

What is the ALERT Program?
The ALERT Program
has three stages:

Stage One
Stage Two
Stage Three
Some engines rev and roar and create lots of noise while others sputter and lug
Your car runs best when its engine is running just right
The engine analogy paints a picture of a child’s internal energy levels

child learns the engine concept, develops an understanding of personal engine levels and identifies the engine analogy that works best for him/her
child independently identifies energy levels
sensory and sensorimotor preferences/strategies are identified
child begins to experiment with and choose strategies that work for him/her
A program designed to assist school aged children (8-12) with developmental disabilities in understanding their state of arousal as it relates to sensory-regulation.
Uses a series of sessions and activities that incorporate sensory integration techniques with cognitive approaches.
Helps children learn to identify, monitor, maintain, and change their level of alertness so that it is appropriate to the situation or task that they are engaged in.

Can be used to educate parents, teachers, and professionals.
Program has been adapted for children from preschool age to high school and can also be adapted for adults.
Things to consider:
Group or individual?
Disability/ diagnosis?
Arousal Theory &
“How Does Your Engine Run?”®
Alert Program®

The Engine Analogy
running low just right running high
1) Crunchy (carrots, apples, pretzels)
2) Chewy (gum, granola bars, beef jerky)
3) Soft (pudding, yogurt, bread)
4) Spicy (cinnamon/mint gum, hot tamales)
5) Sweet (candy, grapes, pineapple)
6) Sour (citrus, vinegar, candy)
7) Salty (pretzels, crackers, dulse)
8) Licking/Sucking/Biting

1) Hot/Cold
2) Straws/Water bottles
3) Thin/Thick

1) Fast/Slow
2) Counting breaths
1) Carrying
2) Moving
3) Pushing
4) Cleaning
5) Putting things away

1) Reaching up
2) Chair push ups
3) Touching toes
4) Body twists
5) Shoulder shrugs

1) Move n’ Sit
2) Disco sit
1) Fidgets (koosh ball, stress ball, play-doh, erasers, pen caps, bracelets, pencil grips, etc)
2) Finger painting
3) Playing with sand
4) Tactile bins

1) Shoulder press
2) Weighted lap pads
3) Body sock
4) Bear hugs/ squishes
5) Joint compressions
6) Back rubs
7) Weighted blankets/being wrapped in a heavy quilt
1) Lights (bright, dim, lava lamps, flashing)
2) Decrease visual distractions
3) Colour code and labels
4) Visual instructions to support verbal

1) Music (classical or a steady beat)
2) Headphones (noise reducing)
3) Provide quiet work areas/space
4) White noise/silence
1) Bottle of favorite scent
-Bubble bath
-Fresh laundry
**Be aware of scent sensitivities or allergies
Eyes and Ears
Body: Movement
Body and Hands: Touch
Sensory Integration Theory
Sensory integration: is the way the brain organizes sensations from the external environment for engagement in daily activities
Sensory Integration theory helps understand behaviour (developed by Dr. Jean Ayers); predict relationships between neurological function and sensorimotor behaviouir, and link it to learning
Computer analogy
Sensory Integration Theory outlines 3 elements:
1) input- information obtained through the senses (can be visual, tactile, auditory, olfactory, and/or gustatory; vestibular and proprioceptive)
2) processing- sort and interpret sensory information
3) output- appropriate behaviour/response

In Conclusion...
"AP is capitalizing on third order awareness of first order state using second order strategies" (Williams & Shellenberger, 1996, p. 1-5)
Arousal: psychological and physiological state describing how alert an individual feels
Self-regulation: refers to the ability to filter unrelated stimuli, process and organize a reaction, and retain a certain level of attention which is necessary for optimal functioning. It's the ability to attain, maintain, and change level of arousal for daily activities.

