Sensory Processing, Sensory Integration, Regulatory Disorder

What are these and why do we care?

Toby Long, PhD, PT, FAPTAGeorgetown UniversityCenter for Child and Human DevelopmentOctober 19, 2012

Todays Workshop

Today evening we will discuss the concept of sensory processing and how children (and adults) perceive, process, and use sensory input during everyday interactions. We will also discuss some of the consequences when children’s interpretation of sensory input leads to undesirable behavior. Strategies that are easy to incorporate into everyday activities and classroom routines will also be discussed.

SpeakerToby Long, PhD, PT, FAPTA is an Associate Professor in the Department of Pediatrics, Georgetown University and the Training Director of the Center for Child and Human Development, University Center for Excellence in Developmental Disabilities. Dr. Long is the Director of the Graduate Certificate Program in Early Intervention offered by Georgetown University and teaches Children with Disabilities, within the undergraduate Minor in Education, Inquiry and Justice. Dr. Long is also the Director of the Comprehensive System of Personnel Development for the District of Columbia’s early intervention program, Strong Start.

She is a Professor of Physical Therapy at the Krannert Graduate School of Physical Therapy at the University of Indianapolis, and Rocky Mountain University of Health Professions. Dr. Long is an internationally known speaker and consultant on service delivery to children with disabilities and special health care needs. She is the author of multiple publications including The Handbook of Pediatric Physical Therapy, Second Edition. The recipient of a variety of awards, Dr. Long is a Catherine Worthingham Fellow of the American Physical Therapy Association.

She can be reached at longt@georgetown.edu

Agenda

Differentiate sensory processing, sensory integration, and regulation

Discuss relationship between sensory processing/regulation and development

Discuss tools used to identify sensory processing challenges in your children

Discuss strategies that promote functional sensory processing and regulation

For Now and Forever

What are your hopes and dreams for the young children in your life?

They have friends

They are happy

They are successful

How do we become happy & successful with good friends ?

Opportunities to participate in community based activities

Use developmental strengths functionally• Social and emotional • Cognition• Language• Motor

Use compensations, modifications, accommodations as needed

What may prevent us from becoming happy & successful?

Disability• ASD• Development

al delay (esp. language)

• Physical disability

Behavior• ADHD• OCD• Depression• Bi-polar• Aggression• Non-

compliance

Family• Maternal

depression• Harsh parenting• Stressful family

life• Low social

support• Family instability

Society• Lack of

accommodation• Attitudes• Lack of

knowledge• Intolerance

Sensory Processing, Sensory Integration, and Regulatory Disorder

Learning and healthy behavior is influenced by

How we experience sensory input from the environment

How we interpret that input

How we organize it

How we use it

How we PROCESS, INTEGRATE, REGULATE and USE sensation

Processing, Integrating, Regulating allows us

• Explore and play• Complete every day

activities• Be available for learning• Maintain focus and

attention• Manage our emotions

PerceiveSense

RecallRemember

PlanThink

PerformDo

Apply this to your life?

PerceiveSense

RecallRemember

PlanThink

PerformDo

Sensory ProcessingThe ability of the centralnervous system to receivesensory information,interpret that information,and make a behavioralresponse that is consistentwith the sensoryinformation

Effective Sensory Processing – leads to a response that is

appropriate or well matched to the situation!

Ineffective Sensory Processing – leads to a response that is not

appropriate.

http://www.youtube.com/watch?v=6O6Cm0WxEZA

What does recent research tells us• 2004: 1 in 20 children were affected by SPD (Ahn, Miller, Milberger,

McIntosh)

• 2007: Children with ASD scored significantly poorer on all aspects of Short Sensory Profile (Tomchek & Dunn, 2007)

• 2009: 1 in 6 children have sensory challenges sufficient to disrupt academic, social, &/or emotional development (Ben-Sasson, Carter, Briggs-Gowen)

• 2011: 2 Subtypes of SPD/SMD identified: – sensory seeking, hyperactive, impulsive, aggressive– movement sensitivity, emotionally withdrawal, and low

energy/weak behavior (James, Miller, Schaaf, Nielsen, Schoen)

• 2011: Sensory over responsiveness correlates with negative temperament and fear in 2 y.o.(Keuler, Schmidt, Van Hulle, Lemery-Chalfant, Goldsmith)

Sensory Processing Profiles

Sensory SeekerSensory AvoiderSensory SensorSensory Bystander

Seeker• Active, engaging, disruptive• Requires novelty• Fidgets, explore objects• Constantly increasing sensory input

Avoider• Limits sensations• Disruptive• May have routines, rituals, rules• Rigid• Avoids or withdraws

Sensor• Aware of surroundings• Distractible• May be hyperactive• Difficulty maintaining attention

Bystander• Appears disinterested• Low energy levels• Appears self-absorbed• Flat affect

Long, 2009

So what profile are you???

