The Diagnostic and StatisticalManual of Mental Disorders–Fourth Edition–Text Revision

(DSM-IV-TR; American Psychiatric As-sociation [APA], 2000) contains themost widely used diagnostic criteria foridentifying Asperger syndrome (AS) as acategory of Pervasive DevelopmentalDisorders (PDD). This document con-tains three behavioral criteria—qualita-tive social impairment, repetitive and re-strictive stereotyped patterns of behavior,and significantly decreased social func-tion—and three exclusion criteria—lan-guage delays, cognitive delays, or othersignificant diagnoses, including schizo-phrenia or autism (APA, 2000).

It is interesting to note that these cri-teria do not contain any explicit referenceto differences in sensory processing, eventhough the original work on this disor-der by Hans Asperger (1944) containeddescriptions about distinct sensory pro-cessing behaviors (Dunn, Myles, & Orr,2002). Asperger studied four children

and recorded the unique characteristicsthey exhibited (Frith, 1991; Wing,1991), including a range of hypo- andhypersensitivities to taste, tactile, and au-ditory stimuli. For example, male chil-dren discussed in his case studies pre-ferred very sour or strongly spiced foods.Similarly, they strongly disliked tactileinput (e.g., textures of some fabrics, fin-gernail cutting) and were also very sensi-tive to noise in certain situations butoblivious to noise in other environments.Each of these sensory problems inter-fered with their daily routines.

More recently, consideration has beengiven to the possibility that sensory pro-cessing is an underlying feature of AS(Attwood, 1998; Fling, 2000; Myles &Simpson, 1998; Myles & Southwick,1999; Stagnitti, Raison, & Ryan, 1999;Willey, 1999). Practitioners and scholarshave anecdotally reported about the re-lationships between sensory processingfunctions in daily life, including learning,play, work, and socialization (e.g., Ad-

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Asperger Syndrome and Sensory Processing:A Conceptual Model and Guidance for Intervention Planning

Winnie Dunn, Jessica Saiter, and Louann Rinner

The purpose of this article is to discuss sensory processing concepts and their applica-tion to the needs of children who have Asperger syndrome (AS). First we will outlinethe basic characteristics of the sensory systems, then discuss a model for sensory pro-cessing, and, finally, present a summary of the data supporting the application of thismodel in work with children who have AS. A framework is outlined for incorporatingsensory processing concepts into practice and research programs that address theneeds of children with AS. Finally, we will present case studies demonstrating theapplication of sensory processing principles.

reon & Myles, 2001; Anderson & Em-mons, 1996; Ayres, 1972, 1979; Cook& Dunn, 1998; Fisher, Murray, &Bundy, 1991). There is some preliminaryempirical evidence suggesting that thereare significant differences in the sensoryprocessing patterns of children who haveAS (Dunn et al., 2002). Some authorsview the specific criteria listed under theheading “Repetitive and RestrictedStereotyped Patterns of Behavior, Activ-ities, and Interests” (p. 84) to be reflec-tive of difficulty with sensory processing,including (a) a preoccupation with oneor more stereotyped and restricted pat-terns of interest that is abnormal either inintensity or focus; (b) inflexible adher-ence to specific, nonfunctional routinesor rituals; (c) stereotyped and repetitivemotor mannerisms; and (d) persistentpreoccupation with parts of objects(Frith, 1991; Gillberg, 1992; Huebner,2001; Zero to Three, 1994).

The purpose of this article is to discusssensory processing concepts and their ap-plication to the needs of children whohave AS. We will outline the basic char-acteristics of the sensory systems, discussa model for sensory processing, and pre-sent a summary of the data supportingthe application of this model in workwith children who have AS. Then we willoutline a framework for incorporatingsensory processing concepts into practiceand research programs that address the

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needs of children with AS. Finally, we willpresent case studies demonstrating theapplication of sensory processing princi-ples.

Basic Characteristics of theSensory Systems

There are seven basic sensory systemswithin the nervous system: sound, touch,vision, taste, smell, movement, and bodyposition. Myles, Tapscott Cook, Miller,Rinner, and Robbins (2000) provided asummary of the characteristics of thesesensory systems and their function inhuman beings (see Table 1). The visualand auditory systems provide informa-tion about the world, the touch and bodyposition systems provide informationabout the person’s body, and the move-ment system provides information aboutthe interaction of the body in the world.The taste and smell systems provide amechanism for sustaining the organismby accessing information for obtainingfood, and for protection.

The sensory systems provide the routefor the brain to receive information. Thefunction of the input mechanisms them-selves produce sensory acuity (e.g.,whether the person’s eyes receive light,etc.). The brain is responsible for makingmeaning out of this information and fordesigning and implementing a response(i.e., processing). For children who haveAS, the sensory input structures are usu-ally intact; the difficulty with sensoryprocessing occurs as the child tries to usethat sensory input (i.e., process it) to re-spond to task and environmental de-mands.

A Model for SensoryProcessing

Dunn (1997) proposed a model forsensory processing that characterizes pat-terns of responding based on a per-son’s neurological thresholds and self-regulation strategies. Figure 1 summariz-es these relationships and provides basicinformation about the characteristics ofeach pattern of sensory processing. Theneurological threshold continuum moves

from low to high thresholds, whereas thebehavioral response continuum movesfrom passive to active self-regulation stra-tegies. When these continua intersect,four basic patterns of sensory processingemerge, representing the anchor points ofthe continua.

The neurological thresholds contin-uum represents the amount of input thenervous system requires before respond-ing. When a person has high thresholds,this means that it takes a lot of input forthe nervous system to take notice andthen generate a response. When a personhas low thresholds, this means that ittakes very little input for the nervous sys-tem to take notice, and lots of responsesare generated.

The self-regulation continuum repre-sents the range of strategies a personmight use in responding to task and en-vironmental demands. A person who re-sorts to passive strategies has a tendencyto let things happen; a person who usesactive strategies reveals a tendency togenerate responses to control input.

The intersection of these continua cre-ates four basic patterns of sensory pro-cessing: low registration, sensation seek-ing, sensory sensitivity, and sensationavoiding. Low registration represents thecombination of high neurological thres-holds with a passive self-regulation strat-egy. Sensation seeking represents thecombination of high thresholds with anactive self-regulation strategy. Sensorysensitivity is the combination of low neu-rological thresholds with a passive self-regulation strategy, and sensation avoid-ing represents the combination of lowneurological thresholds with an activeself-regulation strategy.

