Presentation expands on the specific problems persons with SPD have. Also gives a checklist of characteristic behaviors and issues in persons w/Sensory Processing.

1. Sensory Processing DisorderSensory Processing Disorder
(SPD)(SPD)
By Kimmer Collison-RisBy Kimmer Collison-Ris
MSN, FNP-C, WOCN, MS CAMMSN, FNP-C, WOCN, MS CAM

2. What is SPD?What is SPD?
 Sensory Processing is the way theSensory Processing is the way the
nervous system receives messagesnervous system receives messages
from the senses; converting them intofrom the senses; converting them into
motor and behavioral responses.motor and behavioral responses.
 SPD is also known as "sensorySPD is also known as "sensory
integration dysfunction"integration dysfunction"
 SPD sensory signals don't getSPD sensory signals don't get
organized into appropriate responsesorganized into appropriate responses
 A. Jean Ayres, PhD, compared SPDA. Jean Ayres, PhD, compared SPD
to a neurological "traffic jam" thatto a neurological "traffic jam" that
prevents certain parts of the brainprevents certain parts of the brain
from receiving the information neededfrom receiving the information needed
to interpret sensory informationto interpret sensory information
correctlycorrectly
www.rollingrains.com

3. SPD & Brain FunctionSPD & Brain Function
One study (Ahn, Miller, Milberger, McIntosh, 2004) shows that at least 1 in 20 children’s daily lives is
affected by SPD. Another research study (Ben-Sasson, Carter, Briggs-Gowen, 2009) suggests that 1 in
every 6 children experiences sensory symptoms that may be significant enough to affect aspects of
everyday life functions.

4. Sensory ProcessingSensory Processing
 "Countless bits of sensory"Countless bits of sensory
information enter our brain atinformation enter our brain at
every moment, not only fromevery moment, not only from
our eyes and ears, but alsoour eyes and ears, but also
from every place in ourfrom every place in our
bodies”.bodies”.
 ““The brain must organize andThe brain must organize and
integrate all of theseintegrate all of these
sensations if a person is tosensations if a person is to
move and learn normally.”move and learn normally.”
• Williams & Shellenberger's,Williams & Shellenberger's, HowHow
Does Your Engine Run? ADoes Your Engine Run? A
Leader's Guide to The AlertLeader's Guide to The Alert
Program for Self-RegulationProgram for Self-Regulation

5. SPD…SPD…
 most commonly diagnosed inmost commonly diagnosed in
childrenchildren
 occurs within a broad spectrumoccurs within a broad spectrum
of severityof severity
 difficulties are chronic, anddifficulties are chronic, and
disrupt everyday life for childrendisrupt everyday life for children
& adults& adults
 Untreated SPD that persistsUntreated SPD that persists
into adulthood can affect aninto adulthood can affect an
individual's ability to succeed inindividual's ability to succeed in
marriage, work, and socialmarriage, work, and social
environmentsenvironments

6. speech-language-pathology-audiology.advanceweb.com

7. HeredityHeredity
 Researchers believe sensory integrationResearchers believe sensory integration
issues can be inheritedissues can be inherited
 Implies there is a genetic coding for theImplies there is a genetic coding for the
causes of SPD.causes of SPD.
 Prenatal and birth complications, such asPrenatal and birth complications, such as
preemies or fetal alcohol syndrome, havepreemies or fetal alcohol syndrome, have
also been blamed for some cases ofalso been blamed for some cases of
sensory challengessensory challenges

8. Environmental FactorsEnvironmental Factors
 What appears to contribute to a rise in sensory processing difficulties?What appears to contribute to a rise in sensory processing difficulties?

Exposure to environmental toxinsExposure to environmental toxins

or inability of a child to fight off these toxinsor inability of a child to fight off these toxins

http://www.livestrong.com/article/19379-causes-sensory-processing-disorder/#ixzz1QPUixOhttp://www.livestrong.com/article/19379-causes-sensory-processing-disorder/#ixzz1QPUixO

9. SPD Common w/Other DisordersSPD Common w/Other Disorders
 Sensory processing disorder (SPD) very common in childrenSensory processing disorder (SPD) very common in children

AutismAutism

ADHDADHD

fragile X syndromefragile X syndrome

http://www.livestrong.com/article/19379-causes-sensory-processing-disorder/#ixzz1QPUihttp://www.livestrong.com/article/19379-causes-sensory-processing-disorder/#ixzz1QPUi

