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Differentiating Sensory from Behavior Finding Solutions for
Challenging Behaviors in Children Presented by Joani M. Richardson,
OTR/L
Disclosures • Guidelines exist whereby all speakers must disclose
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• FINANCIAL: Joani Richardson is compensated as the owner of her
private practice (Joani Richardson) and by Summit as an
instructor.
• NONFINANCIAL: Joani Richardson is the developer of the
Intervention Hierarchy which is widely used in treating persons
with autism.
Workshop Notes
Workshop Notes
Workshop Notes
Workshop Notes
Differentiating Sensory
Behaviors in Children
For
Problem Solving Model to Address Problem Behaviors
12
Children
www.joanirichardson.com
1
Sensory Processing •How the nervous system receives sensory
messages and responds to them •We are sensory beings with a wide
variety of tolerances and intolerances •Most of us receive sensory
messages and organize them effortlessly into appropriate responses
•Responses can result in behavioral, emotional, attention related,
motor and organizational outcomes
2
Sensory Processing Disorder
•Sensory Processing Disorder (SPD): difficulties are chronic, are
not singular and disrupt everyday life •Sensory Integration
Dysfunction (SI Dysfunction) •Estimated to affect at least 1 in 20
•Not a medical or mental diagnosis (no ICD10 code, not in DSM
5)
• Jean Ayres: pioneer in field (1960s) (Sensory Integration and The
Child)
• Lucy Jane Miller: one of leading researchers (Sensational
Kids)
• Angie Voss: practical strategies, OT (Understanding your child's
Sensory Signals)
• Carol Stock Kranowitz: educator's perspective (The Out of Sync
Child)
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4
The dual ability to take a real interest in the world – sights,
sounds, sensations; to make sense of those and to calm ones self to
the “just right level”. We call this the arousal level, alertness
level or self regulation. It is the ability to manage our own
internal environment. It is the neurological basis of motor control
and influences all behavior. Children under the age of 8 or those
that are struggling with sensory differences frequently rely on
adults to supervise their regulation.
Mary Sue Williams & Sherry Shellenberger: "The Alert Program"
or "How Does Your Engine Run"
Leah Kuypers, OT Zones of Regulation
www.zonesofregulation.com
A Sensory Experience
1. Proprioception 2. Vestibular
(Lucy Miller includes Interoception)
ASD and sensory symptoms: 69 – 93% (2005 – 2012)
ADHD and SPD age 2 – 21: 40% (2004)
Social Anxiety Disorder & sensory processing sensitivity:
apparent correlation, more info needed
7
What is "Behavior"
B.F. Skinner: human action dependent on consequences of previous
action. Coined term "verbal behavior"
Behavioral biologists: “Behavior is the internally coordinated
responses (actions or inactions) of whole living organisms
(individuals or groups) to internal and/or external stimuli,
excluding responses more easily understood as developmental
changes.”
8
What is "Behavior"
Google dictionary: The way in which an animal or person acts in
response to a particular situation or stimulus.
Merriam Webster : Anything that an organism does involving action
and response to stimulation
Wikipedia: Human behavior refers to the array of every physical
action and observable emotion
9
Challenging Behaviors:
Problem Behavior Theory : Problem behavior is behavior that is
socially defined as a problem, as a source of concern, or as
undesirable by the social and/or legal norms of conventional
society and its institutions of authority; it is behavior that
usually elicits some form of social control response, whether
minimal, such as a statement of disapproval, or extreme, such as
incarceration.
Richard Jessor, Distinguished Professor: Institute of Behavioral
Sciences, University of Colorado Boulder
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Part of typical development
Usually begin around 12 – 18 months. Get worse between 2 – 3 and
then decrease rapidly until age 4. After age 4, should rarely
occur.
Helps child learn boundaries, test limits and exert control.
Usually have a purpose. Kids are looking for a certain
response.
A child can often stop a tantrum if he gets what he wants or if
he's rewarded for using more appropriate behavior.