Ryder (Pathways Awareness Foundation)

http://pathways.org/top/pathways-videos/sensory-integration-processing/

So what do we know about kids and SP

Infants Toddlers Preschoolers

FussyColic Poor feedingIntolerance to formulaShort sleep periodsHyperalertArches away when heldDifficulty self calming

Falls more oftenPrefers soft foods (white diet)Difficulty sleepingSeems weak/low toneLethargicDoesn’t like finger foods

ClumsyDifficulty using crayons/arts and craftsBumps into things and peopleMay get to close ArguesDifficulty with dressingUnintentionally aggressive

What do we know about kids with certain disabilities and SP?

Autism Spectrum Disorders (ASD)

Social-Emotional Difficulties (SED)

Infants with Regulatory Disorders

Attention Deficit Hyperactivity Disorder (ADHD)

ADLPicky eaterDislike hair brushing/hair cuts/washingSensoryUnder responsiveLess sensory seekingDistracted by noiseInattentionDevelopmentMotor planning challengesLanguageSocial interactionsPoor modulation of language, behavior, motor

BehaviorImpulsiveArgue, AggressiveDisruptive, StubbornAnxious, DepressionLearningMay have cognitive, language, motor delaysSocialFew friendsADLMay have disruptive sleepMay have food preferences

Crying3 hours/dayHigh pitchedStart suddenlyHas frantic qualitySleepShort burst of sleepsAwaken suddenlyDifficulty transitioning to sleepFeedingDifficulty nippling Intolerance to formulasPrefers soft/white food

InattentiveDisruptiveImpulsiveMay have behavior issueArgueAggressiveAnxiousDepression May have LD

How we can we tell?

Infants

•Red Flags•Checklists•IT 3

•Infant Toddler Sensory Profile•Early Intervention

Tod

dlers

•Red Flags•Checklists•IT 3

•Infant Toddler Sensory Profile•Early Intervention

Preschooler

s

•Red Flags•Screening•Sensory Profile•Child Find

IT 3: Infant Toddler Temperament Tool

• Temperament: 9 common traits (handout)

• Goodness of Fit: Compatibility between adult and child– Adults expectations and caregiving strategies match

child’s personal style (temperament)http://www.ecmhc.org/temperament/IT3.php?infant

“Participation Period”

Activity LevelDistractibilityIntensity

RegularitySensitivityApproachability

AdaptabilityPersistenceMood

What will we learn? IT 3 : Goodness of Fit concerns Checklists: Child may have sensitivity to certain sense

– Movement– Proprioception– Touch– Auditory– Taste– Smell– Visual

Sensory Profile: Intensity of response to sensation: under over

How the sensitivity impacts every day expectations

Long, 2009

So what do we do???

Well-maybe not that

Sensory diets– By Profile– By Sense

Sensory friendly environments– Accommodations– Modifications

Routines– Especially helpful for infants and toddlers

What does current research tell us

• 2002: Little evidence to effectiveness of sensory-motor intervention for children with ASD (Baraneck)

• 2009: Behavioral strategies more effective than SI in reducing self-injurious behavior in 9 y.o. children (Devlin, Leader, Healy)

• 2010: No differences in preschool teacher assessment of estimated percentages of time on-task with SI (Bonggat, Hall)

• 2011: Social responsiveness, sensory processing, functional motor skills, social emotional factors improved more in 6-12 yo children with ASD receiving SI than the fine motor only group although both groups improved (Pfeiffer, Koenig, Kinnealey, Sheppard, Henderson)

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Little evidence to support effectiveness of intervention

No evidence indicating sensory motor strategies are harmful

Seeker• Active, engaging, disruptive• Require novelty• Fidgets, explore objects• Constantly increasing sensory input

Avoider• Limits sensations• Disruptive• May have routines, rituals, rules• Rigid• Avoids or withdraws

Sensor• Aware of surrounds• Distractible• May be hyperactive• Difficulty maintaining attention

Bystander• Appears disinterested• Low energy levels• Appears self-absorbed• Flat affect

Sensory DietsBy Sense

Movement SwingingToss infants in air (very gently!)Use linear movement to rock babiesSit n Spin

Proprio. Carry pot/panWheel barrel walkingWrap in blanket during TVWear a back packCrawl on hands and knees Under tablesPush small grocery cartPop bubble wrap

Touch Scrub with wash cloth during bath timeDeep massage

By ProfileSeeker Jumping games

Push pull gamesSwinging, trampolinesMake a child sandwichRed light-Green light

Sensor Limit sensations during interactions (only touch not talk)Avoid heavy perfume, detergents, spicesMaintain structure

Bystander Actively encourage (not force)Provide crunchy food to increase alertnessTake stretch breaks

