The OT Toolbox
When kids are in a meltdown and the behaviors are going full force, try some of these techniques to help kids calm down and move out of a harmful or ineffective status.  Meltdowns are oftentimes a result of sensory systems that aren't quite right, causing an overload of sensations.  

When the body is so overwhelmed or underwhelmed by sensory input, it turns to meltdown mode.  

Tricks and tips to help kids with meltdowns. These are sensory based strategies that can help kids overcome meltdowns by using a plan.

What does a meltdown look like?

Meltdowns occur when sensory input is overloading a child's sensory system. This might happen fast and result in overwhelming emotions or behaviors.  You might see kicking, hitting, punching, or other sensory responses.  Kids can shut down when the sensory overload is a slower input. When a meltdown happens, kids need to reset themselves and their sensory systems.  The child who is in midst of a sensory overload may have difficulty getting their attention on the strategies outlined below, but they do need to know that they are safe, loved, and that it will be ok.  

It's important to know that there is a difference between a tantrum and a meltdown.

Meltdowns look like different things to different kids:

For some, it might be laying on the floor and not moving.  

For another child, it might be fleeing or bolting.  

For another child, a meltdown might look like screaming or hurtful actions.  

Still another child might be quiet and hum to block out sensory input.

Just like a meltdown looks different for each individual, so do the strategies that can help move out of that mode.  When a meltdown is occurring, it's best to have an arsenal of tools available in mind.  Most important though, is keeping the child's safety and best interests in mind.  Below is a list of meltdown mode tricks and tips to try.

Meltdown Tricks and Tips

Try the following tips and tricks to help kids when they are having a meltdown:

Proprioceptive Input to help with meltdowns

Bear hug
weighted blanket
Crash on a couch or crash pad
Bounce on a therapy ball
Hide under cushions
Exercise: push-ups, sit-ups, burpees
Weighted vest (therapist approved)
Pull a heavy weight
Pound pillows
Punch and squeeze play dough
Bounce on a therapy ball
Get under a mattress
Joint compressions
Jump on a trampoline

Sensory-based movement to help with meltdowns

Distractions or a change in environment can help when meltdown mode is in full effect.  Add slow movements to these activities such as slow swinging or calmly walking.
Take a nap
Move to another space or room
Practice deep breathing in a quiet space
Go outside
Take a walk
Run at a park or play at a playground
Turn on music (loud or quiet)
Roll down hills (fast or slow)
Play on swings
Rock in a rocking chair
Slowly spin in an office chair (limit time in spinning as indicated)

Refocus attention from the biggest cause of the meltdown with multiple-system sensory input:
Deep breathing
Close your eyes and imagine
Low lighting
Put static on the radio
Set a timer to scream/run/cry/dance/jump
Write a story
Act out frustrations with puppets, figures, or dolls
Get in water: take a shower, bath, play in water, swim

Calming Tactile Sensory Input to help with meltdowns

Incorporate calming tactile sensory input into a calm down space or room:
Fidget toys
Sand box
Rub on lotion
Brush your hair
Heated microwave (scented or unscented) bag
Write or draw with a vibrating pen
Use a vibrating toothbrush

Calming foods to help with meltdowns

Try some of these oral sensory motor calming foods:
Suck a smoothie through a straw
Chew on fruit chews or licorice
Chew gum
Chamomile tea

If any or some of these tips and tricks help, it can be beneficial to talk over the successes with your child.  Address things like impulse control in a way that they are able to understand and relate to the meltdown they just experienced.  A good way to do this is with the Impulse Control Journal.  

What are your best strategies for addressing meltdowns?

Tricks and tips to help kids with meltdowns. These are sensory based strategies that can help kids overcome meltdowns by using a plan.
Learning styles are the manner in which we best learn and process information. Examples of learning styles includ auditory learners, kinesthetic learners, and visual learners.  Each of us has a preference (either obvious or less obvious) to one style of learning or another.  As children develop, they can progress through different stages and preferences of learning.  

Kids can succeed with a variety of learning styles.  One strategy is to address the sense of hearing when teaching new concepts or reinforcing older concepts. 

There are many characteristics of a student who is an auditory learner.  A few indications include the children who can't seem to stop talking, the child who repeats verbal information outloud, or the child who prefers discussion in classroom activities.  