Some kids with learning and attention issues are more prone to
tantrums, ie: may be impulsive and have trouble keeping emotions in
check. May get angry or frustrated quickly.
A tantrum can lead to a meltdown
Challenging Behaviors: Tantrums vs. Meltdowns
12
Challenging Behaviors: Tantrums vs. Meltdowns
Meltdowns: are a reaction to something and are usually beyond a
child's control. Typically a reaction to feeling overwhelmed.
Occur in kids who lack abilities, skills or coping
strategies.
Serves no purpose, is an emotional reaction.
Is not likely to stop when a child gets what he wants. In fact, may
not even know what he wants.
Can occur without a tantrum.
Tend to end in one of two ways. 1. Fatigue: kids wear themselves
out. 2. A change in the amount of environmental impact which helps
them feel less overwhelmed.
14
13
Speak in calm, quiet voice. Emotions naturally match other's
emotions
Make it clear that you understand what he/she is after Be clear,
firm and consistent Visually ignore what the child wants without
giving in Tell him how to get what he wants; Use redirection Try
distraction Teach skills to avoid future tantrums
Managing Meltdowns
Help child find a safe, quiet place to deescalate.
Provide a calm presence without talking too much to the
child.
Goal is to reduce the input coming at the child .
When old enough, help child understand and prepare to avoid future
meltdowns.
Sensory strategies to support a child during a meltdown: Get below
their eye level and whisper Firm hugs from behind, or deep pressure
Change the lighting and noise level Invert the child's head, or get
them moving
14
CHAMPS Model for Classroom Management ABA: Applied Behavioral
Analysis PBIS: Positive Behavioral Interventions and Support FBA:
Functional Behavioral Assessment Parent Training Story Based
Intervention (Social Stories most well known) Cognitive Behavioral
Therapy DIR Floortime Video Modeling
15
CHAMPS Model for Classroom Management
Designed to help K – 8th grade classroom teachers develop a
classroom management plan that is proactive, positive and
instructional. Guides teacher in decision making for behavior
management. Book includes reproducible forms and visuals.
Communication Help Activity Movement Participation Success For more
information: CHAMPS A Proactive & Positive Approach to
Classroom Management Second Edition by Randy Sprick, PH.D.
16
ABA: Applied Behavioral Analysis The applied use of behavioral
principles to every day situations with the goal of either
increasing or decreasing targeted behaviors. Components:
discrete trial teaching programming for generalization
reinforcement prompting and fading strategies outcome based
decision making
Systematically applies interventions based on the principles of
learning theory, to improve socially significant behaviors to a
meaningful degree, and to demonstrate that the interventions
employed are responsible for the improvement in behavior.
17
PBIS: Positive Behavioral Interventions and Support
A framework for preventing problem behaviors and supporting a
persons social, emotional and behavioral needs.
Two critical approaches 1. Person centered; Show the individual
that their needs, interest, passions and dreams are always the core
focus 2. Strength based; Build from and celebrate the person's
competencies and abilities instead of focusing on deficits and
disabilities.
For further information: www.crisisprevention.com search PBIS on
their site
18
15
FBA: Functional Behavioral Assessment
Developed to ascertain the purpose or reason for behaviors
displayed by individuals with severe cognitive or communication
disabilities. Investigatory procedures include gathering data and
conducting experiments to evaluate the effects of environmental
variables on specific behavior. Used to try to determine why
behaviors were occurring, and develop behavior change programs to
help the disabled individual display more appropriate behavior in
meeting his or her needs.
19
Parent Training University of Washington researchers evaluated
about 20 parenting programs and found five that are especially
effective. These programs also have scientific evidence showing
that they work. • Nurse Family Partnership • Positive Parenting
Program • The Incredible Years (teaches children ages 3 6) •
Strengthening Families Program: (Parents and Youth 10 14) • Staying
Connected with Your Teen (designed to help children 12 17 years old
avoid risky sexual activity)
All five programs are consistent with the Social Development Model,
which focuses on fostering opportunities, skills, rewards for
positive social behaviors, bonding and clear expectations for
behavior.