Low Registration

Children who have low registration pat-terns seem uninterested, self-absorbed,and sometimes dull in affect. They donot notice what is going on around themand miss cues that might guide their be-haviors. We hypothesize that most eventsin daily life do not contain a sufficientamount of intensity to meet these chil-dren’s thresholds; their passive strategieslead to their being somewhat oblivious to

activities. Some families report that theirchild does not respond to initial auditoryinformation. For example, parents maybe concerned about a hearing problembecause their child does not respond tohis or her name (Marks, Schrader, Ton-gaker, & Levine, 2000).

Weimer, Schatz, Lincoln, Ballantyne,and Trauner (2001) reported a deficit inproprioception (sensory input from themuscles and joints) for children with AS,which may contribute to the characteris-tic of “clumsiness” cited by multiple au-thors (Attwood, 1998; Bonnet & Goa,1996; Gillberg, 1989; McKelvey, Lam-bert, Mottron, & Shevell, 1995; Tatum,1988; Wing, 1981). From a sensory pro-cessing point of view, these children mayneed a high amount of proprioceptiveinput to successfully participate in physi-cal activities. This would be achieved byadding weight to the child’s body or toobjects the child interacts with. For ex-ample, we might have the child wear a weighted vest, or wrist and ankleweights, during specific activities. Theadded weight provides additional bodysensory input so the child can be moreaware of body parts. Authors have alsoreported increased attention and de-creased fidgeting using weighted vestsfor children with autism and attention-deficit/hyperactive disorder (Fertel-Daly, Bedell, & Hinojosa, 2001; Van-denBerg, 2001; see Figure 2).

Sensation Seeking

Children who have sensation-seeking pat-terns are very active, continuously en-gaging, and excitable. They take pleasurefrom sensory experiences and so gener-ate additional sensory input for them-selves. We hypothesize that they are en-gaging in active strategies to increaseinput as a means to meet high thresholds.For children who have AS, sensationseeking may manifest as the need tomove about the environment, for exam-ple, pacing back and forth when othersremain seated.

Peculiarities that others might classifyas speech and language issues also have asensory-seeking quality. For example, thechild might overuse hand gestures or

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TABLE 1Location and Functions of the Sensory Systems

System Location Function

Tactile (touch)

Vestibular (balance)

Proprioception (body awareness)

Visual (sight)

Auditory (hearing)

Gustatory (taste)

Olfactory (smell)

Note. From Asperger Syndrome and Sensory Issues: Practical Solutions for Making Sense of the World, by B. S. Myles, K. T. Cook, N. E. Miller, L. Rinner, and L. A. Robbins, (p. 5). Copyright 2000 by the Autism Asperger Publishing Company. Reprinted with permission.

Skin—density of cell distribution varies throughoutthe body. Areas of greatest density include mouth,hands, and genitals.

Inner ear—stimulated by head movements andinput from other senses, especially visual.

Muscles and joints—activated by muscle contrac-tions and movement.

Retina of the eye—stimulated by light.

Inner ear—stimulated by air/sound waves.

Chemical receptors in the tongue—closely en-twined with the olfactory (smell) system.

Chemical receptors in the nasal structure—closelyassociated with the gustatory system.

Provides information about the environment and ob-ject qualities (touch, pressure, texture, hard, soft,sharp, dull, heat, cold, pain).

Provides information about where our body is inspace, and whether or not we or our surroundingsare moving. Tells about speed and direction ofmovement.

Provides information about where a certain bodypart is and how it is moving.

Provides information about objects and persons.Helps us define boundaries as we move throughtime and space.

Provides information about sounds in the environ-ment (loud, soft, high, low, near, far).

Provides information about different types of taste(sweet, sour, bitter, salty, spicy).

Provides information about different types of smell(musty, acrid, putrid, flowery, pungent).

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FIGURE 1. Characteristics of specific sensory processing patterns when considering Dunn’s conceptual model of sensoryprocessing. Note. For original discussion of these concepts, see Dunn (1997).

FIGURE 2. Common characteristics of individuals with Asperger syndrome when considering Dunn’s conceptual model ofsensory processing.

Low Sensation Sensory SensationRegistration Seeking Sensitivity Avoiding

Neurologicalthresholdsa

(The amount ofstimuli we need High High Low Lowto notice or react)

Behavioralresponse/self-regulation Passive Active Passive Activestrategya

Functional High ability to focus High ability to High ability to High ablity tocharacteristics on something generate ideas and notice what is going on design & implementof this pattern responses in the environment structureof sensoryprocessing Unaffected by Notices and enjoys Particular Enjoys routines

varying all the activity in about task completionenvironments the environment parameters

Potentially Appears to be Always active, Distractible in Resistant tointerfering uninterested or continuously busy, complex changecharacteristics withdrawn engaging settingsof this patternof sensory May have a dull Fidgety and May seem like Reliant onprocessing affect or seem excitable a “complainer” rituals to participate

self-absorbed

May seem “overly tired”or apathetic

aHypothesized relationships based on Dunn’s conceptual model of sensory processing.

Low Sensation Sensory SensationRegistration Seeking Sensitivity Avoiding

Neurologicalthresholdsa High High Low Low

Behavioralresponse/self-regulation Passive Active Passive Activestrategya

Common Does not notice facial Demonstrates Marked distress with Lack of spontaneouscharacteristics expressions or gestures repetitive patterns change seeking to shareof individuals of others of behavior enjoymentwith Aspergersyndrome Limited capacities for Intense pursuit of Strong dislike for Limited participation in

self-monitoring interests and certain fabrics social play or gamesactivities

May be motorically Verbosity Aversion to daily life May create “rituals” or“clumsy” activities with strong rigid social approaches

Symptoms of tactile sensory inputoveractivity and Self-isolation

inattention Hypersensitive toenvironmental noise

aHypothesized relationships based on Dunn’s conceptual model of sensory processing.

