Sensory Processing Disorder: Identification and Intervention

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Sensory Processing Disorder Identification and
Intervention

• Linda King-Thomas MHS, OTR/L
• Developmental Therapy Associates
• Durham and Cary
• www.developmentaltherapy.com

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Sensory Integration
Sensory integration is the neurological process
that organizes sensation from ones own body and
from the environment and makes it possible to use
the body effectively within the environment.
Ayres (1972) Sensory Integration and Learning
Disorders p.11
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Uses of the term Sensory Integration

• Theory (sensory integration theory)
• Diagnosis (based on an assessment)
• Sensory Processing Disorder (SPD)
• Functional pattern (normal sensory integration
  abilities)
• Remediation approach (therapy/intervention

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Sensory Systems

• Vestibular (movement and gravity)
• Tactile (touch)
• Proprioceptive (heavy work, input to muscles
  and joints)
• Auditory (hearing)
• Visual (sight)
• Olfactory (smell)
• Gustatory (taste)

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Sensory Integration Foundations for Learning and
Behavior
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Sensory Processing Disorder

• Sensory Modulation Disorder
• Sensory Over-Responsivity
• Sensory Under-Responsivity
• Sensory Seeking / Craving
• Sensory Discrimination Disorder
• Sensory-Based Motor Disorder
• Postural Disorder
• Dyspraxia

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Sensory Modulation Disorder

• Difficulty modulating, discriminating and
  organizing sensory input
• Difficulty with self-regulation, in terms of
  arousal states, may be under or over responsive
  to sensory input
• Difficulty interacting effectively to demands of
  environment, relationships and tasks
• Difficulty adapting to challenges in daily life

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Sensory Modulation Disorder

• Sensory Over-Responsivity quick or intense
  response to sensory stimuli
• Sensory Under-Responsivity -- slow response to
  sensory stimuli, requires a high intensity or
  increased duration of stimuli to elicit a
  behavioral response
• Sensory Seeking/Craving actively seeking
  sensation often in socially unacceptable way

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Alertness / Arousal States
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Sensory Over-Responsivity

• Covers ears with loud noises
• Is sensitive to bright lights
• Fears movement or changes in position
• Avoids touching certain textures (grass, sand,
  finger paints, squishy)
• Does not like to get messy
• Has strong clothing preferences
• Does not like to be touched unexpectedly
• Has a poor tolerance to grooming

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Sensory Over-Responsivity

• Is often irritable, aggressive, impulsive, and
  moody
• Has a poor tolerance to transitions
• Frequently cries and is hard to console
• Does not like to be held or cuddled
• Needs help to fall asleep and stay asleep
• Exhibits extreme separation anxiety
• Has difficulty transitions to new foods

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Sensory Under-Responsivity

• Has delayed reaction time
• Is slow to respond to name
• Seems unaware of environment, wanders
• Has a high pain tolerance
• Does not sense when diaper is wet
• Does not feel clothing twisted on body
• Does not feel food on face or in mouth, or dirt
  on hands

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Sensory Under-Responsivity

• Does not seem to notice when touched
• Has flat affect much of the time
• Is hard to engage, may observe but not
  participate
• Is unaware of body sensations (temperature,
  hunger)
• Does not seem to notice noxious odors
• Appears slow, unmotivated, unaware,or withdrawn
• Seems to be lost in fantasy world

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Sensory Seeking

• Has a high activity level, seldom sits still
• Touches everything
• Hangs on people/objects
• Smells or mouths everything
• Takes excessive risks that compromise personal
  safety
• Prefers foods with strong flavors
• Often mouths or licks non-food items

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Sensory Seeking

• Seeks out loud noise
• Likes to watch bright/spinning objects
• Is excessively affectionate
• May be demanding or hard to calm
• Is a risk taker
• Intrudes on others
• May be kicked out of child care or expelled from
  preschool

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Influence on Play Skills

• Avoidance of handling toys and typical play
  materials
• Withdrawal from noisy play, toys that make sounds
• Fearfulness of movement limits desire for
  exploration of the physical world
• Avoidance or lack of registration reduces vital
  developmental stimulation
• Withdrawal from special childhood events such as
  birthday parties, dressing up for Halloween and
  holiday parties

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Influence on Self-Care and Feeding

• Avoidance and/or rejection of food textures,
  tastes, smells, temperature
• Avoidance and/or rejection of tooth brushing and
  bathing
• Avoidance and/or rejection of hair brushing, hair
  washing, hair cutting
• Avoidance and/or rejection of clothing textures
  and dressing process