20
21
Developed by Carol Gray. "A Social Story accurately describes a
context, skill, achievement, or concept according to 10 defining
criteria. These criteria guide Story research, development, and
implementation to ensure an overall patient and supportive quality,
and a format, “voice”, content, and learning experience that is
descriptive, meaningful, and physically, socially, and emotionally
safe for the child, adolescent, or adult with autism."
Provide missing information about the perspectives of others
Provide missing information about relevant social cues Define
expectations or assist in establishing routines Celebrate
successes
Book: Revealing the Hidden Social Code, Eileen Arnold & Marie
Howley For more information: www.carolgraysocialstories.com
Cognitive Behavioral Therapy
Short term, goal oriented psychotherapy treatment. Goal is to
change patterns of thinking or behavior that are behind people’s
difficulties, and therefore, change the way they feel Used to help
treat a wide range of issues Focuses on the thoughts, images,
beliefs and attitudes that are held (a person’s cognitive
processes) and how these processes relate to the way a person
behaves. Combination of psychotherapy and behavioral therapy Most
widely used psychosocial approach
22
Developmental level: meet child where they are Individual
differences Relationship based
Premise is that adults can help children expand their circles of
communication by meeting them at their developmental level and
building on their strengths
For further information: www.icdl.com/DIR
models 1. Video of unknown person: YouTube, Autism websites,
commercially available, etc.
2. Video of known person
3. Video self modeling: relatively well developed skill; watching
examples of best performance or performance in different
environment to transfer
4. Video feedforward: with people who do not have a skill or when a
new skill is just emerging. Requires editing to make it appear the
viewer is performing in advanced manner
24
16
So that's sensory and behavior…
What does all this mean in our world and how do we help the kids
navigate their way through a very complex world?
25
Our job is to help kids learn to successfully maneuver their
way
through the world How do we do that?
1. Skilled observation: Identify the problem and define it Be
specific – collect data (what do you see and hear?)
2. Determine what you need him/her to do Functional and child
specific Use positive language
* Write what you WANT to see, not what you don't want to see
26
Objective Observation Let go of your perceptions
What you see and what you hear Where you see it and where you hear
it How often you see it and how often you hear it
27
Limit competing stimuli (eye contact ?)
Decrease your impact: When in doubt: voice off Change what you can
in the environment
Routine is vital Use music to arouse or calm to signal transitions
to communicate
Refer to handout: “Altering the Environment: Sensory, Alertness,
Regulation, Attention”
28
General rules for altering alertness level:
To alert or increase arousal: use upbeat music light jumping
running light rubbing of skin crunchy foods, sour balls, ice chips
require trunk of body to work in sedentary postures
To calm or decrease arousal slow, rhythmical music slow and
rhythmical movements: swings, spinning, rocking weight / heavy
pressure: vest, lap, shoulders, backpack, theraband heavy work:
chewing, weight bearing, heavy jumping dim lighting: use natural
lighting and lamps decrease noise, including your voice
29
“just right”
equals heavy work
pressure & movement with feet.
Spinning board, slow rhythmical
31
Weighted transition back pack
provides focus. Heavy jumping
Rice sock Weighted sweatshirt
32
Calm their system through the mouth
Chew gum: sugarless bubble gum Narrow straw for drinks at meals
Sugarless lollipops or hard candy Sweat bands on wrists or sewn
into collar of
shirt (instead of chewing on clothing) Aqua tubing from hardware
store
Commercial chewy tools
Headphones (no sound) are used at younger ages.
Earplugs work well for
Headphones with music or white noise (ocean sounds, etc.)
Allow the option of skipping pep rallies and assemblies. Consider
allowing "hoodies" or ball caps. Don't forget hallways, lockers and
cafeteria May need a separate work area for independent work
Study carrel
Provide Structure and Clear Boundaries Colored tape: the “miracle
worker”
For older kids use solar system, time line, environmental signs,
animals, steps of photosynthesis, etc.