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nod his or her head when speaking, ormight stand closer to others than is nec-essary during conversation. Childrenwith AS also make repeated noises andwords that create a certain feel and soundas the word flows across the tongue andmouth. Shore (2001) reported that theseactions are pleasurable for children withAS. They may seek sensation by puttingunusual, nonedible objects in theirmouths, chewing whole sugar packets,using their teeth to shave sand fromemery boards, or crunching up tin foil intheir mouths. These activities providescratchy and gritty texture sensations be-yond those a typical diet might provide(Willey, 1999).

Sensory Sensitivity

Children who have sensory-sensitivitypatterns are distractible, are hyperactive,and can be complainers. They noticemany more sensory events than others doand comment about them with regular-ity. We hypothesize that they have lowthresholds that enable them to have aheightened awareness of what is goingon around them. These children use pas-sive strategies in that they allow things to happen and comment rather than removing themselves (as a sensationavoider is likely to do). Children with ASand their families frequently reportsound and touch sensitivities. These chil-dren may, for example, report hearingthe sound of an approaching train or air-plane some time before others notice it.Some children with AS have reportedbeing distracted by butterflies or anotherperson’s teeth to the point that it in-terferes with maintaining a conversation(Attwood, 1998).

Sensation Avoiding

Children who have sensation-avoidingpatterns are rule bound, ritual driven, anduncooperative. They engage in behaviorsto limit the sensory input they must dealwith. We hypothesize that they are en-gaging in these active self-regulationstrategies because unfamiliar sensory in-put is difficult to understand and organize

or might even be “threatening” to theirnervous systems. Predictable patterns ofbehavior provide a high rate of familiarsensory input while simultaneously limit-ing the possibility of unfamiliar input.

For children who have AS, avoidingpatterns interfere with their use of typi-cal materials and lead to the design ofspecific ways to achieve an outcome. Fre-quently, these specific ways restrict thechild’s willingness to participate in typi-cal daily routines. The potential of deal-ing with threatening input often leads achild to impose rules and restrictionsupon others, as well. For example, whileshampooing, a child who is a sensationavoider might want to avoid the unex-pected splash of water on his or her face.The child’s parent may have learned touse a dry washcloth to wipe shampooaway from the child’s face, therefore be-coming the only person who can helpwith this routine. Another child mayrefuse to participate in small cooperative-group educational activities becauseworking with others on the floor posestoo many opportunities for accidentalbumping. For others, the feeling of cer-tain fabrics is an aggravation that leads tolimitations of clothing choices. Emo-tional reactions that seem extreme or in-congruent to the situation may result ifescape from the sensation is not possible.

Combined Patterns of Sensory Processing

It is important to remember that chil-dren do not have a single sensory pro-cessing pattern but, rather, have severalpatterns in their repertoires (Dunn,2001). A child might be a sensationavoider for auditory stimuli and yet havemore moderate responses for other sen-sory-system input. For intervention plan-ning, knowledge about sensory systems(e.g., visual, auditory, touch) and sensoryprocessing patterns are helpful.

Studies About SensoryProcessing

Several lines of investigation have beenaimed at understanding both the nature

of sensory processing and the role of sen-sory processing in various human condi-tions. The findings from these studiesprovide support for the concepts aboutsensory processing reflected in Dunn’smodel of sensory processing and indicatethat there are distinct differences in sen-sory processing patterns among personswith disabilities, including AS.

The Nature of SensoryProcessing

Dunn and colleagues have studied thenature of sensory processing in infants,toddlers (Dunn, 2002; Dunn & Daniels,in press), children (Dunn, 1999; Dunn& Brown, 1997; Dunn & Westman,1997), adolescents, and adults (Brown,Tolefson, Cromwell, Dunn, & Filion,2001; Brown, Tolefson, Dunn, Crom-well, & Filion, 2001). Using a set ofmeasures of sensory processing in dailylife (i.e., the Infant/ Toddler Sensory Pro-file, Sensory Profile, Adolescent/AdultSensory Profile), these researchers con-ducted a series of principal componentfactor analyses and found that items clus-tered by the level of responsivity requiredby the items rather than by the sensorysystem tapped by the item. For example,speaking loudly to get the child’s atten-tion and finding ways to make noise withtoys are both auditory items, but the firstone reflects low registration and the sec-ond one reflects sensation seeking. Theseitems loaded on different factors fromeach other, and in the same factor withother items that were similar in their sen-sory processing patterns (in these cases,low registration and sensation seeking).

Researchers have also reported prelim-inary evidence that skin conductance pat-terns (i.e., amplitude and habituation)are unique for persons with a predomi-nance of each of the sensory processingpatterns from Dunn’s (1997) model(Brown et al., 2001; McIntosh, Miller,Shyu, & Hagerman, 1999; Miller et al.,1999). Dunn (2001) hypothesized thatthe Sensory Profile measures ask ques-tions in a way that enables persons to re-port on what is happening inside theirown (or their child’s) body. These psy-

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chophysiological data provide interdisci-plinary support for Dunn’s model.

Role of Sensory Processing inVarious Human Conditions

Dunn (2001) provided a summary of theevidence indicating that difficulty withsensory processing is a feature of variousdisabilities, including genetic and devel-opmental disorders, brain disorders,schizophrenia, and chronic fatigue. Forexample, Baranek (1999) studied chil-dren with developmental disabilities andautism and reported that these childrenprocessed visual, auditory, touch, andbody position input differently from eachother and from peers without disabilities.McIntosh et al. (1999) reported that chil-dren with Fragile X syndrome respond tosensory stimuli with more intensity, athigher rates, and for longer times thanother children.

In studies using the Sensory Profile, re-searchers have reported on differences insensory processing patterns with childrenwho have attention-deficit/hyperactivitydisorder (ADHD), autism, Asperger syn-drome, Fragile X syndrome, and sensorymodulation disorder (Dunn & Bennett,2002; Ermer & Dunn, 1998; Kientz &Dunn, 1997; McIntosh et al., 1999; Wat-ling, Deitz, & White, 2001). In addition,Ermer and Dunn reported that disabilitygroups are significantly different fromeach other. They conducted a discrimi-nant analysis and classified the childrenwith autism, children with ADHD, andchildren without disabilities correctly(89% accuracy) based on Sensory Profilescores alone. For the children withADHD, low-threshold items were themost discriminating, whereas for the chil-dren with autism, oral sensory processingwas the most discriminating.