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Influence on School Related Activities

• Avoidance of classroom tools and materials
• Difficulty with participation in group activities
  which involve movement, touch or sound
• Difficulty staying in line
• Difficulty self-regulation attention in the
  classroom

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Influence on Social Participation

• Disruption of attachment relationships due to
  approach/avoidance conflict
• Avoidance of a need to be in control, or
  aggression towards peers
• Disruption in ability to develop and maintain
  friendships and love relationships in adults
• Decreased perception of social acceptance which
  leads to decreased self-esteem

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Sensory-Based Motor Disorder

• Postural Disorder difficulty stabilizing the
  body during movement or at rest to meet demands
  of a motor task
• Dyspraxia difficulty translating sensory
  information into planning and/or sequencing
  movement, especially new or unfamiliar

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Postural Disorder

• Fears movement due to inadequate postural control
• Does not like tummy time
• Has decreased muscle tone
• Seems weak compared to peers
• Loses balance easily
• Tires easily, has poor endurance
• Frequently trips and falls
• Appears lazy and unmotivated
• Has difficulty using both hands and feet at the
  same time (bilateral coordination)

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Dyspraxia

• Difficulty translating sensory information into
  ideas for movement, planning, organizing and/or
  sequencing movement, especially new and
  unfamiliar actions
• Can manifest as gross motor, fine motor and/or
  oral-motor problems

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Dyspraxia

• Is clumsy
• Eats messily
• Has a disheveled appearance
• Uses toys the same way over and over
• Is rigid in play/routines
• Frustrates easily
• Has trouble maneuvering around obstacles
• Breaks things unintentionally

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Dyspraxia

• Has difficulty following directions for
  activities that require more than one step
• Has trouble learning new skills
• Is disorganized
• Prefers fantasy games over physical games
• Prefers sedentary activities
• Has delays in speech and/or motor skills ranging
  from mild to severe

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Influence on Play Skills

• Difficulty with playground activities
• Difficulty with manipulative and construction
  toys
• Difficulty with the sequence and rules of play
• Difficulty with timing and sequencing of body
  parts in sports and motor activities
• Directional confusion leads to poor spatial
  organization with team sports.
• Poor ideation leads to decreased play
  possibilities

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Influence on Self-Care and Feeding

• Slow in managing dressing fasteners and shoe
  tying
• Difficulty in mastering the spatial organization
  of clothing
• Problems managing tools for self-care (hairbrush,
  washcloth, utensils)
• Difficulty with food wrappers
• Messy eater
• Disorganization with personal belongings

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Influence on School Related Activities

• Poor and/or slow handwriting and drawing skills
• Difficulty using classroom tools and materials
  effectively (scissors, glue bottle)
• Disorganization of work space (desk, locker)
• Difficulty learning new skills through imitation

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Influence on Social Participation

• Social rejection by peers during games due to
  poor motor skills
• Withdrawal from social situations due to poor
  self-esteem
• Difficulty discerning social and physical
  boundaries poor social judgment
• Disorganized peer interactions due to poor
  ability to read non-verbal cues
• Tendency to be rigid and controlling

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Intervention

• Education/awareness
• reframe behavior (view) from a new perspective
• Individual therapy using a sensory integrative
  approach
• Consultation model for home and school
• Develop new strategies sensory diet

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Research

• Roberts, J. E., King-Thomas, L., Boccia, M. L.
  (2007). Behavioral indexes of the efficacy of
  sensory integration therapy. AJOT, 61, 555-562
• Single subject ABAB design subject diagnosed
  with sensory modulation disorder and delayed
  communication skills
• Behavioral data collected by preschool teachers
  who were blind to the timing of sensory
  integration therapy
• Improvements in behavioral regulation noted
  increased engagement decreased aggression, less
  need for intense teacher direction, decreased
  mouthing objects

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Research

• Miller, L. J., Coll, J. R., Schoen, S. A.
  (2007). A randomized controlled pilot study of
  the effectiveness of occupational therapy for
  children with sensory modulation disorder. AJOT,
  61, 228-238.
• Twenty-four children assigned to 1 of 3 treatment
  groups OT-SI, Activity Protocol, and No
  Treatment
• Significant changes noted in OT-SI group on GAS
  (goal attainment scaling), attention,
  Cognitive/Social composite of Leiter-R parent
  rating