35
can travel are a great addition
36
18
Finding Solutions
Use a strength based approach Find a motivator Facilitate active
involvement Build relationships to foster desirable behavior
37
Use a Strength Based Approach
Ask: What is healthy? What is working? What are the child’s
strengths? What is the child good at?
Acknowledge fears and anxiety; be empathetic Let go…. adjust the
activity as needed, change the task, change the environment,
provide scaffolding
Empower by teaching self awareness at child's developmental
level
I finally figured out public school. They find out what you aren't
good at and make you do it over and over again.
38
If it's Meaningful to them, It's a Motivator If it's Not, It's
Not
If using a “major” motivator, always limit time up front (timer) or
use at natural transition (lunch; end of day) and have a visual
ready to indicate time is over. May need a reward for walking away
from the reward.
Break basket, break box or break desk.
Flour balloon
Having choices is motivating, provides a sense of control and
facilitates "buy in"
Not a choice to do it or not do it Limit choices to 3 max, 2 is
better
39
Laminate a picture. (Clear packing tape) Many kids need variety.
Print 8 10 different pictures.
40
Facilitate Active Involvement
BUILD ON STRENGTHS Some kids are self motivated, eager to please
and
intrinsically driven; Others need extrinsic support and rewards
Meet the child where they are: provide the "just right"
challenge Let it go…let it go….. Let go of trying to stop and
control
behaviors: work to influence and mold behaviors Give choices
41
When you build positive relationships and provide frequent positive
feedback, you motivate students to demonstrate their best
behavior.
Students have higher achievement and engage in fewer problem
behaviors when they have a positive relationship with their
teacher.
Chalk & Bizo, 2004; Reinke, Lewis Palmer & Martin, 2007;
Stormont, Smith & Lewis, 2007
Students work more diligently when they receive higher rates of
positive feedback than when they do not. Findings are consistent
from preschool to high school.
42
19
Problem identification: Specific, objective, data driven Identify
child's strengths Environment: global and specific Communication is
key: ask the right questions Educated guess/hypothesis Solution:
test it, re evaluate and start again if unsuccessful
43
We are sensory beings It's all behavior Objective observation is
critical Problems need to be specific & data driven Meet the
child where they are Build on strengths Child must be motivated
& actively involved Positive relationships foster positive
behavior
RULES OF THE ROAD
Altering the Environment Sensory, Alertness, Regulation,
Attention
The dual ability to take a real interest in the world – sights,
sounds, sensations; to make sense of those and to calm ones self to
the “just right level”. We call this the arousal level, alertness
level or self-regulation. It is the ability to manage our own
internal environment. It is the neurological basis of motor control
and influences ALL behavior. Children under the age of 8 or those
that are struggling with sensory differences frequently rely on
adults to supervise their regulation.
Basic Rules: Limit competing stimuli – change what you can in the
environment Work at child’s eye level
Pay attention to yourself and the use of affect. When in doubt:
Voice off Eye contact? Remember you are ALWAYS impacting their
world. Routine is vital. Child needs to know what to expect and
have clear boundaries and structure Use music In General: To
increase arousal: Use up beat music Trampoline with “light” jumping
Jumping games/running games Sit-and-spin or spinning board in
generally fast and/or non-rhythmical rotations Play “be an animal”
game or march Light rubbing of skin (pass around the circle)
Crunchy foods, sour balls, ice chips Chewing To decrease arousal
Use slow rhythmical music Rocking chair Swing set – slow and
rhythmical Weight: vest, lap, shoulders, back pack Dim lighting and
use lamps and/or use natural light Decrease noise, including your
voice Vibrating pen Bubble wrap to pinch “drown out” environmental
sounds (headphones with or without music) Calmer, more focused
activities “womb” like space; beanbag, blanket, weighted blanket,
tent with single book.