In summary, there seems to be somepromise in Dunn’s model for providing astructure for understanding sensory pro-cessing patterns in all persons. Data fromseveral studies support the concepts ofthis model in samples of persons withoutdisabilities across the life span. Addition-ally, in studies with children who have var-ious conditions, there are indications that

sensory processing may be an underlyingfactor in the manifestation of the condi-tions. Therefore, knowledge about sen-sory processing may be useful in guidingresearch and practice.

Incorporating SensoryProcessing Concepts Into Practice

Each family has its own dynamics, but re-searchers have noted some trends relatedto children with AS. Families and thefamily member with this diagnosis mayhave used additional effort to pursue a di-agnosis (Cohen & Volkmar, 1997).Therefore, families may be familiar withsensory processing through a variety ofavenues. Some family members reportnoticing “different” responses to daily life(Klin, Volkmar, & Sparrow, 2001) priorto a diagnosis. Other children may havereceived a previous diagnosis (e.g., au-tism, obsessive–compulsive disorder,ADHD, Tourette syndrome, schizophre-nia; Attwood, 1998; Wing, 1991) thatalso has associated sensory processingconcerns.

A diagnosis of AS typically occurs in el-ementary school or later (Cohen & Volk-mar, 1997; Gillberg & Coleman, 1992;Volkmar, 1996). Research in sensory pro-cessing has indicated that there are somedevelopmental trends in the evolution ofa child’s responses to sensory events, butby school age, these trends have stabilized(Dunn, 2001). Therefore, practitionersmay anticipate that sensory processingpatterns, once identified, can continue tobe helpful guideposts for interventionand daily life planning for school person-nel and families.

Also, researchers have noted the ge-netic tendencies (Cohen & Volkmar,1997; Gillberg, 1991; Gillberg & Cole-man, 1992; Volkmar, 1996; Wing, 1991)of AS. A child’s sibling, father, or unclemay have similar traits. Therefore, familymembers may have sensory processingpatterns that are similar, contributing an-other dimension to the way that sensoryexperiences are interpreted in families.The potential increase in the complexityof family dynamics has an impact on the

design and implementation of interven-tions for these families.

This information about sensory pro-cessing and the unique features of ASoffer practitioners a starting point for de-signing and implementing interventionsthat employ a sensory processing per-spective. Additionally, with occupationaltherapy’s emphasis on functional perfor-mance in daily routines, we have aframework for applying sensory process-ing knowledge within the child’s life.Therefore, the examples we provide il-lustrate home, school, and communityapplications.

A Sensory ProcessingPerspective on theCharacteristics of Daily Life Settings

During a typical day, a child gets ready inthe morning, participates in learning op-portunities throughout the school day,and accompanies family into the com-munity for errands or leisure activitiesafter school. Each setting, and each ac-tivity within those settings, containsunique characteristics that can supportchildren and/or create challenges fortheir performance. Although it is morecommon to consider cognitive, social,and motor opportunities, these settingsand activities also contain inherent (or, inthe case of intervention planning, con-structed) sensory features. For this sec-tion we will emphasize the sensory char-acteristics of particular settings andactivities, acknowledging that cognitive,social, and motor characteristics intersectwith those we are discussing here.

Home

The home offers familiar sensory infor-mation. Family members’ voices are rec-ognizable, as are sounds related to mealpreparation, laundry tasks, and otherhousehold routines. The visual system ofthe child’s room has an anticipated set-up. The furniture feels the same from dayto day. Household activities and choreshave established patterns that generate

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vestibular and proprioceptive sensationsas family members move about to com-plete them. The family typically struc-tures routines around the child’s prefer-ences (Gillberg, 1991; Wing, 1991); forexample, the family establishes a patternof agreed-upon foods at mealtime. Fam-ily members engage in similar routines intheir home, including preparing and eat-ing meals, getting ready for the day, andinteracting with each other. Typically, theactivities have a pattern that is acceptableto most members. When families have amember with AS, establishing these pat-terns can be challenging. Conversely,once a pattern is established, childrenwith AS can be very resistant to changes.Sensory processing knowledge can helpmake this process more successful.

School

School environments include sensory in-formation that is familiar, but different inintensity or duration. Students comeacross additional sensory experiencesthat are not typically within the home.“One size fits all” desks and chairs madefor durability and efficient managementof school materials are difficult to toler-ate for the child who needs movement tostay focused. Colorful materials on bul-letin boards and art projects hangingfrom ceilings, meant to provide informa-tion or visually motivate students, dis-tract some students from their learningtasks. Children with sound and smell sen-sitivities may find it difficult to manageencounters with school cafeterias servinghundreds of lunches daily.

The environment of the middleschool–age child or high school studentincludes multiple passing periods andclassrooms, myriad hallways, lockers thatcontinuously open and close, and a num-ber of teachers with individual teachingstyles and expectations. For the childoverresponsive to touch sensations, un-expected bumping by other studentswithin cooperative learning activities, inlines, or during passing periods createsanxiety and irritation that can lead to ameltdown. The effective modulation ofsensations that is required by increasedsensory demands is difficult for the indi-

vidual with AS in school, where sensationis not as familiar or readily changeable.

Community

Transportation, shopping, eating out,and attending community events pose aneven greater variety of inherent sensa-tions, many unpredictable and beyondthe control of the participating public.Children often need to accompany par-ents as they tend to the necessities ofdaily life. Shopping for groceries can bean overwhelming sensory experience forthe child sensitive to smells, overheadlighting, and unexpected intercom mes-sages. The everyday activities that manyfamilies take for granted become strug-gles requiring management planning forthe individual with AS.

Summary

Creating successful supports that enableindividuals to participate more fully re-quires consideration of the sensory pro-cessing needs of the individual and theinherent sensory characteristics of thetask and context. Persons with autismspectrum disorders, including those withAS, are often unable to report their ownsensory preferences and needs (Baranek,1997), making it difficult for family,teachers, and other individuals to under-stand the basis for challenging behaviors.Gaining an understanding about the childand his or her environment throughskilled observation and ecological assess-ment (including checklists, histories, andquestionnaires) is the first step to creat-ing meaningful changes. The authorspropose to link Dunn’s model for un-derstanding sensory processing patternswith several instructional strategies foundto be effective for persons with AS.