Read below to find more characteristics of auditory learners and activities for auditory learners in the classroom or at home.

Try these strategies to help kids who are auditory learners in the classroom or at home.

Characteristics of Auditory Learners

Not all children who are auditory learners will experience all of the characteristics below.

Prefer listening in the classroom
Like to talk
Repeats directions
Can't concentrate when there are noises in the environment
Can't fall asleep to music or a television
Benefits from repetition of directions
Learns best when listening
Learns well from videos
Easily recalls songs, poems, and phrases
Talks out decision processes
Remembers facts in detail when hearing them
Prefers to hear all of the facts when learning something new
Hums or talks to self
Easily can identify differences in pitch or tone of sounds
Follows verbal instructions better than written instructions
Prefers smaller groups in the classroom (limits the auditory distractions)
Remembers facts better after repeating them
Talks or moves lips while they write
Recalls a person's tone of voice when remembering a conversation
When reading or writing, written information may not make sense until it's been read aloud
Writes with light pencil pressure

Children who learn best through the auditory sense may benefit from auditory strategies.  Try some of the activities for auditory learners that are listed below:

Try these strategies to help kids who are auditory learners in the classroom or at home.

Activities for Auditory Learners

Read homework directions out loud
Record facts on video and then replay it.  A mobile phone or tablet works well for this strategy.
Sing facts to a tune
Write a song when memorizing facts or spelling words
Teach to other students or even to stuffed animals
Practice in front of a mirror
Try a whisper phone
Listen to books on tape using headphones
Rhyme facts
Spell words out loud in different pitches and tones
Use noise eliminating headphones in the classroom or during tests
Find a quiet space for homework
Turn off distractions. Consider televisions, phones, or even fans
Use mnemonic devices to memorize facts 
Listen to audiobooks
Use oral reports for classroom projects
Allow students to record portions of homework or projects onto devices
Make flashcards and read them out loud
During classroom lessons, clap or speak louder during important parts
Speak in syllables

What are your best strategies to help auditory learners?

Try these strategies to help kids who are auditory learners in the classroom or at home.

I've had a few questions and comments recently about PANDAS. I wanted to put together a collection of resources for PANDAS and PANS so that families, teachers, therapists, grandparents, and caregivers can easily find everything they need to know about this disorder.  The links below are sites that describe more about PANDAS and PANS, including diagnostic information, signs and symptoms of PANDAS, information on clinical trials, and places to find more help.  PANDAS/PANS can be a confusing diagnosis, happening overnight and with dramatic and substantial outcomes.  Use the information below as a starting point when looking for information on PANDAS.

This information is not meant to be a diagnostic tool or means for intervention. It is essential that concerned individuals seek consult from the child's pediatrician. This information is strictly a collection of information and a starting point when seeking out resources.

What is PANDAS and PANS and how are kids impacted by behavioral changes

What is PANDAS?

PANDAS is an acronym standing for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. The disorder appears suddenly following a strep infection like strep throat or scarlet fever and results in obsessive compulsive disorder, behaviors, tics, and similar symptoms.  

PANS, or pediatric acute-onset neuropsychiatric syndrome, refers to children with sudden onset of obsessive–compulsive and other neurobehavioral symptoms, including children with PITAND (pediatric infection-triggered autoimmune neuropsychiatric disorder), children with PANDAS, and children with exacerbations that are due to environmental or metabolic triggers.

Symptoms of PANDAS and PANS

There is not a predictable sequence of symptoms, but a child with a diagnosis of PANDAS/PANS may present with the following symptoms:
  • ADHD symptoms (hyperactivity, inattention, fidgety)
  • Sensory defensiveness
  • Attention difficulties
  • Hyperactivity
  • Impulsivity
  • Age-inappropriate behaviors
  • Obsessions
  • Choreiform movements
  • Separation anxiety (child is "clingy" and has difficulty separating from his/her caregivers; for example, the child may not want to be in a different room in the house from his or her parents)
  • Restricted eating or changes to eating patterns
  • Mood changes, such as irritability, sadness, emotional lability 
  • Trouble sleeping, night-time bed-wetting, day-time frequent urination or both
  • Changes in motor skills (e.g. changes in handwriting)
  • Personality changes
  • Joint pains
  • Changes in occupational performance and performance skill deficits
  • Separation anxiety
  • Oppositional behaviors
  • Marked deterioration in handwriting or math skills
  • Urinary frequency/enuresis
  • Joint pain or stiffness
  • Sleep problems
  • Slow processing speed

How to Help a child with PANDAS/PANS:

Occupational Therapy can help with these symptoms and the difficulties as a result of PANDAS/PANS, as outlined here.

