Post on 22-Jan-2016
Sensory Sensory Processing Processing Disorder: Disorder:
Identification Identification and Intervention and Intervention
Linda King-Thomas MHS, OTR/LLinda King-Thomas MHS, OTR/L
Developmental Therapy Developmental Therapy AssociatesAssociates
Durham and CaryDurham and Cary
www.developmentaltherapy.comwww.developmentaltherapy.com
Sensory IntegrationSensory Integration
Sensory integration is the neurological Sensory integration is the neurological process that organizes sensation from process that organizes sensation from one’s own body and from the one’s own body and from the environment and makes it possible to environment and makes it possible to use the body effectively within the use the body effectively within the environment.environment. Ayres (1972) Ayres (1972) Sensory Integration and Learning Sensory Integration and Learning DisordersDisorders p.11 p.11
Uses of the term Uses of the term Sensory IntegrationSensory Integration
Theory (sensory integration theory)Theory (sensory integration theory)
Diagnosis (based on an assessment)Diagnosis (based on an assessment) Sensory Processing Disorder (SPD)Sensory Processing Disorder (SPD)
Functional pattern (normal sensory Functional pattern (normal sensory integration abilities)integration abilities)
Remediation approach Remediation approach (therapy/intervention(therapy/intervention
Sensory SystemsSensory Systems Vestibular (movement and gravity)Vestibular (movement and gravity) Tactile (touch)Tactile (touch) Proprioceptive (“heavy work”, Proprioceptive (“heavy work”,
input to muscles and joints)input to muscles and joints) Auditory (hearing)Auditory (hearing) Visual (sight)Visual (sight) Olfactory (smell)Olfactory (smell) Gustatory (taste)Gustatory (taste)
Sensory Integration Sensory Integration Foundations for Learning Foundations for Learning
and Behaviorand Behavior
Sensory Processing Sensory Processing DisorderDisorder
Sensory Modulation DisorderSensory Modulation Disorder Sensory Over-ResponsivitySensory Over-Responsivity Sensory Under-ResponsivitySensory Under-Responsivity Sensory Seeking / CravingSensory Seeking / Craving
Sensory Discrimination DisorderSensory Discrimination Disorder
Sensory-Based Motor DisorderSensory-Based Motor Disorder Postural DisorderPostural Disorder DyspraxiaDyspraxia
Sensory Modulation Sensory Modulation DisorderDisorder
Difficulty modulating, discriminating Difficulty modulating, discriminating and organizing sensory inputand organizing sensory input
Difficulty with self-regulation, in terms Difficulty with self-regulation, in terms of arousal states, may be under or over of arousal states, may be under or over responsive to sensory inputresponsive to sensory input
Difficulty interacting effectively to Difficulty interacting effectively to demands of environment, relationships demands of environment, relationships and tasksand tasks
Difficulty adapting to challenges in Difficulty adapting to challenges in daily lifedaily life
Sensory Modulation Sensory Modulation DisorderDisorder
Sensory Over-Responsivity – quick or Sensory Over-Responsivity – quick or intense response to sensory stimuliintense response to sensory stimuli
Sensory Under-Responsivity -- slow Sensory Under-Responsivity -- slow response to sensory stimuli, requires a response to sensory stimuli, requires a high intensity or increased duration of high intensity or increased duration of stimuli to elicit a behavioral response stimuli to elicit a behavioral response
Sensory Seeking/Craving – actively Sensory Seeking/Craving – actively seeking sensation often in socially seeking sensation often in socially unacceptable wayunacceptable way
Sensory Over-Sensory Over-ResponsivityResponsivity
Covers ears with loud noises Covers ears with loud noises Is sensitive to bright lightsIs sensitive to bright lights Fears movement or changes in positionFears movement or changes in position Avoids touching certain textures (grass, Avoids touching certain textures (grass,
sand, finger paints, squishy)sand, finger paints, squishy) Does not like to get messyDoes not like to get messy Has strong clothing preferencesHas strong clothing preferences Does not like to be touched Does not like to be touched