Avoider Use slow, rhythmic movementsPlay calming, gentle musicQuiet environmentLess distractions

Sensory Friendly Environments

De-clutter Maintain arrangement of furniture

– Unambiguous definition of spaces Keep noise level down: radio with gentle music rather than TV or rock music

– Do NOT watch TV during meals or when you want to interact– White noise can be calming

Natural lighting as much as possible Maintain temperature between 68-72o Greens/blues are calming; reds/pinks alerting Keep an activity schedule posted and refer to it on a regular basis

Direct Sensory-Motor Activities Incorporated into Day

• Infant Position: http://www.youtube.com/watch?v=M7J3w7opdUE• Infant Massagehttp://www.youtube.com/watch?v=-clV2Ekn55c&feature=relmfu• Infant Interaction/Bundlinghttp://www.youtube.com/watch?v=pA7vFgKuQdA&feature=relmfu• Preschoolers: Carol Kranowitz, The Out-of-Sync-

Child

Incorporating sensory input into daily activities and routines

• Bath time: Scrub with washcloth or bath brush, try a variety of soaps and lotions, play on the wall with shaving cream or bathing foam, rub body with lotion after bath time (deep massage), sprinkle powder onto body and brush or rub into skin.

• Meal preparation or baking: Let your child mix ingredients, especially the thick ones that will really work those muscles. Let child mix and roll dough and push flat. Allow child to help you carry pots and pans, bowls of water or ingredients (with supervision, of course). Let your child tenderize meat with the meat mallet.

• Grocery shopping: Have your child push the small cart. Let your child help carry heavy groceries and help put them away.

• Mealtime: Encourage eating of chewy foods and drinking out of a straw. Try having your child sit on an air cushion to allow some movement. A weighted lap blanket may be helpful as well. NO TV

Some more routines…• Household chores: Allow child to help with the vacuuming or moving the

furniture; help carry the laundry basket or the detergent; help digging for gardening or landscaping.

• Play time: – Reading books in a rocking chair or bean-bag chair may be calming. – Make obstacle course in the house/ yard using crawling, jumping, hopping,

skipping, rolling, etc. – Incorporate sensory activities into play – Swimming, horseback riding, bowling, mini or full-size trampolines, sandboxes or

big containers of beans or popcorn kernels: add small cars, shovels, cups, etc.

• Errands and appointments: Before visiting dentist/hairdresser try deep massage to the head or scalp or try having your child wear a weighted hat. Try chewy foods or vibration to mouth with an electric toothbrush. Let your child wear a heavy backpack or weighted vest. – Give ample warning before any changes in routine or any unscheduled trips or

errands.

And more….• Be consistent with rules and consequences• Create specific routines for troublesome times of day (bedtime or

getting ready for school).• Discuss upcoming anticipated changes in routine at a point in

time that is beneficial for your child. You will have to experiment with how early the child "needs to know."

• Indirectly use sensory preferences for fun rewards. – For example, having your child work towards an extra trip to go

bowling or horseback riding may be helpful. – Try not to restrict movement activities or sensory preferences as

punishments. Your child may need that movement time, and by removing it, his or her behavior may actually become more difficult later.

Caregiver Strategies

You are an Important Person in the Life of an Infant or Toddler

Connect With Families

Families have the most continuous and emotionally charged relationship with the child. Infants and toddlers learn what people expect of them and what they can expect of other people through early experiences with parents and other caregivers. (Day & Parlakian, 2004)

Learn about a families culture, traditions, beliefs and dreams for their child. Share positive experiences Affirm parents, use reflective listening

“A good example has twice the value of good advice” - author unknown

Provide Activities and Routines

Use routines as a time to connect with children

Maintain a predictable schedule

Plan routines around each child’s needs and

abilities

Ensure time for quiet and active play

Talk, read and sing with children every day

Provide Responsive Caregiving

Hold, cuddle and rock children

Respond to cues (coos, smiles, cries, etc)

Talk to infants and toddlers about their emotions

Stay close by as children interact with one

another

Observe each child’s skills

Provide Safe and Nurturing Learning Environments

• Create a homelike environment

• Have duplicates of favored toys

• Display toys within reach

• Allow children to have and use comfort items

• Keep the room and materials safe

• Make sure there are enough adults to safely care

for children

Application

Summary• All of us perceive sensory input differently

– That’s OK!• Sometimes the way we respond to sensory input get’s in the way of

learning, interacting, and behaving– That’s not OK!

• Strategies embedded into the daily routine are our first choice in helping kids– Some kids may need more

Key Resourceshttp://www.spdfoundation.net/whatweoffer.htmwww.STARCenter.ushttp://out-of-sync-child.com/www.teachingei.orgwww.ecmhc.org