10. Nutritional Deficiences ImpactNutritional Deficiences Impact
 Children who commonly haveChildren who commonly have
sensory problemssensory problems

picky eaterspicky eaters

or have food allergiesor have food allergies
 Many parents believe a lackMany parents believe a lack
of certain nutrients plays aof certain nutrients plays a
role in sensory integrationrole in sensory integration
issuesissues
• http://www.livestrong.com/article/1937http://www.livestrong.com/article/1937

11. DefinitionDefinition
 Sensory Processing DisorderSensory Processing Disorder
(SPD) is(SPD) is
 the inability to properlythe inability to properly
perceive and interpretperceive and interpret
sensory information throughsensory information through
the senses that affects dailythe senses that affects daily
functioning.functioning.
 Previously referred to asPreviously referred to as
Sensory IntegrationSensory Integration
Dysfunction, SPD is not oneDysfunction, SPD is not one
specific disorder.specific disorder.

http://www.child-behavior-guide.cohttp://www.child-behavior-guide.co

12. "Five Caveats""Five Caveats"
 1. "The child with sensory dysfunction does not1. "The child with sensory dysfunction does not
necessarily exhibit every characteristic.necessarily exhibit every characteristic.

ie: child with vestibular dysfunction may have poor balance butie: child with vestibular dysfunction may have poor balance but
good muscle tone."good muscle tone."
 2. "Sometimes the child will show characteristics of a2. "Sometimes the child will show characteristics of a
dysfunction one day but not the next.dysfunction one day but not the next.

ie: child with proprioceptive problems may trip over every bump inie: child with proprioceptive problems may trip over every bump in
the pavement on Friday yet score every soccer goal on Saturday.the pavement on Friday yet score every soccer goal on Saturday.
 Inconsistency is a hallmark of every neurologicalInconsistency is a hallmark of every neurological
dysfunction.dysfunction. ""
3. "The child may exhibit characteristics of a particular3. "The child may exhibit characteristics of a particular
dysfunction yet not have that dysfunction.dysfunction yet not have that dysfunction.

Ie: the child who typically withdraws from being touched may seemIe: the child who typically withdraws from being touched may seem
to be hypersensitive to tactile stimulation but may, instead, haveto be hypersensitive to tactile stimulation but may, instead, have
an emotional problem."an emotional problem."

13. ““5 Caveats”....5 Caveats”....
 4. "The child may be both hypersensitive and4. "The child may be both hypersensitive and
hyposensitive.hyposensitive.

ie: the child may be extremely sensitive to light touch, jerkingie: the child may be extremely sensitive to light touch, jerking
away from a soft pat on the shoulder, while being ratheraway from a soft pat on the shoulder, while being rather
indifferent to the deep pain of an inocculation."indifferent to the deep pain of an inocculation."
 5. "Everyone has some sensory integration problems5. "Everyone has some sensory integration problems
now and then, because no one is well regulated all thenow and then, because no one is well regulated all the
time.time.
 All kinds of stimuli can temporarily disrupt normalAll kinds of stimuli can temporarily disrupt normal
functioning of the brain,functioning of the brain,

either by overloading it of sensory stimulationeither by overloading it of sensory stimulation

Or by depriving it of sensory stimulation."Or by depriving it of sensory stimulation."
• Carol Stock KranowitzCarol Stock Kranowitz ""The Out-Of-Sync ChildThe Out-Of-Sync Child"" (1995)(1995)

15. Signs Of Tactile DysfunctionSigns Of Tactile Dysfunction
 __ becomes fearful, anxious or aggressive with__ becomes fearful, anxious or aggressive with
light or unexpected touchlight or unexpected touch
__ as an infant, did/does not like to be held or__ as an infant, did/does not like to be held or
cuddled; may arch back, cry, and pull awaycuddled; may arch back, cry, and pull away
__ distressed when diaper is being, or needs to__ distressed when diaper is being, or needs to
be, changedbe, changed
__ appears fearful of, or avoids standing in__ appears fearful of, or avoids standing in
close proximity to other people or peersclose proximity to other people or peers
(especially in lines)(especially in lines)
__ becomes frightened when touched from__ becomes frightened when touched from
behind or by someone/something they can notbehind or by someone/something they can not
see (such as under a blanket)see (such as under a blanket)
__ complains about having hair brushed; may__ complains about having hair brushed; may
be very picky about using a particular brushbe very picky about using a particular brush
__ bothered by rough bed sheets (i.e., if old__ bothered by rough bed sheets (i.e., if old
and "bumpy")and "bumpy")
__ avoids group situations for fear of the__ avoids group situations for fear of the
unexpected touchunexpected touch
__ resists friendly or affectionate touch from__ resists friendly or affectionate touch from
anyone besides parents or siblings (andanyone besides parents or siblings (and
sometimes them too!)sometimes them too!)