unexpectedlyunexpectedly Has a poor tolerance to groomingHas a poor tolerance to grooming
Sensory Over-Sensory Over-ResponsivityResponsivity
Is often irritable, aggressive, impulsive, Is often irritable, aggressive, impulsive, and moodyand moody
Has a poor tolerance to transitionsHas a poor tolerance to transitions Frequently cries and is hard to consoleFrequently cries and is hard to console Does not like to be held or cuddledDoes not like to be held or cuddled Needs help to fall asleep and stay asleepNeeds help to fall asleep and stay asleep Exhibits extreme separation anxietyExhibits extreme separation anxiety Has difficulty transitions to new foodsHas difficulty transitions to new foods
Sensory Under-Sensory Under-Responsivity Responsivity
Has delayed reaction time Has delayed reaction time Is slow to respond to nameIs slow to respond to name Seems unaware of environment, Seems unaware of environment,
wanderswanders Has a high pain toleranceHas a high pain tolerance Does not sense when diaper is wetDoes not sense when diaper is wet Does not feel clothing twisted on bodyDoes not feel clothing twisted on body Does not feel food on face or in Does not feel food on face or in
mouth, or dirt on handsmouth, or dirt on hands
Sensory Under-Sensory Under-ResponsivityResponsivity
Does not seem to notice when touchedDoes not seem to notice when touched Has flat affect much of the timeHas flat affect much of the time Is hard to engage, may observe but not participateIs hard to engage, may observe but not participate Is unaware of body sensations (temperature, Is unaware of body sensations (temperature,
hunger)hunger) Does not seem to notice noxious odorsDoes not seem to notice noxious odors Appears slow, unmotivated, unaware,or withdrawnAppears slow, unmotivated, unaware,or withdrawn Seems to be ‘lost in fantasy world’Seems to be ‘lost in fantasy world’
Sensory Seeking Sensory Seeking
Has a high activity level, seldom sits Has a high activity level, seldom sits stillstill
Touches everythingTouches everything Hangs on people/objectsHangs on people/objects Smells or mouths everythingSmells or mouths everything Takes excessive risks that compromise Takes excessive risks that compromise
personal safetypersonal safety Prefers foods with strong flavorsPrefers foods with strong flavors Often mouths or licks non-food itemsOften mouths or licks non-food items
Sensory SeekingSensory Seeking
Seeks out loud noiseSeeks out loud noise Likes to watch bright/spinning Likes to watch bright/spinning
objectsobjects Is excessively affectionateIs excessively affectionate May be demanding or hard to calmMay be demanding or hard to calm Is a risk takerIs a risk taker Intrudes on othersIntrudes on others May be kicked out of child care or May be kicked out of child care or
expelled from preschoolexpelled from preschool
Influence on Play SkillsInfluence on Play Skills
Avoidance of handling toys and typical play Avoidance of handling toys and typical play materialsmaterials
Withdrawal from noisy play, toys that make Withdrawal from noisy play, toys that make soundssounds
Fearfulness of movement limits desire for Fearfulness of movement limits desire for exploration of the physical worldexploration of the physical world
Avoidance or lack of registration reduces vital Avoidance or lack of registration reduces vital developmental stimulationdevelopmental stimulation
Withdrawal from special childhood events such Withdrawal from special childhood events such as birthday parties, dressing up for Halloween as birthday parties, dressing up for Halloween and holiday partiesand holiday parties
Influence on Self-Care and Influence on Self-Care and FeedingFeeding
Avoidance and/or rejection of food Avoidance and/or rejection of food textures, tastes, smells, temperaturetextures, tastes, smells, temperature
Avoidance and/or rejection of tooth Avoidance and/or rejection of tooth brushing and bathingbrushing and bathing
Avoidance and/or rejection of hair Avoidance and/or rejection of hair brushing, hair washing, hair cuttingbrushing, hair washing, hair cutting