Applying Sensory ProcessingKnowledge Within Other

Learning Paradigms

Many cognitive and behavioral para-digms can be applied when providing in-struction and other interventions with

children who have AS. For this discus-sion, we have selected five strategies fre-quently included in supports designedfor individuals with AS. We will illustrateadjustments that can be incorporatedwithin these five learning strategies to re-spect individual sensory processing pat-terns. The authors acknowledge that thestrategies addressed have inherent cogni-tive features or may be behaviorally in-fluential; additionally, for purposes of thisdiscussion we will point out both the in-herent sensory processing characteristicsof the strategies and sensory processingadaptations that can be made within thesestrategies to refine the intervention forindividual children with particular sen-sory processing patterns. We will empha-size the most prominent characteristics ofeach strategy, acknowledging that all ac-tivities involve a number of sensory sys-tem inputs. The five strategies are as fol-lows: priming, working independently,visual supports, home base, and socialstories; we provide an abbreviated defi-nition for each of the strategies here. Ta-ble 2 summarizes the definitions and in-herent sensory processing characteristicsof each strategy.

Priming

This preview activity presents materialsor task processes in advance of actual in-struction or expectation for participationand interaction. Typically, priming in-cludes elements with which the child islikely to have trouble, and presentation isin a nondemand manner to facilitate laterinteractions. The purpose is to familiar-ize the individual through exposure, de-crease anxiety, and allow exploration.Priming does not include teaching or at-tempts to correct but incorporates highlevels of reinforcement for any attemptsto explore (Wilde, Koegel, & Koegel,1992).

Working Independently

This strategy involves using personal andenvironmental resources to complete atask without reliance on or assistancefrom another individual to initiate, per-sist throughout, or terminate an activity.

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Strategies may be highly variable for thesame individual across different daily ac-tivities. Initial instruction of the strategy,with opportunities to practice and adjust,is necessary before independent imple-mentation is expected.

Visual Supports

A variety of supports presented in a visualmanner help organize physical and tem-poral space so individuals can (a) antici-pate and predict upcoming activities andevents, (b) experience easier transitions,and (c) understand expectations. Audi-tory cues and instructions are transientand not available for reviewing. Concreterepresentations not only limit ambiguityfor the individual with AS but also helpothers convey directions and preparationin a consistent manner.

Home Base

Access to a location apart from the in-dividual’s routine environment allowshim or her to plan, regroup, or recover.Home base is viewed as a positive at-mosphere, not one to be associated withpunishment or escape from tasks. It maybe necessary to identify a number ofhome base locations across contexts. Ac-cess may be built into routines, such as atthe beginning of each day, or “on de-mand” according to the needs of the in-dividual child.

Social Stories Social stories are short stories writtenfrom the child’s perspective that describesocial situations and include relevant so-cial cues. The purposes of social storiesvary, including addressing a variety of

behaviors (fears, obsessions, etc.); pro-viding a model for desirable actions;teaching routines; and correcting socialresponses in a nonthreatening manner.Gray (1995) provided comprehensiveguidelines for the creation and imple-mentation of social story strategies.

Application of SensoryProcessing Knowledge:

Case Examples

The following examples illustrate a sen-sory processing approach to interven-tion. Children with AS seem to have sen-sory processing patterns that are distinctfrom other children’s and that can inter-fere with their children’s interactions.Knowledge about a child’s specific sen-sory processing patterns can be useful incrafting home, school, and community

TABLE 2Examples of Interventions Using Learning Strategies Adjusted for Various Sensory Processing Patterns

Sensory processing pattern

Low registration Sensation seeking Sensory sensitivity Sensation avoiding

Overall approach to intervention

Learning strategyPriming

Workingindependently

Visual supports

Home base

Social stories

Embed sensation to meethigh thresholds so activitygains child’s attention

Prepare for upcoming taskby meeting child’s highthreshold with media-related activity

Embed sensations thatmeet high thresholds w/inwork activity

Place supports in positionthat includes access tosensation

Arrange home base tooffer items that meetchild’s need for calmingsensation

Develop stories with back-ground sensations

Embed sensation to meethigh thresholds so childdoes not seek out distract-ing sensations

Engage in pleasurable taskwith sensations that meetthresholds of next activity

Offer access to preferredsensations in a manner thatassists performance

Add sensation to maintainattention

Include sensations in homebase that meet child’s highthresholds

Give additional sensationswhile using social story

Offer discriminating sen-sory information to honorlow thresholds so child isavailable to learn

Provide discriminatingsensation prior to task

Offer consistent discrimi-nating input during worktasks

Place visual so it is acces-sible with low sensory de-mands

Offer calming sensationsw/in home base environ-ment

Discuss social story whilereceiving discriminatingsensations

Offer discriminating sen-sory information

Offer expected or familiarsensations when introduc-ing a new task

Request/instruct duringtasks with sensation belowchild’s thresholds

Use visuals with sensa-tions familiar to the user

Set up safe room withpreferred sensations

Review the social story ina setting with familiarsensations

Intervention/Learning strategy

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activities and environments that supportthe child’s success. We provide generalsensory processing concepts, and exam-ples of how to apply these concepts tochildren’s performance. The strategieslisted are not formulas; rather, they areexamples founded in theory to supportthe intervention planning process. Sen-sory processing interventions focus notonly on the person but also on matchingthe context and task to the person’sstrengths and challenges during dailyroutines.

Case Study 1: Mark

Mark is an elementary school studentwho needs to get ready for school in amore efficient manner (illustrating low-registration issues; see Table 3). He andhis younger brother attend the same ele-mentary school. His parents report thatMark has a difficult time getting readyfor school in the morning: He cannot

seem to wake up, and repeatedly lies backdown on the bed. His father says he“runs out of gas”; he may get one sockon and stop, for example. Another fam-ily member has to continuously check onhim to keep things moving along.

Currently, he misses the bus about 2 to 3 times a month. He hates missingthe bus and typically takes 30 minutes toan hour to calm down enough to leavefor school on these days. In addition,these delays affect his parents’ schedulesbecause one of them has to calm him anddrive him to school, resulting in late ar-rival to work.