More information about PANDAS and PANS
This fact sheet breaks down diagnosis and treatment strategies.

This research library has a comprehensive collection of references and published works related to PANDAS.  This is a great source for recent research and work related to PANDAS/PANS.

An overnight transition from a typical child to high emotional temperament changes can be overwhelming and scary! The NIHM website has information that answers the question 'What is PANDAS?".  

This site has local support groups available and can direct you to local practitioners.

Find hands-on and creative ways to address attention and executive functioning skills.

Try these sensory-based tricks and tips to help with meltdowns.

Books on PANDAS and PANS for kids, parents, teachers, and therapists

Books about PANDAS and PANS:

These books may help kids with PANDAS or PANS to better understand the disorder and symptoms.  Children with siblings or friends who are experiencing symptoms of PANDAS or PANS would benefit from information relayed in easy-to-understand children's books with pictures.  Also included in this list of books about PANDAS are books that can be referred to parents and teachers of children who are experiencing PANDAS or PANS. 

Affiliate links are included in this post. 

In a Pickle Over PANDAS is a book for kids with PANDAS or PANS

In a Pickle Over PANDAS is a children's book about a young boy who wakes up one morning with new and strange things happening in his body.  They symptoms of PANDAS are described in a way that kids will understand and relate to.  This book is a great resource for kids who are struggling to understand what PANDAS is and that they are not alone. 

Saving Sammy is a book written by a mother of a boy with a sudden onset of PANDAS and describes her fight against the medical establishment to prove the link between infection-triggered PANDAS and her son’s sudden-onset OCD and Tourette syndrome.

PANDAS and PANS in School Settings is a handbook for teachers, administrators, school professionals, school based Occupational Therapists, and anyone who works with a child who is struggling with PANDAS or PANS.  This handbook can help identify challenges and offers strategies to incorporate into the learning environment. 

Childhood Interrupted: The Complete Guide to PANDAS and PANS is a guide for parents of children who are experiencing PANDAS/PANS and are seeking information related to behaviors, treatment interventions, therapy, support, and interventions. 

A Child's Introduction to Understanding PANDAS  is a book that parents can work through with their kids as they struggle to explain what exactly PANDAS is and how it's affecting the child. This workbook is a resource for identifying a individualized strategy plan using the book's journal sheets and strategy plans. 

How to take the Grrr out of Anger is a book that can address one of the common symptoms of PANDAS and PANS.  For kids that are experiencing behavior and emotional challenges as a result of PANDAS/PANS, the new feeling changes can be confusing and overwhelming.  This book is a guide to helping kids understand anger-management tips strategies that can be used in healthy ways.  This book can help kids understand and deal with the anger and emotions they feel.

What to Do When Your Brain Gets Stuck is a book that addresses the obsessive compulsive tendencies that are common with PANDAS and PANS.  This book helps kids understand the obsessions or compulsions they may feel and act on and guides kids and parents through strategies that can help.  The book has a lot of activities, tools, and guided instructions that can help kids take control of their OCD actions or thoughts. 

Books on PANDAS for parents, teachers, kids, and therapists impacted by Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus

Information on PANDAS for parents, teachers, kids, and therapists impacted by Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus

Janice Trigilio Tona, Sutanuka Bhattacharjya, Denise Calaprice; Impact of PANS and PANDAS Exacerbations on Occupational Performance: A Mixed-Methods Study. Am J Occup Ther 2017;71(3):7103220020P1-7103220020P9. doi: 10.5014/ajot.2017.022285.

Tona, J., & Posner, T. (2011, November). Pediatric Autoimmune Neuropsychiatric Disorders: A New Frontier for Occupational Therapy InterventionOT Practice, 14-19. 