Avoidance and/or rejection of Avoidance and/or rejection of clothing textures and dressing clothing textures and dressing processprocess
Influence on School Related Influence on School Related ActivitiesActivities
Avoidance of classroom tools and Avoidance of classroom tools and materialsmaterials
Difficulty with participation in group Difficulty with participation in group activities which involve movement, activities which involve movement, touch or soundtouch or sound
Difficulty staying in lineDifficulty staying in line Difficulty self-regulation attention in Difficulty self-regulation attention in
the classroomthe classroom
Influence on Social Influence on Social ParticipationParticipation
Disruption of attachment relationships Disruption of attachment relationships due to approach/avoidance conflictdue to approach/avoidance conflict
Avoidance of a need to be in control, or Avoidance of a need to be in control, or aggression towards peersaggression towards peers
Disruption in ability to develop and Disruption in ability to develop and maintain friendships and love maintain friendships and love relationships in adultsrelationships in adults
Decreased perception of social Decreased perception of social acceptance which leads to decreased self-acceptance which leads to decreased self-esteem esteem
Sensory-Based Motor Sensory-Based Motor DisorderDisorder
Postural Disorder: difficulty stabilizing the body during Postural Disorder: difficulty stabilizing the body during movement or at rest to meet demands of a motor taskmovement or at rest to meet demands of a motor task
Dyspraxia: difficulty translating sensory information Dyspraxia: difficulty translating sensory information into planning and/or sequencing movement, especially into planning and/or sequencing movement, especially new or unfamiliarnew or unfamiliar
Postural DisorderPostural Disorder Fears movement due to inadequate Fears movement due to inadequate
postural controlpostural control Does not like ‘tummy time’Does not like ‘tummy time’ Has decreased muscle toneHas decreased muscle tone Seems weak compared to peersSeems weak compared to peers Loses balance easilyLoses balance easily Tires easily, has poor enduranceTires easily, has poor endurance Frequently trips and fallsFrequently trips and falls Appears lazy and unmotivatedAppears lazy and unmotivated Has difficulty using both hands and feet Has difficulty using both hands and feet
at the same time (bilateral coordination)at the same time (bilateral coordination)
DyspraxiaDyspraxia
Difficulty translating sensory Difficulty translating sensory information into ideas for movement, information into ideas for movement, planning, organizing and/or planning, organizing and/or sequencing movement, especially sequencing movement, especially new and unfamiliar actionsnew and unfamiliar actions
Can manifest as gross motor, fine Can manifest as gross motor, fine motor and/or oral-motor problemsmotor and/or oral-motor problems
DyspraxiaDyspraxia
Is clumsyIs clumsy Eats messilyEats messily Has a disheveled appearanceHas a disheveled appearance Uses toys the same way over and overUses toys the same way over and over Is rigid in play/routinesIs rigid in play/routines Frustrates easilyFrustrates easily Has trouble maneuvering around Has trouble maneuvering around
obstaclesobstacles Breaks things unintentionally Breaks things unintentionally
DyspraxiaDyspraxia
Has difficulty following directions for Has difficulty following directions for activities that require more than one stepactivities that require more than one step
Has trouble learning new skillsHas trouble learning new skills Is disorganizedIs disorganized Prefers ‘fantasy games’ over physical Prefers ‘fantasy games’ over physical
gamesgames Prefers sedentary activitiesPrefers sedentary activities Has delays in speech and/or motor skills Has delays in speech and/or motor skills
ranging from mild to severeranging from mild to severe
Influence on Play Skills Influence on Play Skills
Difficulty with playground activitiesDifficulty with playground activities Difficulty with manipulative and construction Difficulty with manipulative and construction