Classroom ideas: When on the floor, have a carpet to contain the
group or use individual carpet squares, throw rugs, chairs, hula
hoops or colored tape. Desk/table & chairs should be at correct
height: feet on floor, writing surface at / just above elbow Allow
alternative seating: T-stools, bean bag chairs, inner tubes Allow
varied positions: laying on tummy with clipboard or standing at
desk Use a plush area rug or soft carpet to dampen noise Hang a
hammock, swinging chair, or porch swing in nearby area Have a
rocking chair available Let child use a sleeping bag to calm self
down for nap or reading time Develop a quiet corner in the room Use
weighted items, lap, shoulders, vest, backpack. Allow the over
aroused child to sit in a tent Use visual markers on the floor to
help maintain place when lining up Post a daily schedule using
pictures if able
21
Altering the Environment - Continued Have ear plugs available for
older children to use Simplify directions: Break down into very
concrete simple steps, one at a time Always show a finished product
of art and other projects first and KEEP it visible. Background
music may be distracting, not calming 60 beats per minute music is
calming Keep chalkboards and wipe-erase boards clean Cover open and
“busy” shelves with sheets Keep all the “stuff” in opaque boxes Put
all children in chairs even in circle time Position furniture
around the perimeter of the room Pay attention to how fast you move
Tubing tied around 2 front legs of the chair for them to push
against Cut swim noodles and place them on backs and sides of chair
to give child feedback. Warn early that the day will be different
and repeat it. Place a “waiting” mat on the floor near activities
Work at the child’s eye level Use small flashlights with overhead
lights out to help kids focus, especially in groups. Minimize the
number of items that are out. Put some away and “rotate the stock”
Tape artwork outside in the hallway instead of the room and avoid
hanging things from the ceiling Use hand signals or home made signs
instead of voice Use an auditory signal, such as specific clapping
rhythm to attract attention before giving instructions Use close
proximity and touch to help kids focus Foam and duct tape over the
bell/loud speaker, etc. Wear sunglasses and/or ball cap for outside
or places with bright florescent lighting (gym, cafeteria)
Tennis balls on the bottom of chairs to decrease noise when
scooting them. Cover florescent lights with sheets like a swag.
Fire retardant billowing is commercially available Have them sit on
a beach ball ($1 at dollar store) only partially blown up. Make
sure the activities you’re doing do not have odors that are noxious
or too strong for the child. Use picture icons or photographs for
“quiet hands” , “quiet feet”, “sit down” and “voice off” Wear a
loose fitting “hoodie” sweatshirt and allow the child to pull arms
in and to pull hood onto head in
busy environments like hallways, cafeteria, gym and school
bus.
22
Flour Balloons You will need: -party balloons; heavy duty if
possible -flour -funnel -scissors 1. Stretch the balloon: Using
your mouth or a pump blow air into the balloon so that it inflates
and stretches. Let the air out of the balloon. Repeat a few times.
2. Using the funnel fill the balloon with flour. Make sure to be
holding the end of the balloon tightly to avoid a mess. Stop
putting flour in the balloon when it reaches the neck. Don't fill
the neck. Make sure no air is trapped inside and then tie the end
into a knot.
3. If preferred, take another balloon and cut the neck off. Stretch
the second balloon over the first one as a second layer. The second
layer will help prevent the dispersion of flour all over the place
in the event a hole would appear.