PANDAS—Questions and Answers. (2016, Sept) Retrieved from:

A child is over responding to sensory input from the classroom environment.  The fluorescent lights are too bright, the janitor is rolling his cart down the hallway, a new pair of socks are too tight, and a fly is buzzing near a window.  The combined sensations are too much. 

The classroom is an environment that is a place where over-responsiveness can easily interfere with learning, self-confidence, or social emotional development. 

Having a toolbox of sensory strategies to address over-responsiveness can be invaluable in the classroom.  

Use these sensory calm down strategies for school to help kids with self-regulation and over responsiveness in the classroom.

Calm Down Strategies for School

Below are sensory strategies for school that can be used with children who over-respond to sensory input, have difficulties with anxiety, or struggle with attention or executive functioning difficulties.

Get a printable version of this list HERE.

A child who needs self-regulation strategies to better learn or function in the classroom can benefit from one or more of these strategies.  Every child is different and each will respond in different ways. Not all of these sensory strategies will help every child.  Consider underlying issues and consult a school-based occupational therapist for assessment and interventions.

Related Read: Try these free classroom fidget tools and sensory strategies for the classroom.

Use these sensory calm down strategies for school to help kids with self-regulation and over responsiveness in the classroom.

Sensory Strategies to help children calm down at school:

Use a predictive schedule
Limit close seating 
Minimize auditory stimulation (Utilize earbuds, sound-minimizing headphones, white noise, whisper phones)
Increase space between children
Movement breaks
Sensory seating
Provide a calm down zone
Weighted lap blanket
Try tactile tools at the desk
Decrease visual distractions (trifold, work standing at an easel, single color bulletin boards)
Use a visual schedule for transitions
Provide a warning before fire drills or bus evacuation drills
Plan an accomodate for school-wide assemblies
Provide a calm down portion of the day build into the schedule with deep breathing and soft music
Yoga breaks
Stretches before desk work or tests
Add wall push-ups or chair push-ups into the daily schedule
Water bottles with a straw at each desk (ask parents to send in sports bottles)
Allow gum during tests or quiet work time
Quiet fidget toys
Movement learning with the whole classroom

Here are more classroom sensory strategies that may help.

Use these sensory calm down strategies for school to help kids with self-regulation and over responsiveness in the classroom.

Need more information on sensory processing, grab the Sensory Processing Disorder Handbook

Use these sensory calm down strategies for school to help kids with self-regulation and over responsiveness in the classroom.

As an additional school-based OT resource, I wanted to share the Super Sensory Bundle that is on sale NOW until July 10th.  

The Super Sensory Bundle includes 38 products. When you buy, you also get over 200 printable bonus offers. The activities, games, play dough mats, exercises, and tools can be used in therapy planning and throughout the entire year. These are strategies and solutions for every sensory kiddo!
The guides in the bundle will help to create simple sensory routines that fit into a family's schedule, help parents figure out why their child responds to sensory stimulation in the ways that they do, help master sensory behaviors with simple activities, manage appointments and sensory routines, and find balance in sensory strategies.
Some of the products that stand out to me are:

  • The strengthening activities (Use these in therapy planning!) 
  • The fine motor development book with TONS of fine motor activities you can start on right now 
  • Printable yoga cards that can be used in brain break activities 
  • The emotional regulation tools and strategies- Including the Impulse Control Journal
  • Handwriting resources like The Handwriting Handbook and When Your Child Hates Handwriting Ebook 
  • The alternative seating for the classroom guide -School-based therapists will love this resource.