toystoys Difficulty with the sequence and rules of playDifficulty with the sequence and rules of play Difficulty with timing and sequencing of Difficulty with timing and sequencing of
body parts in sports and motor activitiesbody parts in sports and motor activities Directional confusion leads to poor spatial Directional confusion leads to poor spatial
organization with team sports.organization with team sports. Poor ideation leads to decreased play Poor ideation leads to decreased play
possibilitiespossibilities
Influence on Self-Care and Influence on Self-Care and FeedingFeeding
Slow in managing dressing fasteners and Slow in managing dressing fasteners and shoe tyingshoe tying
Difficulty in mastering the spatial Difficulty in mastering the spatial organization of clothingorganization of clothing
Problems managing tools for self-care Problems managing tools for self-care (hairbrush, washcloth, utensils)(hairbrush, washcloth, utensils)
Difficulty with food wrappersDifficulty with food wrappers Messy eaterMessy eater Disorganization with personal belongingsDisorganization with personal belongings
Influence on School Related Influence on School Related ActivitiesActivities
Poor and/or slow handwriting and Poor and/or slow handwriting and drawing skillsdrawing skills
Difficulty using classroom tools and Difficulty using classroom tools and materials effectively (scissors, glue materials effectively (scissors, glue bottle)bottle)
Disorganization of work space (desk, Disorganization of work space (desk, locker)locker)
Difficulty learning new skills through Difficulty learning new skills through imitation imitation
Influence on Social Influence on Social ParticipationParticipation
Social rejection by peers during games Social rejection by peers during games due to poor motor skillsdue to poor motor skills
Withdrawal from social situations due to Withdrawal from social situations due to poor self-esteempoor self-esteem
Difficulty discerning social and physical Difficulty discerning social and physical boundaries; poor social judgmentboundaries; poor social judgment
Disorganized peer interactions due to Disorganized peer interactions due to poor ability to read non-verbal cuespoor ability to read non-verbal cues
Tendency to be rigid and controllingTendency to be rigid and controlling
InterventionIntervention
Education/awarenessEducation/awareness reframe behavior (view) from a new reframe behavior (view) from a new
perspectiveperspective
Individual therapy using a sensory Individual therapy using a sensory integrative approachintegrative approach
Consultation model for home and schoolConsultation model for home and school Develop new strategies – sensory dietDevelop new strategies – sensory diet
ResearchResearch Roberts, J. E., King-Thomas, L., & Boccia, M. L. Roberts, J. E., King-Thomas, L., & Boccia, M. L.
(2007). Behavioral indexes of the efficacy of sensory (2007). Behavioral indexes of the efficacy of sensory integration therapy. integration therapy. AJOTAJOT, 61, 555-562, 61, 555-562
Single subject ABAB design: subject diagnosed with Single subject ABAB design: subject diagnosed with sensory modulation disorder and delayed sensory modulation disorder and delayed communication skillscommunication skills
Behavioral data collected by preschool teachers who Behavioral data collected by preschool teachers who were blind to the timing of sensory integration were blind to the timing of sensory integration therapytherapy
Improvements in behavioral regulation noted: Improvements in behavioral regulation noted: increased engagement & decreased aggression, increased engagement & decreased aggression, less need for intense teacher direction, decreased less need for intense teacher direction, decreased mouthing objectsmouthing objects
Research Research Miller, L. J., Coll, J. R., & Schoen, S. A. (2007). A Miller, L. J., Coll, J. R., & Schoen, S. A. (2007). A
randomized controlled pilot study of the randomized controlled pilot study of the effectiveness of occupational therapy for children effectiveness of occupational therapy for children with sensory modulation disorder. with sensory modulation disorder. AJOTAJOT, 61, , 61, 228-238.228-238.