16. Signs Of Tactile Dfxn cont.Signs Of Tactile Dfxn cont.
 __ prefers hugs__ prefers hugs
__ a raindrop, water from the shower, or wind blowing on the skin may feel__ a raindrop, water from the shower, or wind blowing on the skin may feel
like torture and produce adverse and avoidance reactionslike torture and produce adverse and avoidance reactions
__ may overreact to minor cuts, scrapes, and or bug bites__ may overreact to minor cuts, scrapes, and or bug bites
__ avoids touching certain textures of material (blankets, rugs, stuffed__ avoids touching certain textures of material (blankets, rugs, stuffed
animals)animals)
__ refuses to wear new or stiff clothes, clothes with rough textures,__ refuses to wear new or stiff clothes, clothes with rough textures,
turtlenecks, jeans, hats, or belts, etc.turtlenecks, jeans, hats, or belts, etc.
__ avoids using hands for play__ avoids using hands for play
__ avoids/dislikes/aversive to "messy play", i.e., sand, mud, water, glue,__ avoids/dislikes/aversive to "messy play", i.e., sand, mud, water, glue,
glitter, playdoh, slime, shaving cream/funny foam etc.glitter, playdoh, slime, shaving cream/funny foam etc.
__ will be distressed by dirty hands and want to wipe or wash them__ will be distressed by dirty hands and want to wipe or wash them
frequentlyfrequently
__ excessively ticklish__ excessively ticklish
__ distressed by seams in socks and may refuse to wear them__ distressed by seams in socks and may refuse to wear them

17. Signs Of Tactile Dfxn cont.Signs Of Tactile Dfxn cont.
 __dislikes kisses, will "wipe off" place where kissed__dislikes kisses, will "wipe off" place where kissed
__ distressed by clothes rubbing on skin; may want to wear shorts and short__ distressed by clothes rubbing on skin; may want to wear shorts and short
sleeves year round, toddlers may prefer to be naked and pull diapers andsleeves year round, toddlers may prefer to be naked and pull diapers and
clothes off constantlyclothes off constantly
__ or, may want to wear long sleeve shirts and long pants year round to__ or, may want to wear long sleeve shirts and long pants year round to
avoid having skin exposedavoid having skin exposed
__ distressed about having face washed__ distressed about having face washed
__ distressed about having hair, toenails, or fingernails cut__ distressed about having hair, toenails, or fingernails cut
__ resists brushing teeth and is extremely fearful of the dentist__ resists brushing teeth and is extremely fearful of the dentist
__ is a picky eater, only eating certain tastes and textures; mixed textures__ is a picky eater, only eating certain tastes and textures; mixed textures
tend to be avoided as well as hot or cold foods; resists trying new foodstend to be avoided as well as hot or cold foods; resists trying new foods
__ may refuse to walk barefoot on grass or sand__ may refuse to walk barefoot on grass or sand
__ may walk on toes only__ may walk on toes only

18. Hyposensitivity To Touch (Under-Responsive)Hyposensitivity To Touch (Under-Responsive)
 __ may crave touch, needs to touch everything and__ may crave touch, needs to touch everything and
everyoneeveryone
__ is not aware of being touched/bumped unless done with__ is not aware of being touched/bumped unless done with
extreme force or intensityextreme force or intensity
__ is not bothered by injuries, like cuts and bruises, and__ is not bothered by injuries, like cuts and bruises, and
shows no distress with shots (may even say they loveshows no distress with shots (may even say they love
getting shots!)getting shots!)
__ may not be aware that hands or face are dirty or feel__ may not be aware that hands or face are dirty or feel
his/her nose runninghis/her nose running
__ may be self-abusive; pinching, biting, or banging his own__ may be self-abusive; pinching, biting, or banging his own
headhead
__ mouths objects excessively__ mouths objects excessively

