1. Sensory Processing, Sensory Integration, Regulatory Disorder
What are these and why do we care?
Toby Long, PhD, PT, FAPTA
Georgetown University
Center for Child and Human Development
October 19, 2012

2. 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.

3. Speaker
Toby 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

4. 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

5. What are your hopes and dreams for the young children in your life?
For Now and Forever
What are your hopes and dreams for the young children in your life?
They have friends
They are successful
Ask this question to the audience and let them throw out some words- could flip chart answers. Typically ask the participants if they notice anything that the words have in common, The bottom line is that answers almost always relate back to social-emotional health- this begins the flow of the talk- that in order to support infants and toddlers to have healthy relationships, success and fulfillment we need to begin by understanding and supporting social and emotional health the critical foundation for building bright futures.
They are happy

6. 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

7. What may prevent us from becoming happy & successful?
Disability
ASD
Developmental 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

8. How we PROCESS, INTEGRATE, REGULATE and USE sensation
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

9. Processing, Integrating, Regulating allows us
Perceive
Sense
Recall
Remember
Think
Plan
Perform Do
Explore and play
Complete every day activities
Be available for learning
Maintain focus and attention
Manage our emotions

10. Apply this to your life? Recall Perceive Sense Perform Do Remember
Think
Plan
Perform Do
WHO HAS A 4 YEAR OLD—GETTING COAT ON TO GO TO SCHOOL---

11. Sensory Processing
The ability of the central nervous system to receive sensory information, interpret that information, and make a behavioral response that is consistent with the sensory information
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.

12. 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)

13. Sensory Processing Profiles
Sensory Seeker
Sensory Avoider
Sensory Sensor
Sensory Bystander

14. Seeker Sensor Avoider Bystander 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

15. So what profile are you???
Long, 2009

16. Ryder (Pathways Awareness Foundation)
Stop tape with him crawling and ask what they think is up with Ryder.
At end ask what they think is up with Ryder?

17. So what do we know about kids and SP
Infants
Toddlers
Preschoolers
Fussy
Colic
Poor feeding
Intolerance to formula
Short sleep periods
Hyperalert
Arches away when held
Difficulty self calming
Falls more often
Prefers soft foods (white diet)
Difficulty sleeping
Seems weak/low tone
Lethargic
Doesn’t like finger foods
Clumsy
Difficulty using crayons/arts and crafts
Bumps into things and people
May get to close
Argues
Difficulty with dressing
Unintentionally aggressive

18. 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)
ADL
Picky eater
Dislike hair brushing/hair cuts/washing
Sensory
Under responsive
Less sensory seeking
Distracted by noise
Inattention
Development
Motor planning challenges
Language
Social interactions
Poor modulation of language, behavior, motor
Behavior
Impulsive
Argue, Aggressive
Disruptive, Stubborn
Anxious, Depression
Learning
May have cognitive, language, motor delays
Social
Few friends
May have disruptive sleep
May have food preferences
Crying
3 hours/day
High pitched
Start suddenly
Has frantic quality
Sleep
Short burst of sleeps
Awaken suddenly
Difficulty transitioning to sleep
Feeding
Difficulty nippling
Intolerance to formulas
Prefers soft/white food
Inattentive
Disruptive
May have behavior issue
Argue
Aggressive
Anxious
Depression
May have LD

19. How we can we tell? Infants Red Flags Checklists IT 3
Infant Toddler Sensory Profile
Early Intervention
Toddlers
Preschoolers
Screening
Sensory Profile
Child Find

20. 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)
“Participation Period”
Activity Level
Distractibility
Intensity
Regularity
Sensitivity
Approachability
Adaptability
Persistence
Mood

21. How the sensitivity impacts every day expectations
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

22. So what do we do???
Long, 2009

23. Well-maybe not that Sensory diets Sensory friendly environments
By Profile
By Sense
Sensory friendly environments
Accommodations
Modifications
Routines
Especially helpful for infants and toddlers

24. 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)

25. Sooooooo
Evidence to support sensory modulation and responsive differences in children with a variety of challenges
Little evidence to support effectiveness of intervention
No evidence indicating sensory motor strategies are harmful

26. Seeker Sensor Avoider Bystander 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

27. Sensory Diets By Sense By Profile Movement Swinging
Toss infants in air (very gently!)
Use linear movement to rock babies
Sit n Spin
Proprio.
Carry pot/pan
Wheel barrel walking
Wrap in blanket during TV
Wear a back pack
Crawl on hands and knees Under tables
Push small grocery cart
Pop bubble wrap
Touch
Scrub with wash cloth during bath time
Deep massage
Seeker
Jumping games
Push pull games
Swinging, trampolines
Make a child sandwich
Red light-Green light
Sensor
Limit sensations during interactions (only touch not talk)
Avoid heavy perfume, detergents, spices
Maintain structure
Bystander
Actively encourage (not force)
Provide crunchy food to increase alertness
Take stretch breaks
Avoider
Use slow, rhythmic movements
Play calming, gentle music
Quiet environment
Less distractions

28. 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

29. Direct Sensory-Motor Activities Incorporated into Day
Infant Position:
Infant Massage
Infant Interaction/Bundling
Preschoolers: Carol Kranowitz, The Out-of-Sync-Child

30. 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

31. 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.

32. 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.

33. You are an Important Person in the Life of an Infant or Toddler
Caregiver Strategies
Now that we have explored what social, emotional health is, why it is so important and what it looks like- lets talk about what you can do to support SE health for the infants and toddlers in your care
You are an Important Person in the Life of an Infant or Toddler

34. 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

35. “A good example has twice the value of good advice” - author unknown
If we work from a strength based approach- it can lead to strength based partnerships and more enriching relationships

36. 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

37. 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

38. 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

39. Application

40. 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 Resources