Twenty-four children assigned to 1 of 3 treatment Twenty-four children assigned to 1 of 3 treatment groups: OT-SI, Activity Protocol, and No groups: OT-SI, Activity Protocol, and No TreatmentTreatment
Significant changes noted in OT-SI group on GAS Significant changes noted in OT-SI group on GAS (goal attainment scaling), attention, (goal attainment scaling), attention, Cognitive/Social composite of Leiter-R parent Cognitive/Social composite of Leiter-R parent ratingrating
Sensory DietSensory Diet
The daily intake of sensory and motor The daily intake of sensory and motor experiences needed by a person to experiences needed by a person to adaptively interact with the adaptively interact with the environmentenvironment
Sensory and motor experiences help Sensory and motor experiences help maintain optimal arousal and attention maintain optimal arousal and attention for learning for learning
Sensory diet formula: intensity, Sensory diet formula: intensity, frequency, duration, rhythm of input is frequency, duration, rhythm of input is varied to achieve optimal performancevaried to achieve optimal performance
Sensory Diet ActivitiesSensory Diet Activities
Specific to the individual based on Specific to the individual based on assessmentassessment
Planned throughout the day to help Planned throughout the day to help maintain optimal level of organizationmaintain optimal level of organization
Most powerful and long lasting include: Most powerful and long lasting include: movement, heavy work, deep touch movement, heavy work, deep touch pressurepressure
Sensation can have calming or alerting Sensation can have calming or alerting effecteffect
Sensory Diet Activities Sensory Diet Activities
Structure activities in a playful, non-Structure activities in a playful, non-threatening mannerthreatening manner
Closely monitor for an adaptive Closely monitor for an adaptive response -- more organized behaviorresponse -- more organized behavior
More sensation in not always better More sensation in not always better --observe for signs which might --observe for signs which might indicate an overstressed nervous indicate an overstressed nervous systemsystem
MovementMovement
Unstable surfaces: therapy ball, Unstable surfaces: therapy ball, air pillow, air pillow, air cushionair cushion
Games and calisthenicsGames and calisthenics Jumping, swinging, Jumping, swinging, Rocking, rolling, Rocking, rolling, Bouncing, Bouncing, Marching, dancingMarching, dancing
Heavy WorkHeavy Work
Carrying heavy objectsCarrying heavy objects Wheelbarrow walk, animal walksWheelbarrow walk, animal walks BackpackBackpack Digging in a gardenDigging in a garden Working out on weight machinesWorking out on weight machines Pulling friend in a wagonPulling friend in a wagon Pushing heavy grocery cartPushing heavy grocery cart SportsSports
Deep Pressure TouchDeep Pressure Touch
Weighted vest, Weighted vest, weighted blanketweighted blanket
Firm hugs, Firm hugs, massagemassage
Lycra exercise Lycra exercise shorts or tights shorts or tights under clothing under clothing
Games: Games: rough house playrough house play tactile sandwichtactile sandwich
Oral MotorOral Motor
Suck: long straw or thick liquids; Suck: long straw or thick liquids; sour, sweet, spicy hot candysour, sweet, spicy hot candy
Blow: whistles; bubblesBlow: whistles; bubbles
Chew and crunch: gum, popcorn, Chew and crunch: gum, popcorn, dried fruit, bagel, pretzels; chewy dried fruit, bagel, pretzels; chewy tube, straws tube, straws
Womb SpacesWomb Spaces
Under a table or deskUnder a table or desk Tent or sleeping bagTent or sleeping bag Inside a closet or other small space Inside a closet or other small space
(box)(box) Pillow in a corner of the roomPillow in a corner of the room Creating small space feeling with Creating small space feeling with
furniture positionfurniture position