19. Hyposensitivity To Touch (Under-Responsive)Hyposensitivity To Touch (Under-Responsive)
 ____ frequently hurts other children or pets whilefrequently hurts other children or pets while
playingplaying
__ repeatedly touches surfaces or objects that__ repeatedly touches surfaces or objects that
are soothing (i.e., blanket)are soothing (i.e., blanket)
__ seeks out surfaces and textures that provide__ seeks out surfaces and textures that provide
strong tactile feedbackstrong tactile feedback
__ thoroughly enjoys and seeks out messy play__ thoroughly enjoys and seeks out messy play
__ craves vibrating or strong sensory input__ craves vibrating or strong sensory input
__ has a preference and craving for excessively__ has a preference and craving for excessively
spicy, sweet, sour, or salty foodsspicy, sweet, sour, or salty foods

20. Poor Tactile Perception And DiscriminationPoor Tactile Perception And Discrimination
 __ has difficulty with fine motor tasks such as buttoning, zipping,__ has difficulty with fine motor tasks such as buttoning, zipping,
and fastening clothesand fastening clothes
__ may not be able to identify which part of their body was touched__ may not be able to identify which part of their body was touched
if they were not lookingif they were not looking
__ may be afraid of the dark__ may be afraid of the dark
__ may be a messy dresser; looks disheveled, does not notice__ may be a messy dresser; looks disheveled, does not notice
pants are twisted, shirt is half un tucked, shoes are untied, one pantpants are twisted, shirt is half un tucked, shoes are untied, one pant
leg is up and one is down, etc.leg is up and one is down, etc.
__ has difficulty using scissors, crayons, or silverware__ has difficulty using scissors, crayons, or silverware
__ continues to mouth objects to explore them even after age two__ continues to mouth objects to explore them even after age two
__ has difficulty figuring out physical characteristics of objects;__ has difficulty figuring out physical characteristics of objects;
shape, size, texture, temperature, weight, etc.shape, size, texture, temperature, weight, etc.
__ may not be able to identify objects by feel, uses vision to help;__ may not be able to identify objects by feel, uses vision to help;
such as, reaching into backpack or desk to retrieve an itemsuch as, reaching into backpack or desk to retrieve an item

21. Vestibular Sense:Vestibular Sense:
 Input from the inner ear about equilibrium,Input from the inner ear about equilibrium,
gravitational changes, movementgravitational changes, movement
experiences, and position in space.experiences, and position in space.
Signs Of Vestibular Dysfunction
1. Hypersensitivity To Movement (Over-Responsive)
2. Hyposensitivity To Movement (Under-Responsive
3. Poor Muscle Tone And/Or Coordination

22. Hypersensitivity To MovementHypersensitivity To Movement
(Over-Responsive)(Over-Responsive)
 __ avoids/dislikes playground equipment; i.e., swings, ladders,__ avoids/dislikes playground equipment; i.e., swings, ladders,
slides, or merry-go-roundsslides, or merry-go-rounds
__ prefers sedentary tasks, moves slowly and cautiously, avoids__ prefers sedentary tasks, moves slowly and cautiously, avoids
taking risks, and may appear "wimpy"taking risks, and may appear "wimpy"
__ avoids/dislikes elevators and escalators; may prefer sitting while__ avoids/dislikes elevators and escalators; may prefer sitting while
they are on them or, actually get motion sickness from themthey are on them or, actually get motion sickness from them
__ may physically cling to an adult they trust__ may physically cling to an adult they trust
__ may appear terrified of falling even when there is no real risk of it__ may appear terrified of falling even when there is no real risk of it
__ afraid of heights, even the height of a curb or step__ afraid of heights, even the height of a curb or step
__ fearful of feet leaving the ground__ fearful of feet leaving the ground
__ fearful of going up or down stairs or walking on uneven surfaces__ fearful of going up or down stairs or walking on uneven surfaces