The parents expressed these concernsat the team meeting to plan Mark’s edu-cational program. The teacher agreedwith the parents that getting ready wasimportant for Mark’s school day; whenMark comes in late, the teacher sees amuch less effective school performance.Team members also noticed these “slowto start” patterns at school: Mark lays his

head down on his desk, leans on furni-ture and other people, and is slow to re-spond to questions. Mark’s Sensory Pro-file (Dunn, 1999) results also verifiedthat he has low registration (i.e., missesinformation, is slow to respond to stim-uli in the environment). The team de-cided that the occupational therapist(OT) and the parents would have afollow-up meeting to brainstorm strate-gies and initiate interventions at home,while the school team would identifyways to enhance Mark’s classroom rou-tines.

First, the OT explained low registra-tion and Mark’s need for more intensityof input so that he could notice and re-spond to cues. Then they brainstormedways to increase Mark’s sensory inputduring the morning routine at home.They discussed turning up the volumeon Mark’s radio and changing it to a sta-tion with upbeat music, to offer ade-quate auditory input for meeting Mark’s

TABLE 3Examples of Interventions That Combine Learning Strategies (Rows) with Low Registration Patterns (Columns):

Case Study 1–Mark

Sensory processing Sensation Sensory Sensationpattern Low registration seeking sensitivity avoiding

Overall approach to interventionfor each sensory processing pattern

Learning strategyPriming

Home base

Social stories

Note. Mark is an elementary student who needs to get ready for school in a more effective manner (illustrating issues with low registration). We acknowledgethat the learning strategies have inherent cognitive features; we are pointing out the sensory processing characteristics only for the purposes of this discussion. H = ideas for use in the home; S = ideas for use in the school; C = ideas for use in the community.

H: Auditory—Provide loud, upbeat music while Mark isgetting ready

S: Proprioceptive—Have Mark hand out books to class andmove items for teacher to provide additional input tohis body

C: Vestbular—Ask Mark to bend down to get suppliesfrom lower shelves in grocery store with head invertedto increase input to movement receptors

H: Proprioceptive—Have Mark move furniture in his roomto create a cozy home base

S: Vestibular—Offer rocking chair in back of the classroomC: Tactile—Give Mark items for “fiddling” (e.g., stress ball,

mini-video games on a keyring)

H: Olfactory—Light a scented candle when reviewing thestory

S: Tactile—Use textured paper or cloth when writingC: Visual—Offer the story in pictures in Mark’s wallet

NO

T A

PP

LIC

AB

LE F

OR

MA

RK

NO

T A

PP

LIC

AB

LE F

OR

MA

RK

NO

T A

PP

LIC

AB

LE F

OR

MA

RK

Embed sensation into activities to meet high thresholdsso the activity gains the person’s attention

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high thresholds. They also decided toopen the blinds in Mark’s bedroom, tointroduce natural light for help withwaking up. After addressing the issue ofgetting out of bed, they turned their at-tention to the structure of the bath-room. Mark’s father installed color-coded dividers into Mark’s toiletriesdrawer to make a section for each set ofsupplies. This setup allowed for all ofMark’s supplies to be more noticeable,which met his high-threshold need forvisual information.

In addition, the OT and Mark’s par-ents reevaluated Mark’s home base—where he goes to calm himself whenupset. Typically, he goes into his room,lies on his bed, and plays the radio loudly.They decided to add some additionalsensory input that would simultaneouslycalm Mark and provide him with moreintense information about his body tomeet his thresholds. To accomplish thisaddition to home base, the family en-couraged Mark to push his bed againstthe wall to create a nook. They addedheavy pillows and beanbags for him toarrange while listening to his music (i.e.,he could sit on some of them, and pileothers on top of him). They also movedhis radio to a higher place, so he wouldhave to stretch his body to adjust the vol-ume and other dials. While looking for aheavy container to hold his CDs, Markfound an old toolbox in the garage. Heloaded the CDs into this metal box, andthis provided additional input to his mus-cles and joints as he manipulated the boxto make his selections. His family col-lected supplies with similar characteristicsto take with them when the family wentout (a stress ball, mini–video games on a key ring, travel games, etc.). Thesechanges were helpful in getting Mark outthe door in the morning. His mother alsomoved one of her scented candles intothe bathroom to provide some olfactoryinput while Mark was washing his face,brushing his teeth, and so forth, and thisseemed to help him also. The schoolteam created routines for Mark to gethim up and moving around the class-room more often. For example, they hadhim pass out worksheets, collect materi-als from other students, move books for

reading groups, and wipe off the boardfor the teacher throughout the day. Thisconcept also helped when the family ranerrands: While shopping, they mighthave Mark push the cart, send him to re-trieve items at the end of the aisle, or re-quest that he locate intriguing items withunique or intense sensory features (fra-grant foods or household items, clothingwith specific textures, etc.). The teachergave Mark some “smelly” markers towrite with, and this seemed to help himduring seatwork time. As the family andother team members understood Mark’sneeds, they contributed additional ideasto keep his thresholds activated through-out the day.

Case Study 2: Ben

Ben is a middle school student whoneeds to complete his homework and hischores (illustrating sensation-seeking is-sues; see Table 4). This year his school-work demands have increased. AlthoughBen is cognitively capable of doing thework, he is struggling to get his home-work finished. His teachers are frustratedabout this, too, as they are interested infinding ways to get Ben to practice hisnew skills (the primary function of hishomework right now). His family reportsthat he gets distracted both from school-work and from his assigned chores athome. Ben engages in other activities(playing with the dog, surfing the Inter-net, rollerblading) instead of working onhis homework and completing his part ofthe chores. His exuberance used to becute to his sisters, but they are becomingincreasingly irritated as they see that he iscapable and still does not pull his weight.His family is glad that he is energetic, andthey want to work with school personnelto channel that energy into productivework as well as recreation options.

Because Ben would engage in otheractivities instead of completing his home-work, it was suggested that his familywork to reduce those distractions. Theyset up a designated study space and re-moved all extraneous materials and activ-ities. Ben’s mother became frustrated be-cause this actually made things worse;

Ben kept coming into the kitchen to seewhat she was doing, roaming around thehouse to ask siblings questions, singing,and tapping on the walls. He would alsofind alternate uses for his homework sup-plies instead of completing the work.When his mother checked, his work wasno further along.