Seriously, this bundle is a goldmine of resources for any pediatric therapist!
This is a huge packet of resources for the home, classroom, or therapy clinic. Included in the packet:
Complete Robot Calming Toolkit Bundle
My Personal Printable Routine Schedule
The Impulse Control Journal
Unwired – A Game to Calm Anxiety
Beat Buster- A Role-Playing Game to Boss Back OCD
Emotions Dress Up Doll Kit
Pocket Sized Feelings Journal
Sensory Exercise Video Membership (one month access)
Digital Yoga Cards
Wiggle Worms: A Guide to Alternative Seating for the Classroom Ebook
Superhero Themed Brain Break Cards
Basics of Fine Motor Skills - Developmental Activities for Kids Ebook
The Handwriting Handbook
When Your Child Hates Handwriting Ebook
Seasonal Counting Clip Cards
Sowing the Seeds of Wonder- A Guide for Creating and Nurturing a Garden with Kids Ebook
Steam Powered Kids Learning The Senses Ebook
Slime Play Mats
Alphabet Letter Mats with Craft and Process Art Ideas (180 page resource)
A-Z Beginning Sounds Playdough Mats
Alphabet Playdough Mats
Fall Themed Playdough Mats
Four Seasons Printable Playdough Mats
Discover: Printable Activity Plans to Explore with Your One Year Old
Fun Surprises for Kids Ebook
Rice Play Ebook
Sports Themed Printable Boredom Busters
Sensory Bins: The What, The How, & The Why Ebook
The Homemade Playdough Recipe Ebook
PARENTING RESOURCES- Understand Sensory, Behaviors, and Get Organized
The Beginner’s Guide to Essential Oils for Sensory Needs Ecourse
Unlock the Sensory Secret Ecourse
Game Changing Sensory Strategies Ecourse for Picky Eaters
The Magic 7 Ebook
Decoding Sensory Tantrums Ecourse
Scriptures for Special Needs Moms Ebook
SPD Brochure for Caregivers
The Autism Planner Workbook
Potty Training Visual Schedule
TOTAL VALUE: $294.25!

From July 6th-10th, the Super Sensory Bundle is 90% off at $29.99. And, when you get your bundle, you'll also get over 200 printable sheets, resources, activities, and tools added for free.
Get your sensory resources bundle before it goes away on the 10th! (That's next Monday!)
Sensory Bundle Base. 90 off

When a child sits down to write at a desk, it can be easy for everything to go awry and messy, illegible handwriting to result.  It might be poor carryover of handwriting skills, difficulty with letter formation, visual motor skills that are not up to par, or weak fine motor skills and pencil grasp struggles.  The issue with sloppy handwriting is that there is a LOT going on!  One tip to check as soon as a child sits down to write, is their posture.  Everything from head positioning and visual view of the writing space to positioning of the arm and hand on the paper stems from the midline and base of support.  Because of this, I wanted to share ways that core strength impacts handwriting.

Core strength impacts handwriting legibility and neatness when it comes to attention, posture, and every aspect of handwriting, a great resource for teachers or school based OT in the classroom who work on handwriting with kids.

Core Strength and Handwriting

The child with weak core strength may have sloppy handwriting that just can't be fixed.  Band-aides of pencil grips, specialty lined paper, and handwriting modifications can help improve written work, but when a weak core is holding up the child, the handwriting struggles will never be fully fixed. 

It is so important to start with the midline and base of support when it comes to handwriting.  That proximal beginning of assessing the child can make a world of difference with just a few adjustments in posture and strengthening. 

When there are handwriting problems, there are underlying issues that cause them.  Core strength is a big cause of handwriting struggles.

Here are 6 ways that core strength impacts handwriting legibility and neatness:

1) When a child has a weak core, they may tend to sit with a modified base of support.  They might slump over at their desk and lean on their elbows.  You might see a slouched back, knees and legs sticking out between the rows of desks.  You might see kids who are slumped over their papers or are leaning on one hand as they write.  You might see the child lying forward on an extended arm that reaches over the front of their desk.  An inefficient posture can lead to poor handwriting.  Read more about a 90/90/90 posture and how to promote that posture using cue cards.

2) Classroom teachers will say they often times see students who are not active and alert during school tasks.  A weak core can transition to inattention and inability to focus on learning or handwriting tasks.  A core strengthening plan can help this problem.

3) When the core is not engaged, the child's non-dominant hand can not support the paper.  When this happens, the paper isn't stabilized and legibility can suffer.  Coordinating both hands together with an engaged midsection requires a strong core. Read here about tricks for holding the paper when writing.

4) A weak core can lead to a child who can't engage their muscles over a period of time.  This looks like a child who wiggles, moves in their seats, jumps up, and slouches.  With all of that wiggling and moving, handwriting can suffer!