23. Hypersensitivity To MovementHypersensitivity To Movement
(Over-Responsive)(Over-Responsive)
 __ afraid of being tipped upside down, sideways or backwards; will__ afraid of being tipped upside down, sideways or backwards; will
strongly resist getting hair washed over the sinkstrongly resist getting hair washed over the sink
__ startles if someone else moves them; i.e., pushing his/her chair__ startles if someone else moves them; i.e., pushing his/her chair
closer to the tablecloser to the table
__ as an infant, may never have liked baby swings or jumpers__ as an infant, may never have liked baby swings or jumpers
__ may be fearful of, and have difficulty riding a bike, jumping,__ may be fearful of, and have difficulty riding a bike, jumping,
hopping, or balancing on one foot (especially if eyes are closed)hopping, or balancing on one foot (especially if eyes are closed)
__ may have disliked being placed on stomach as an infant__ may have disliked being placed on stomach as an infant
__ loses balance easily and may appear clumsy__ loses balance easily and may appear clumsy
__ fearful of activities which require good balance__ fearful of activities which require good balance
__ avoids rapid or rotating movements__ avoids rapid or rotating movements

24. Hyposensitivity To MovementHyposensitivity To Movement
(Under-Responsive)(Under-Responsive)
 __ in constant motion, can't seem to sit still__ in constant motion, can't seem to sit still
__ craves fast, spinning, and/or intense movement experiences__ craves fast, spinning, and/or intense movement experiences
__ loves being tossed in the air__ loves being tossed in the air
__ could spin for hours and never appear to be dizzy__ could spin for hours and never appear to be dizzy
__ loves the fast, intense, and/or scary rides at amusement parks__ loves the fast, intense, and/or scary rides at amusement parks
__ always jumping on furniture, trampolines, spinning in a swivel chair, or__ always jumping on furniture, trampolines, spinning in a swivel chair, or
getting into upside down positionsgetting into upside down positions
__ loves to swing as high as possible and for long periods of time__ loves to swing as high as possible and for long periods of time
__ is a "thrill-seeker"; dangerous at times__ is a "thrill-seeker"; dangerous at times
__ always running, jumping, hopping etc. instead of walking__ always running, jumping, hopping etc. instead of walking
__ rocks body, shakes leg, or head while sitting__ rocks body, shakes leg, or head while sitting
__ likes sudden or quick movements, such as, going over a big bump in the__ likes sudden or quick movements, such as, going over a big bump in the
car or on a bikecar or on a bike

25. Poor Muscle Tone And/Or Coordination
 __ has a limp, "floppy" body__ has a limp, "floppy" body
__ frequently slumps, lies down, and/or leans head on hand or arm while__ frequently slumps, lies down, and/or leans head on hand or arm while
working at his/her deskworking at his/her desk
__ difficulty simultaneously lifting head, arms, and legs off the floor while__ difficulty simultaneously lifting head, arms, and legs off the floor while
lying on stomach ("superman" position)lying on stomach ("superman" position)
__ often sits in a "W sit" position on the floor to stabilize body__ often sits in a "W sit" position on the floor to stabilize body
__ fatigues easily!__ fatigues easily!
__ compensates for "looseness" by grasping objects tightly__ compensates for "looseness" by grasping objects tightly
__ difficulty turning doorknobs, handles, opening and closing items__ difficulty turning doorknobs, handles, opening and closing items
__ difficulty catching him/her self if falling__ difficulty catching him/her self if falling
__ difficulty getting dressed and doing fasteners, zippers, and buttons__ difficulty getting dressed and doing fasteners, zippers, and buttons

26. Poor Muscle Tone And/Or Coordination
 __ may have never crawled as an baby__ may have never crawled as an baby
__ has poor body awareness; bumps into things, knocks things__ has poor body awareness; bumps into things, knocks things
over, trips, and/or appears clumsyover, trips, and/or appears clumsy
__ poor gross motor skills; jumping, catching a ball, jumping jacks,__ poor gross motor skills; jumping, catching a ball, jumping jacks,
climbing a ladder etc.climbing a ladder etc.
__ poor fine motor skills; difficulty using "tools", such as pencils,__ poor fine motor skills; difficulty using "tools", such as pencils,
silverware, combs, scissors etc.silverware, combs, scissors etc.
__ may appear ambidextrous, frequently switching hands for__ may appear ambidextrous, frequently switching hands for
coloring, cutting, writing etc.; does not have an established handcoloring, cutting, writing etc.; does not have an established hand
preference/dominance by 4 or 5 years oldpreference/dominance by 4 or 5 years old
__ has difficulty licking an ice cream cone__ has difficulty licking an ice cream cone
__ seems to be unsure about how to move body during movement,__ seems to be unsure about how to move body during movement,
for example, stepping over somethingfor example, stepping over something
__ difficulty learning exercise or dance steps__ difficulty learning exercise or dance steps