23
Rice Socks and Weighted Sweatshirts
For Rice Socks you will need: -White rice - uncooked (&
optional flax seed) approx. 38-42 oz per sock, but this will vary
depending on sock size. Do NOT use minute rice. One 10-pound bag
makes approximately 4 - 5 large rice socks. -Funnel -Paper or
plastic cup to pour rice into funnel -Cotton athletic men's tube
sock(s) - -as large as can easily find. Grey tube socks won't show
spots as much. If using with small children, you may prefer smaller
socks. Use a thick athletic type sock, so grain will not stick
through. Using the funnel and cup, (or with two people or after a
bit of practice, just a cup) fill the sock with uncooked rice. You
can also add flax seed which takes longer to heat than rice, but is
also smoother and stays warm longer. Add any additional aromas or
herbs. Don't pack it in tightly; leave some room for the grains to
move around so that it will more easily conform to the body. Tie a
knot in the open end of the sock. You may choose to use string, etc
to tie the end closed or sew it closed instead. I prefer just to
knot the end of the sock. You can put a second sock over the first,
if preferred for more protection. Put the filled sock in a
microwave oven for approximately 1-3 minutes (or to chill the sock,
put it in a freezer for about 45 minutes). When you heat the rice
sock you may also place a cup of water in the microwave to add
extra moisture during the heating process. Heat time will vary
depending on size. For Weighted Sweatshirt you will need: - 1
sweatshirt without a hood. Washed and thoroughly dried - 2 rice
socks as noted above that will easily fit in the length of the
sweatshirt sleeve OR the rice and other items noted above, but no
socks. - needle and heavy thread or sewing machine Sew or stitch
the distal end of each sleeve near the wrist cuff closed with a
tight stitch. Going through the neck or bodice of the sweatshirt,
slip one rice sock into each sleeve making sure there is plenty of
room to stitch the shoulder closed. Place the knotted end of the
rice sock near the wrist, and the wider part (the toe of the sock)
at the shoulder. NOTE: You can also skip the socks and just make
sure the sweatshirt sleeve is tightly sewn closed and fill the
sleeve itself with rice. Sew or stitch the upper arm of the
sweatshirt closed on or near the shoulder seam.
24
Possible Reinforcers and specific type
Always
Frequently
Sometimes
Never
gum ____________ marshmallows chocolate cookies ____________
crackers ___________ cereal _____________ chips ______________
pretzels popcorn bagels pizza _____________ cheese ___________
peanut butter grapes bananas ice cream popsicle M&Ms skittles
juice ______________ soda ______________ milk _______________ water
outside play walking inside running / chasing bicycling dancing
bubbles watching videos digital games music rough & tumble play
rocking (chair) coloring drawing shape sorters finger play swimming
playing ball games manipulative toys stickers music books
Please list favorite / preferred items noted below. Base on what
you most see, not only what the child says. If none, write N/A or
leave blank. Other foods_______________________________
____________________________________ Color (s)
_________________________________ TV show
_________________________________ Computer game / site
_______________________ ___________________________________ Video /
movie _____________________________ Character (TV, movie, book)
______________________ __________________________________ Outing
(restaurant, park,etc.) ______________________
_________________________________ Animal
__________________________________ Book
____________________________________ Anything else?
____________________________
________________________________________
Possible Reinforcers
dolls figurines airplanes tractors animals cars balloons blocks
pats praise shoulder rubs
high 5 hugs tickles fist bump
25
Resources and References
Smart but Scattered: The Revolutionary “Executive Skills” Approach
to Helping Kids Reach Their Potential by Peg Dawson and Richard
Guare copyright: January 2,2009
The Smart but Scattered Guide to Success: How to Use Your Brain's
Executive Skills to Keep Up, Stay Calm, and Get Organized at Work
and at Home by Peg Dawson EdD, Richard Guare PhD copyright: January
16, 2016
The Sensory Child Gets Organized: Proven Systems for Rigid,
Anxious, or Distracted Kids, by Carolyn Dalgliesh copyright:
September 3, 2013
Sensational Kids: Hope and Help for Children with Sensory
Processing Disorder (SPD) by Lucy Jane Miller copyright: May 6,
2014
Naturalistic Developmental Behavioral Interventions: Empirically
Validated Treatments for Autism Spectrum Disorder, Journal of
Autism and Developmental Disorders; August 2015, Volume 45, Issue
8, pp 2411–2428 U.S. Department of Education, National Center for
Education Statistics. (2015). Digest of Education Statistics.