Three "orders" of self-regulation:
"First order": automatic (e.g. respiration, sleep-wake cycles, emotional maintenance)
"Second order": develops during infancy (e.g. attend selectively, monitor, suck,/swallow/breathe, vocalize)
"Third order": use of strategies that require higher order cognitive skills. (e.g. ability to problem solve, ability to self-monitor and evaluate behaviour, sustained attention, choice of goals, organization of spaces)
Stage One:

Stage Two:

Stage Three:
Independent Regulation
child independently chooses and uses strategies
child learns to change engine levels according to the environment, situation, or task
Underlying Theory
Arousal Theory and Sensory-Integration Theory
Stage one activities:
Engine speed guessing game, creating an engine speedometer, an obstacle course

Stage two activities:
Engine tune-up (use tools for the mouth, body, hands, eyes, ears, and nose)

Stage three activities:
Sharing stories, charts (what works and what bothers me), the fanny pack game (what “tools” would a child put in an imaginary fanny pack?)
Barnes, K. J., Vogel, K., Beck, A. J., Schoenfeld, H. B., & Owen, S. V. (2008). Self-regulation strategies of children with emotional disturbance. Physical and Occupational Therapy in Pediatrics, 28(4), 369.

Bertrand, J. (2009). Interventions for children with fetal alcohol spectrum disorders (FASDs): Overview of findings for five innovative research projects. Research in Developmental Disabilities, 30, 986-1006.

Miller, L. J. (2003). Empirical evidence related to therapies for sensory processing impairments. NASP Communique, 31(5), 2-5.

Mulligan, S. (2003). Examination of the evidence for occupational therapy using a sensory integration framework with children: Part two. Sensory Integration Special Interest Section Quarterly, 26(2), 1-4.

Parham, D., & Mailloux, Z. (2001). Sensory Integration. In J. Case-Smith (Ed.), Occupational therapy for children (pp. 329-381). Philadelphia: Mosby

Salls, J., & Bucey, J. (2003). Self-regulation strategies for middle school students. OT Practice, 8(5), 11.

Schaaf, R. C., & Miller, L. J. (2005). Occupational therapy using a sensory integrative approach for children with developmental disabilities. Mental Retardation and Developmental Disabilities Research Reviews, 11(2), 143-148. doi:10.1002/mrdd.20067

Schaaf, R. C., & Nightlinger, K. M. (2007). Occupational therapy using a sensory integrative approach: A case study of effectiveness. American Journal of Occupational Therapy, 61(2), 239-246.

Schoonover, J., Swinth, Y., & Hanft, B. (2002). Teaching social skills. school-based practice: Moving beyond 1:1 service delivery. OT Practice, 7(16), 18.

The Hebrew University of Jerusalem. (n.d). Sensory Modulation Disorders Laboratory. Retrieved from http://ot.huji.ac.il/index.php?option=com_content&task=view&id=40&Itemid=52

Thompson, C. J. (2011). Multi-sensory intervention observational research. International Journal of Special Education, 26(1), 202-214.

Wells, A.M., Chasnsoff, I.J., Schmidt, C.A., Telford, E., & Schwartz, L.D. (2012). Neurocognitive habilitation therapy for children with fetal alcohol spectrum disorders: An adaptation of the Alert Program®. American Journal of Occupational Threapy, 66, 24-34.

Williams, M. S. & Shellenberger, S. (1996). “How does your engine run?” a leader’s guide to the alert program for self-regulation. Albuqerque, NM: Therapy Works Inc.

evidence base for the SI theory is somewhat inconclusive
SI approach is common in occupational therapy settings yet the quality of the research done so far has been spotty (Schaaf & Nightlinger, 2007)
efficacy studies, conducted separately by Miller and Mulligan, indicated a range of results, due in part to a “lack of strict adherence to the principles of sensory integration theory and treatment, and use of outcome measures that are not “occupation” based” (Schaaf & Nightlinger, 2007, p. 240)
a challenge of sensory integration therapy is the heterogeneity of the population that might benefit from it (originally geared toward children with learning disabilities) (Schaaf & Miller, 2005; Schaaf & Nightlinger, 2007)
future research considerations: utilize a case study design or an observational quantitative approach (Schaaf & Nightlinger, 2007; Thompson, 2011)

(Williams & Shellenberger, 1996; Parham & Mailloux, 2001)
(Williams & Shellenberger, 1996)
(Williams & Shellenberger, 1996)
(Williams & Shellenberger, 1996)
(Williams & Shellenberger, 1996)
(Co-authors: Mary Sue Williams & Sherry Shellenberger)

Colors (
for high,
for just right,
for low)
Animals (turtle or sloth for low and rabbit or cheetah for high)
Cartoon characters (Tigger, Winnie the Pooh and Eeyore)
Try anything that may suit your particular group or child!
Other Ideas
Get creative!
Full transcript