5) Copying a list of words from a smartboard, book, or homework assignment center across the classroom or desk requires visual shift and the ability to quickly scan using visual perceptual skills.  When a child who has weak core tries to copy a list or sentences, they might present with a slouched upper back and neck over their desk.  Looking up and back down again can be really difficult for these students with the repeated flexion and extension of the neck.  This can result in skipped words, letters, and phrases as well as poor margin use, line awareness, and spatial awareness when writing and copying written work.

6) A weak core leads to weak fine motor skills distally.  The engaged and strong muscles of the abdomen and upper body allow for strength and engagement of the upper arm, and in turn leads to dexterity and motor control of the hands.  When the core is weak the hands can not effectively do their job to hold the pencil and manage tasks such as in-hand manipulation.

What should you do when weak core muscles impact handwriting?

Strengthening the core can have a HUGE impact in handwriting!  

Use the strategies and tips in The Core Strengthening Handbook is a resource for fun and creative core strengthening activities for kids with awesome exercises, games, and activities designed to give kids the strong core foundation they need to improve handwriting.

The Core Strengthening Exercise Program to help make core strengthening fun and entertaining for kids while promoting carryover in the classroom and when writing.

 The Core Strengthening Handbook has everything you need to know outlined into informative strategies and tips that work to meet the needs of kids of all kinds! 

 Core Strengthening Handbook

Core strength impacts handwriting legibility and neatness when it comes to attention, posture, and every aspect of handwriting, a great resource for teachers or school based OT in the classroom who work on handwriting with kids.

As kids, we used to hop from couch to couch and make a flying leap across the living room to the corner chair.  We would hop from one surface to another with one thing on our minds...

The living room floor had turned into boiling hot lava!

When my kids started hopping around from pillow to pillow and landing with a roll onto the couch with claims of the floor turning to lava, I had to smile. 

The Floor is Lava is Back!

What is so cool about the floor being lava (besides the nostalgic sentiments from parents?)  A great game of The Floor is Lava has some major motor movements and sensory play components!

From jumping, leaping, hopping, rolling, and crashing, The Floor is Lava is a fun and creative way to encourage movement and sensory motor play, both indoors and out!

Play these The Floor is Lava Games with your kids to build development of skills like motor control, sensory input, motor planning, gross motor skills, core strength, and balance.

The Floor is Lava Games

Here are some fun ways to use The Floor is Lava Games to promote sensory input and motor movements:

  • Place pillows and couch cushions on the floor.  Kids can hop from pillow to pillow on one foot or two.  Move the pillows further and further apart to promote movement coordination and motor planning.  Don't touch the carpet, it's lava!
  • Place paper plates in a line on the floor.  Use them as a balance beam to address vestibular sensory input.  Hop from plate to plate without touching the ground, it's burning up!
  • Play a stop and go game that promotes auditory processing skills like auditory figure-ground discrimination.  Call out, "The floor is lava!" and everyone has to hop off the ground onto something besides the hot, hot ground!
  • Use boxes like milk crates, stools, or dining room chairs to add height components to The Floor is Lava game.
  • Add a learning component by asking kids questions when they land on a safe space.  Think about incorporating spelling words, math facts, or memorization facts.
  • Play The Floor is Lava at the playground to add vestibular sensory components to the game. Don't touch the ground, it's hot!  Read more about the sensory benefits of the playground.
  • Make a Safe Island when playing a lava game.  Use a hula hoop and all kids can hop in the hoop to stay safe from that burning hot lava.  Don't hop out of the other side of the hoop to stay safe and to work on motor control.

Develop Skills While Playing The Floor is Lava

When playing these lava games, kids are developing and building so many skills!
  • Gross motor coordination
  • Core strength
  • Eye-body coordination
  • Visual motor skills
  • Motor planning
  • Balance
  • Attention
  • Vestibular sensory tolerance 
  • Proprioceptive sensory tolerance
  • Impulse control

Do your kids play The Floor is Lava?  Did you play as a child?  Introduce your kids to some of these versions of the lava game and boost movement and development skills at the same time!

Play these The Floor is Lava Games with your kids to build development of skills like motor control, sensory input, motor planning, gross motor skills, core strength, and balance.

Working on Handwriting?