27. Proprioceptive SenseProprioceptive Sense
 Input from theInput from the
muscles and jointsmuscles and joints
about body position,about body position,
weight, pressure,weight, pressure,
stretch, movement,stretch, movement,
and changes inand changes in
position in spaceposition in space..
Signs Of Proprioceptive Dysfunction
1. Sensory Seeking Behaviors
2. Difficulty With "Grading Of Movement“

28. Sensory Seeking BehaviorsSensory Seeking Behaviors
 __ seeks out jumping, bumping, and crashing activities__ seeks out jumping, bumping, and crashing activities
__ stomps feet when walking__ stomps feet when walking
__ kicks his/her feet on floor or chair while sitting at desk/table__ kicks his/her feet on floor or chair while sitting at desk/table
__ bites or sucks on fingers and/or frequently cracks his/her__ bites or sucks on fingers and/or frequently cracks his/her
knucklesknuckles
__ loves to be tightly wrapped in many or weighted blankets,__ loves to be tightly wrapped in many or weighted blankets,
especially at bedtimeespecially at bedtime
__ prefers clothes (and belts, hoods, shoelaces) to be as tight as__ prefers clothes (and belts, hoods, shoelaces) to be as tight as
possiblepossible
__ loves/seeks out "squishing" activities__ loves/seeks out "squishing" activities
__ enjoys bear hugs__ enjoys bear hugs
__ excessive banging on/with toys and objects__ excessive banging on/with toys and objects

29. Sensory Seeking BehaviorsSensory Seeking Behaviors
 __ loves "roughhousing" and tackling/wrestling games__ loves "roughhousing" and tackling/wrestling games
__ frequently falls on floor intentionally__ frequently falls on floor intentionally
__ would jump on a trampoline for hours on end__ would jump on a trampoline for hours on end
__ grinds his/her teeth throughout the day__ grinds his/her teeth throughout the day
__ loves pushing/pulling/dragging objects__ loves pushing/pulling/dragging objects
__ loves jumping off furniture or from high places__ loves jumping off furniture or from high places
__ frequently hits, bumps or pushes other children__ frequently hits, bumps or pushes other children
__ chews on pens, straws, shirt sleeves etc.__ chews on pens, straws, shirt sleeves etc.

30. Difficulty w/"Grading Of Movement“Difficulty w/"Grading Of Movement“
 ____ misjudges how muchmisjudges how much
to flex and extend musclesto flex and extend muscles
during tasks/activities (i.e.,during tasks/activities (i.e.,
putting arms into sleevesputting arms into sleeves
or climbing)or climbing)
__ difficulty regulating__ difficulty regulating
pressure whenpressure when
writing/drawing; may bewriting/drawing; may be
too light to see or so hardtoo light to see or so hard
the tip of writing utensilthe tip of writing utensil
breaksbreaks
__ written work is messy__ written work is messy
and he/she often rips theand he/she often rips the
paper when erasingpaper when erasing
__ always seems to be__ always seems to be
breaking objects and toysbreaking objects and toys

31. Difficulty w/"Grading Of Movement“Difficulty w/"Grading Of Movement“
 __ misjudges the weight of an__ misjudges the weight of an
object, such as a glass of juice,object, such as a glass of juice,
picking it up with too muchpicking it up with too much
force sending it flying orforce sending it flying or
spilling, or with too little forcespilling, or with too little force
and complaining about objectsand complaining about objects
being too heavybeing too heavy
__ may not understand the__ may not understand the
idea of "heavy" or "light"; wouldidea of "heavy" or "light"; would
not be able to hold two objectsnot be able to hold two objects
and tell you which weighs moreand tell you which weighs more
__ seems to do everything with__ seems to do everything with
too much force; i.e., walking,too much force; i.e., walking,
slamming doors, pressingslamming doors, pressing
things too hard, slammingthings too hard, slamming
objects downobjects down
__ plays with animals with too__ plays with animals with too
much force, often hurting themmuch force, often hurting them

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