Retrieved from: https://nces.ed.gov/fastfacts/display.asp
Looking at Autism: ABA and a Behavior Analysis of Sensory Needs: By
Carl Sundberg, Ph.D., BCBA-D Executive Director/President, Behavior
Analysis Center for Autism (BACA) 2017, Retrieved from
https://thebaca.com Myths & Facts About Applied Behavior
Analysis; - kennedykrieger.org, April 17, 2016
Evidence-Based Practice of Cognitive-Behavioral Therapy, Second
Edition, by Deborah Dobson PhD and Keith S. Dobson PhD, Copyright:
Dec 7, 2016
Behavior analytic approaches to problem behavior in intellectual
disabilities; Hagopian, Louis P.; Gregory, Meagan K.: Current
Opinion in Psychiatry: March 2016 - Volume 29 - Issue 2
National Standards Project, Phase 2: Addressing the need for
evidence based practice guidelines for Autism Spectrum Disorder
NationalAutismCenter.org Copyright 2015 Ahn, R. R., Miller, L. J.,
Milberger, S., and McIntosh, D. N. (2004). Prevalence of parents’
perceptions of sensory processing disorders among kindergarten
children. Am. J. Occup. Ther. 58, 287–302. Ben-Sasson, A., Carter,
A. S., and Briggs-Gowan, M. J. (2009). Sensory over-responsivity in
elementary school: prevalence and social-emotional correlates. J.
Abnorm. Child Psychol. Front. Integr. Neurosci., 30 September 2009
| https://doi.org/10.3389/neuro.07.022.2009 Perspectives on sensory
processing disorder: a call for translational research Lucy J.
Miller1,2,3*, Darci M. Nielsen1, Sarah A. Schoen1,2,3 and Barbara
A. Brett-Green1
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Resources and References - Continued
Sensory Experiences Questionnaire: discriminating sensory features
in young children with autism, developmental delays, and typical
development. Baranek GT, David FJ, Poe MD, Stone WL, Watson LR J
Child Psychol Psychiatry. 2006 Jun; 47(6):591-601. Autism in
adults: symptom patterns and early childhood predictors. Use of the
DISCO in a community sample followed from childhood. Billstedt E,
Gillberg IC, Gillberg C J Child Psychol Psychiatry. 2007 Nov;
48(11):1102-10. Sensory abnormalities in autism. A brief report.
Klintwall L, Holm A, Eriksson M, Carlsson LH, Olsson MB, Hedvall A,
Gillberg C, Fernell E Res Dev Disabil. 2011 Mar-Apr; 32(2):795-800.
Describing the sensory abnormalities of children and adults with
autism. Leekam SR, Nieto C, Libby SJ, Wing L, Gould J J Autism Dev
Disord. 2007 May; 37(5):894-910. Sensory symptoms in children with
autism spectrum disorder, other developmental disorders and typical
development: A longitudinal study Carolyn McCormick,1 Susan
Hepburn,2 Gregory S Young,3 and Sally J Rogers3 Published in final
edited form as: Autism. 2016 Jul; 20(5): 572–579. Published online
2015 Sep 22. doi: 10.1177/1362361315599755 Sensory-processing
sensitivity in social anxiety disorder: Relationship to harm
avoidance and diagnostic subtypes Stefan G. Hofmann* and Stella
Bitran Published in final edited form as:J Anxiety Disord. 2007;
21(7): 944–954. www.simplypsychology.org: Skinner - Operant
Conditioning : by By Saul McLeod published 2007, updated 2015
Strength-Based Assessment and School Psychology: A Summary and
Synthesis Shane R. Jimerson, Jill D. Sharkey, Vanessa Nyborg,
Michael J. Furlong, University of California, Santa Barbara The
California School Psychologist, Vol. 9, pp. 9-19, 2004 A Strengths
Based Approach to Working with Youth and Families: A Review of
Research Prepared by The University of California, Davis, Extension
The Center for Human Services April 2009 Strength-based approach: A
guide to writing Transition Learning and Development Statements
Published by the Communications Division for Early Childhood
Strategy Division Department of Education and Early Childhood
Development Melbourne ,February 2012 ©State of Victoria (Department
of Education and Early Childhood Development) 2012
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driven:_____________________________________________________
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driven:_____________________________________________________
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Educated
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32
Aaron is a 4 yr, 2 mo. old male who attends the Head Start program
full-time with 13 other kids in his classroom. He has medical
diagnoses of Other Disorders of Psychological Development. He
receives OT on a weekly basis due to concerns regarding his