The OT and Ben completed theAdolescent/Adult Sensory Profile (Brown& Dunn, 2002), and confirmed that Benseeks more sensations than do other chil-dren. The OT met with Ben, his teach-ers, and his parents to discuss the situa-tion with them. Although others aredistracted by additional sensations, chil-dren like Ben require extra stimulation tobe productive. When the family andteachers removed things, they reducedthe information available to Ben, so heincreased his “recruitment” behaviors toprovide himself with the stimulation heneeded. The complication was that whenBen did that, he stopped the focus activ-ities to get the sensory input he needed.The challenge for the team was to findways for Ben to get the extra sensoryinput during the focus activities (home-work and chores), so that he continuedto meet his needs while being produc-tive.

Everyone decided that homeworkshould be tackled first. For the home-work area, the OT suggested introducingsnacks that provided strong sensoryinput (e.g., apples or carrots for theircrunchiness, strong mints, hard candy orpopping gum for their intense flavor andtexture in the mouth, a bowl of nuts forthe texture to the hands). Ben could ob-tain additional sensory input with thesesnacks and continue to work on hishomework. With their new understand-ing about Ben’s needs, they offered toget headsets so Ben could listen to music.The OT suggested that they experimentwith which kinds of music supportedhomework completion, limiting Ben’schoices to that music that kept him work-ing. They also moved a glider chair intothe space, so Ben could move back andforth while studying.

Currently Ben uses a calendar torecord his assignments. The therapistsuggested modifying this visual schedule

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to another media that would meet Ben’sneed for information to meet his highthresholds. The teachers offered to e-mail Ben his assignments so that he hadan opportunity to click through all thecomputer menus to get them each day.They also agreed to receive his work viae-mail attachments, giving Ben more vi-sual cues to employ to send his work(e.g., using the word processing and thee-mail programs together requires tog-gling back and forth, creating a morevaried and interesting visual environ-ment than paper and pencil). The OTsuggested that Ben select a different au-ditory cue for each class so he wouldknow which class an e-mail pertained to;Ben asked if he could add a signaturesound for himself to let the teachersknow it was him.

The family decided to apply these ideasto chores at home. With Ben’s help theydesigned a calendar for chores. Ben tookit upon himself to find intricate, active

singing icons for his chores, which helpedhim in following the visual schedule.Ben’s sisters suggested that the family usethe concept of increasing sensations atrestaurants when the entire family wentout to eat. They sought out restaurantsthat offered a visually busy environment,buffets where he could walk to get hisfood, and tables with paper and crayonsto supply him with proprioceptive inputwhile he colored.

Occasionally, Ben would refuse to dohis homework in favor of a preferred ac-tivity. The family had a social story to ad-dress this issue, yet had difficulty main-taining Ben’s attention while reviewingit. Thinking about Ben’s needs for addi-tional input, the family recorded thestory on videotape using animatedvoices. They added sounds effect, such ashis dog barking, to affirm a point, or a fa-vorite song in the background to em-phasize responses. Because it increasedthe visual and auditory input, the story

matched Ben’s high thresholds and hewas more successful at using his socialstory to guide him. The family appliedthese concepts for his other social storythemes, such as how to act when at thegrocery store, how to behave at restau-rants, and so forth.

Once the school personnel and familybegan to understand the sensory pro-cessing aspects of Ben’s behaviors, every-one was able to generate ideas and talkwith Ben about strategies. Ben also be-came more aware of his own needs andcame up with ideas on his own.

Case Study 3: Miranda

Miranda is a junior in high school whohas difficulty making friends (illustratingissues with sensation avoiding and sen-sory sensitivity; see Table 5). Mirandaparticipates in general education classes aswell as academic programming for gifted

TABLE 4Examples of Interventions That Combine Learning Strategies (Rows) with Sensation-Seeking Patterns (Columns):

Case Study 2–Ben

Sensory processing Low Sensation Sensory Sensationpattern registration seeking sensitivity avoiding

Overall approach to interventionfor each sensory processing pattern

Learning strategyWorking independently

Visual supports

Social stories

Note. Ben is a middle school student who needs to complete his homework and his chores (illustrating issues with sensation seeking). We acknowledge that thelearning strategies have inherent cognitive features; we are pointing out the sensory processing characteristics only for the purposes of this discussion. H = ideas for use in the home; S = ideas for use in the school; C = ideas for use in the community.

H: Gustatory—Offer Ben crunchy snacks, gum, etc., to provide additional imput

S: Visual—Provide worksheets on colored paper, write withcolored or fragrant pens, change fonts on computer

C: Proprioceptive—Have Ben push the grocery cart, carrybags between stores, get heavy items from the shelves

H: Visual—Embed cues with visual interest (e.g., movingparts, colorful words, complex pictures)

S: Auditory—Change songs, volume control, backgroundsounds on computer programs

C: Vestibular—Invite Ben to walk while reviewing his schedule

H: Auditory—Tape-record story in character voices, addsound effects within story, set script to song

S: Proprioceptive—Dramatize the scenario with jumping,skipping, holding heavy objects during scenes

C: Visual—Videotape story or make a pop-up book

NO

T A

PP

LIC

AB

LE F

OR

BE

N

NO

T A

PP

LIC

AB

LE F

OR

BE

N

NO

T A

PP

LIC

AB

LE F

OR

BE

N

Embed sensation to meet high thresholds so the persondoes not seek out distracting sensations

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learners. This setup includes a smaller class-room, moderate academic flexibility withtopics of interest for part of her day, andan individualized work area. During hergeneral education classes, this room dou-bles as a home base for when she is feel-ing overwhelmed.

Although Miranda performed aboveher peers academically, she struggled withsocial issues. For example, teachers andfamily members commented on her al-ways “messing with her hair,” to the pointwhere she was pulling out large clumps.During the interview with the OT, Mi-randa revealed that she was bothered bythe light touch of her hair brushingagainst the side of her face. Utiliz-ing interviews, observation, and the Ado-lescent/Adult Sensory Profile (Brown &Dunn, 2002), the team refined their in-terpretation of this behavior. They origi-

nally assumed that Miranda sought outsensation, when actually she was sensitiveto the light touch of her hair, and pullingit firmly helped her cope with the dis-tracting sensation.