TactileTactile Hand toys to fidget: koosh balls, Hand toys to fidget: koosh balls,
silly putty, bendable figures, small silly putty, bendable figures, small stuffed animals, pieces of soft fabricstuffed animals, pieces of soft fabric
Extra toweling after the bathExtra toweling after the bath Tactile fine motor activities Tactile fine motor activities
kneading bread kneading bread sand playsand play bean playbean play finger paintingfinger painting
Tactile StrategiesTactile Strategies
Temperature: cool is alerting, warm Temperature: cool is alerting, warm is calmingis calming
Clothing preferences: long sleeve, Clothing preferences: long sleeve, short sleeve, cut out tags, sport short sleeve, cut out tags, sport socks (no seams)socks (no seams)
Bed clothes: flannel sheets, heavy Bed clothes: flannel sheets, heavy blanket, light sheetblanket, light sheet
Light touch (tickling): alertingLight touch (tickling): alerting
Auditory StrategiesAuditory Strategies
Soft music-- Mozart, fast music -- Soft music-- Mozart, fast music -- driving beatdriving beat
Ear muffs, headphonesEar muffs, headphones White noise machine, water White noise machine, water
fountain, soft background musicfountain, soft background music Voice quality -- high or low pitchVoice quality -- high or low pitch
Visual StrategiesVisual Strategies
Soft dim lightsSoft dim lights Natural light, avoid fluorescent lightNatural light, avoid fluorescent light Muted colors and plain wallsMuted colors and plain walls Bright lightsBright lights Movement in peripheral visual fieldMovement in peripheral visual field Lots of colorLots of color
Resources BooksResources Books Heller, S. (2002). Too Loud, Too Bright, Heller, S. (2002). Too Loud, Too Bright,
Too Fast, Too Tight. New York: Too Fast, Too Tight. New York: HarperCollins Publishers.HarperCollins Publishers.
Henry, D., Kane-Wineland, M., Henry, D., Kane-Wineland, M., Swindeman, S., (2007). Tools for Tots: Swindeman, S., (2007). Tools for Tots: Sensory Strategies for Toddlers and Sensory Strategies for Toddlers and Preschoolers. Glendale, AZ: Henry OT Preschoolers. Glendale, AZ: Henry OT Services.Services.
Isbell, C. & Isbell, R. (2007). Sensory Isbell, C. & Isbell, R. (2007). Sensory Integration A Guide for Preschool Integration A Guide for Preschool Teachers. Beltsville, MD: Gryphon Teachers. Beltsville, MD: Gryphon House.House.
Resources BooksResources Books Kranowitz, C. (2005). The Out-of-Sync Kranowitz, C. (2005). The Out-of-Sync
Child. New York: Penguin Group.Child. New York: Penguin Group. Miller, L. J. (2006). Sensational Kids. Miller, L. J. (2006). Sensational Kids.
New York: Penguin Group.New York: Penguin Group. Williams, M. S., Shellengerger, S. (2001). Williams, M. S., Shellengerger, S. (2001).
Take Five! Staying Alert at Home and Take Five! Staying Alert at Home and School. Albuquerque, NM: School. Albuquerque, NM: TherapyWorks, Inc.TherapyWorks, Inc.
Yack, E., Aquilla, P. & Sutton, S. (2002). Yack, E., Aquilla, P. & Sutton, S. (2002). Building Bridges through Sensory Building Bridges through Sensory Integration. Las Vegas: Sensory Integration. Las Vegas: Sensory Resources.Resources.
Resources catalogs Resources catalogs Abilitations 1-800-850-8602 Abilitations 1-800-850-8602
www.abilitations.com Fun and Function 1-800-231-6329 Fun and Function 1-800-231-6329
www.FunANDFunction.com Sensory Critters 1-866-749-2737 Sensory Critters 1-866-749-2737
www.SensoryCritters.com Southpaw Products 1-800-228-1698Southpaw Products 1-800-228-1698
www.southpawenterprises.com Therapy Skill Builders 1-800-872-Therapy Skill Builders 1-800-872-
1726 1726 www.psychcorp.com
Resources on the webResources on the web
Sensory Processing Disorder Sensory Processing Disorder FoundationFoundation www.spdfoundation.net
SI Focus magazine SI Focus magazine www.sifocus.com
Developmental Therapy AssociatesDevelopmental Therapy Associates www.developmentaltherapy.com