behavior and social interaction, non-preferred activity completion,
difficulty regulating himself in relation to other children and his
surroundings, and sensory differences. He is being raised by his
mom, who reports that he is happiest when he is playing by himself
and that he plays purposefully with preferred toys at home. At home
his favorite toys are his toy trucks. She reports that "everything
makes him angry', that he is "never calm" and that he does not like
being "fussed at" or told that he has done something wrong, or told
"no". He has one younger sister. Aaron's gross motor skills are at
age level. He is able to access all areas of the classroom and
playground independently. He is fully verbal, speaking in full
sentences. He uses a loud voice and yells frequently. His
vocabulary is at or above age level. He is inquisitive and likes to
"solve problems" presented by adults. He interacts relatively well
1:1 with adults if they follow his lead. On Visual Motor testing he
demonstrates an age equivalency of 3 years, 4 months. He is able to
copy lines and a circle, build a 10-block tower, strings beads and
cut a piece of paper in two. He demonstrates right hand dominance.
He struggles to alter the force required on school tools and
frequently applies excessive force and moves quickly through tasks,
or parts of tasks. Aaron prefers the music center and the block
center. He also enjoys art activities, especially those that
include using glue and cutting. One-on-one with an adult he likes
books that he can participate in naming animals or other familiar
items. He has strong preferences, not only of what he plays with,
but how it should be played with, as well as whom he
interacts/plays with and how. He tantrums frequently, yells, hits
other children and dumps toys on them, as well as clearing off
shelves of toys when things don't go his way. He has significant
difficulty regulating his behaviors and emotions. He will use eye
contact fleetingly. He's a very active child who tends to be
constantly on the move. When outside, he runs and jumps and tackles
other children and moves from place to place and equipment to
equipment. He requires constant 1:1 supervision to keep himself and
others safe. He does respond to 1:1 verbal direction from a
familiar adult and can stop himself and refrain from troublesome
behavior with adult intervention. He will raise his voice and cry
with adults, but to date has not been aggressive towards adults.
Troublesome behaviors as reported above are noted to occur
throughout each day that he attends Head Start. Like most children,
he has good days and bad days. The frequency of troublesome
behaviors ranges from 5–10 times per day. On occasion, he will have
an exceptionally good day and troublesome behaviors will only occur
2 times. He consistently struggles with the transition from outside
play back into the classroom. Routinely, after outside time, the
children all transition in, hang up coats, go to the carpet for a
story or short video and then use the toilet and wash hands to
prepare for lunch. The children are divided between 2-3 large
tables and eat "family style". Aaron typically refuses to leave the
playground, but with 1:1 adult direction, will line up, frequently
at the end of the line. Once he enters the classroom he requires
very close adult supervision and it is one of the most difficult
times of the day for him. On the Sensory Profile he shows definite
differences in touch processing & modulation of movement
affecting activity level, and probable differences in the oral
sensory processing and multi sensory processing. He does not appear
to "tune-in" when spoken to & enjoys strange noises and seeks
making noise for noise sake. He has a hard time finding objects in
competing backgrounds. He seeks all kinds of movement, which
interferes with his daily routine. He reacts aggressively or
emotionally to touch, unless initiated by him, has difficulty
standing in line or close to other people but displays an unusual
need for touching toys' surfaces or textures, people and objects.
He has difficulty paying attention and seems oblivious within an
active environment. He becomes overly excitable during movement
activities and avoids quiet play activities. He does not perceive
body language or personal space. He makes negative comments about
himself when he's upset and he says "sorry" about everything he
does.
33
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