Miranda had worn her hair in a shorterstyle in the past but preferred it longerbecause the coverage “protected” thenape of her neck, and she liked theweight against her shoulders. Her familyhad used rubber bands or scrunchies topull it back but were not able to keep ittight enough. Her mother now styles itin a French braid every several days. It istaut enough that Miranda likes the feel ofthe pull and it keeps it off her face. Shehas not pulled strands of hair from thebraid to manipulate, and as a result, hairgrowth is returning to the bald spot shehad created. Miranda is in the process oflearning how to braid her own hair.

In addition, the Adolescent/Adult Sen-sory Profile revealed a difference in Mi-randa’s sensory-avoiding score. Her fam-ily and peers especially noted this in socialenvironments. Miranda shared an interestin having more friends (including boys),but the thought of unexpected touchmade the possibility for close friendshipsstressful to her. She went to the fall dancewith a male friend but did not hold handsor wear the corsage he purchased for her.Therefore, the team brainstormed forstrategies to increase her enjoyment ofthe upcoming winter dance and goingout afterwards with a group.

Miranda and her mother shopped fora long-sleeved dress with tight-fittinggloves. This setup offered consistent pres-sure and minimized contact with herarms. Wearing long-sleeved and fittedclothing has been helpful with her school

TABLE 5Examples of Interventions That Combine Learning Strategies (Rows) with Low Threshold Patterns (Columns):

Case Study 3–Miranda

Sensory processing Low Sensation Sensory Sensationpattern registration seeking sensitivity avoiding

Overall approachto intervention

for each sensoryprocessing pattern

Learning strategyPriming

Working independently

Home base

Note. Miranda is a girl in high school who has difficulty making friends (illustrating issues with sensory sensivity and sensation avoiding). We acknowledge thatthe learning strategies have inherent cognitive features; we are pointing out the sensory processing characteristics only for the purposes of this discussion. H = ideas for use in the home; S = ideas for use in the school; C = ideas for use in the community.

S: Tactile—Braid hair to increase firmpressure and decrease light touchprior to day

C: Olfactory—Offer familiar scents inself-care products to screen outsmells before entering restaurant

S: Tactile—Wear clothing that coverswell and is fitted

H: Visual—Set up a small area withpreferred poster and lava lamp

S: Vestibular—Provide a supportivechair to minimize movement

C: Auditory—Arrrange seating at atable to be next to “laid-back”peers

S: Tactile—Position self in low-traffic areas to prevent bumping

C: Visual—Educate others to use vi-sual cues to gain her attention

C: Auditory—Use trips to the bath-room to lower auditory input fromrestaurant

NO

T A

PP

LIC

AB

LE F

OR

MIR

AN

DA

NO

T A

PP

LIC

AB

LE F

OR

MIR

AN

DA

Offer discriminating sensoryinformation to honor low

thresholds so person is available forlearning

Offer discriminating sensoryinformation to honor low

thresholds so person may engage inuseful routines/habits

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wardrobe, also. Because the dance musicwas loud, her date typically gained her at-tention by tapping her on the shoulder.Miranda asked her date to get her atten-tion visually instead. Furthermore, sherequested that they dance at the fringe ofthe group, so she could avoid bumpinginto people.

After the dance, the group planned ongoing to a restaurant. Miranda expressedconcern about the large size of the groupand all that it entailed (background noise,multiple smells, people bumping into herchair, etc.). Miranda’s family offeredstrategies for addressing her sensitivity tothe smells in the restaurant. They packedsome vanilla lotion and berry-flavored lip-stick into her purse, and encouraged herto apply it before entering the restaurantand intermittently during the meal (Mi-randa enjoys and is familiar with thesescents). The proximity of the scents onher hands and face screened out the back-ground smells of the restaurant.

Remembering her preference to be in alow-traffic area on the dance floor, herdate offered her a chair in an out-of-the-way location in the restaurant. He also in-vited a “laid-back” couple to sit nearthem, thereby decreasing sensations inher immediate environment. Miranda andher family had also brainstormed ideas re-garding potential home bases in therestaurant. They decided the restroomwould be an easily accessed alternativethat would enable Miranda to further de-crease auditory and touch sensation,should it become problematic for her.

Her family and educators utilized sim-ilar concepts in her home bases at homeand school. Miranda and her dad createda special area in her room; she arrangedfirm pillows so that they faced her fa-vorite posters, and added a lava lamp. Inaddition, they reviewed her music collec-tion to explore what songs would helpher relax the most. At school, the teamutilized similar constructs by offering acomfortable chair, headphones, and astudy carrel, to cut down on visual input.

Summary

Individuals with autism spectrum disor-ders, including AS, have complex needs

that often are not understood. Designingstrategies that support success often re-quires adjustment and creativity to meetthe varying needs and strengths of indi-viduals across a variety of contexts. Acomprehensive consideration of the indi-vidual’s sensory patterns of performance,the sensory-related characteristics of thestrategy, and the sensory features of theenvironment is necessary for optimal ef-fectiveness. Additional regard for thesupport person creating, providing, orimplementing supports may also be aconsideration. For example, a social storyread by a father will have auditory inputdifferent from one read by a femaleparaeducator. Without consideration ofsensory processing patterns and charac-teristics, attempts to implement effectivestrategies lack the depth and individual-ity that contribute to and support suc-cessful daily life experiences for individu-als with Asperger syndrome.

ABOUT THE AUTHORS

Winnie Dunn, PhD, OTR, FAOTA, is profes-sor and chairperson of the Department Occu-pational Therapy Education at the Universityof Kansas Medical Center. She has conduced ex-tensive resarch on sensory processing, has pub-lished many articles about the characteristics ofsensory processing in daily life, and offers guid-ance about intervention planning. JessicaSaiter, OTR, is a research assistant and in-structor for the Department of OccupationalTherapy Education at the University of KansasMedical Center. As a service provider, she sup-ports families of children with autism and re-lated developmental disorders within their nat-ural environments. Louann Rinner, MEd,OTR, is clinical occupational therapist and co-ordinator of occupational therapy studenttraining at the University of Kansas Develop-mental Disabilities Center. Address: WinnieDunn, University of Kansas Medical Center,Occupational Therapy Education, 3901 Rain-bow Bldg., Kansas City, KS 66160-7602.

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