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Sensory Diet

• The daily intake of sensory and motor experiences
  needed by a person to adaptively interact with
  the environment
• Sensory and motor experiences help maintain
  optimal arousal and attention for learning
• Sensory diet formula intensity, frequency,
  duration, rhythm of input is varied to achieve
  optimal performance

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Sensory Diet Activities

• Specific to the individual based on assessment
• Planned throughout the day to help maintain
  optimal level of organization
• Most powerful and long lasting include movement,
  heavy work, deep touch pressure
• Sensation can have calming or alerting effect

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Sensory Diet Activities

• Structure activities in a playful,
  non-threatening manner
• Closely monitor for an adaptive response -- more
  organized behavior
• More sensation in not always better --observe for
  signs which might indicate an overstressed
  nervous system

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Movement

• Unstable surfaces therapy ball, air pillow, air
  cushion
• Games and calisthenics
• Jumping, swinging,
• Rocking, rolling,
• Bouncing,
• Marching, dancing

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Heavy Work

• Carrying heavy objects
• Wheelbarrow walk, animal walks
• Backpack
• Digging in a garden
• Working out on weight machines
• Pulling friend in a wagon
• Pushing heavy grocery cart
• Sports

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Deep Pressure Touch

• Weighted vest, weighted blanket
• Firm hugs, massage
• Lycra exercise shorts or tights under clothing
• Games
• rough house play
• tactile sandwich

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Oral Motor

• Suck long straw or thick liquids sour, sweet,
  spicy hot candy
• Blow whistles bubbles
• Chew and crunch gum, popcorn, dried fruit,
  bagel, pretzels chewy tube, straws

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Womb Spaces

• Under a table or desk
• Tent or sleeping bag
• Inside a closet or other small space (box)
• Pillow in a corner of the room
• Creating small space feeling with furniture
  position

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Tactile

• Hand toys to fidget koosh balls, silly putty,
  bendable figures, small stuffed animals, pieces
  of soft fabric
• Extra toweling after the bath
• Tactile fine motor activities
• kneading bread
• sand play
• bean play
• finger painting

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Tactile Strategies

• Temperature cool is alerting, warm is calming
• Clothing preferences long sleeve, short sleeve,
  cut out tags, sport socks (no seams)
• Bed clothes flannel sheets, heavy blanket,
  light sheet
• Light touch (tickling) alerting

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Auditory Strategies

• Soft music-- Mozart, fast music -- driving beat
• Ear muffs, headphones
• White noise machine, water fountain, soft
  background music
• Voice quality -- high or low pitch

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Visual Strategies

• Soft dim lights
• Natural light, avoid fluorescent light
• Muted colors and plain walls
• Bright lights
• Movement in peripheral visual field
• Lots of color

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Resources Books

• Heller, S. (2002). Too Loud, Too Bright, Too
  Fast, Too Tight. New York HarperCollins
  Publishers.
• Henry, D., Kane-Wineland, M., Swindeman, S.,
  (2007). Tools for Tots Sensory Strategies for
  Toddlers and Preschoolers. Glendale, AZ Henry
  OT Services.
• Isbell, C. Isbell, R. (2007). Sensory
  Integration A Guide for Preschool Teachers.
  Beltsville, MD Gryphon House.

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Resources Books

• Kranowitz, C. (2005). The Out-of-Sync Child. New
  York Penguin Group.
• Miller, L. J. (2006). Sensational Kids. New York
  Penguin Group.
• Williams, M. S., Shellengerger, S. (2001). Take
  Five! Staying Alert at Home and School.
  Albuquerque, NM TherapyWorks, Inc.
• Yack, E., Aquilla, P. Sutton, S. (2002).
  Building Bridges through Sensory Integration. Las
  Vegas Sensory Resources.

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Resources catalogs

• Abilitations 1-800-850-8602
• www.abilitations.com
• Fun and Function 1-800-231-6329
  www.FunANDFunction.com
• Sensory Critters 1-866-749-2737
  www.SensoryCritters.com
• Southpaw Products 1-800-228-1698
• www.southpawenterprises.com
• Therapy Skill Builders 1-800-872-1726
  www.psychcorp.com

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Resources on the web

• Sensory Processing Disorder Foundation
• www.spdfoundation.net
• SI Focus magazine
• www.sifocus.com
• Developmental Therapy Associates
• www.developmentaltherapy.com

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