11Sensory Processing Disorder (SPD) “Problems in directing, regulating, interpreting, and responding to sensory input.” (Miller, Anzalone, Lane, Cermak, Osten, 2007)Can influence child’s response to:EnvironmentPeopleTasks/activities*Note: Some of us may have sensory processing challenges, but it is considered a Sensory Processing Disorder when the problem is severe enough to interfere with daily routines or roles.
12Impacts On Every day Life Activities of Daily Living (ADLs)Social ParticipationEducation/WorkPlay/LeisureRest and Sleep
14Ten Fundamental Facts About SPD Sensory Processing Disorder is a complex disorder of the brain that affects developing children and adults.Parent surveys, clinical assessments, and laboratory protocols exist to identify children with SPD.At least one in twenty people in the general population may be affected by SPD.In children who are gifted and those with ADHD, Autism, and fragile X syndrome, the prevalence of SPD is much higher than in the general population.Studies have found a significant difference between the physiology of children with SPD and children who are typically developing.Studies have found a significant difference between the physiology of children with SPD and children with ADHD.Sensory Processing Disorder has unique sensory symptoms that are not explained by other known disorders.Heredity may be one cause of the disorder.Laboratory studies suggest that the sympathetic and parasympathetic nervous systems are not functioning typically in children with SPD.Preliminary research data support decades of anecdotal evidence that occupational therapy is an effective intervention for treating the symptoms of SPD.from Sensational Kids: Hope and Help for Children With Sensory Processing Disorder (SPD)p by Lucy Jane Miller, PhD, OTR
15SPD Subtypes Sensory Modulation Disorder Sensory over-responsivity Too much information coming inSensory under-responsivityInformation comes in but not responsive to itSensory seeking or craving‘Needing’ more information
16Sensory Over-Responsivity Brain has too LOW of a thresholdTactileDifficulty with getting hair cutsAvoidance of touching certain texturesVestibularDisoriented after bending downAnxious when feet leave the groundAvoids rapid or rotating movementsVisualDifficulty tolerating bright lights
17Sensory Over-Responsivity ProprioceptionDifficulty being huggedDifficulty with people moving your bodyAuditoryFearful of soundsDistracted by certain noisesFrequently cover earsOral“Picky” eaterDifficulty brushing teeth
18Sensory Under-responsivity Brain has too HIGH of a thresholdTactileDifficulty noticing touchDress inappropriately for weatherVestibularDoes not get dizzyEnjoys being upside down or sideways“Thrill seeker”VisualOften miss what is right in front of them
19Sensory Under-responsivity ProprioceptionPoor body awarenessFloppy or poor postureAuditoryListens to loud music or TVTalks to self during a task (out loud)OralMay be able to eat anything
20Sensory Seeking/Craving Seeks arousal of nervous system (inappropriately)TactileEnjoy “bear” hugsCrave touch of texturesVestibularJumpingEnjoy spinning in circles, being upside down
21Sensory Seeking/Craving ProprioceptionLoves crashing or bumping into objectsCraves highly physical activitiesAuditorySpeaks louder than necessaryNeeds to listen to music to concentrateOralPuts anything in mouth (searching for oral input)
23Sensory Discrimination Disorder Examples ProprioceptionConstant slamming of doorsPushing too hard (to increase awareness)TactileNeed to use eyes when searching for object in backpack or purseTaste/smellDifficulty distinguishing between flavors or scentsVestibularFrequently falls out of chairs
24SPD Subtypes Sensory Based Motor Disorder Dyspraxia Difficulty motor planningPostural disorderPoor cocontractionMuscle tone (Low)Equilibrium and postureImmature reflexive abilitiesBilateral Integration
25Examples of Dyspraxia Proprioception Poor gross motor skills Poor motor control and body awareness during dressingVisionNavigating through crowded hallwaysPoor gross motor skillsRunningjumpingPoor fine motor skillsZippingButtoningProblems in figuring out how to do movementsDressingComplex dance steps
26Examples of Postural Disorders Low muscle tone‘slumped’ in chairLeans on thingsPoor balanceOften trips or bumps into objectsDifficulty with riding a bike or jumpingPoor stabilitySits in awkward positionsHead and eye stabilityDifficulty when reaching for objectsUse of two sides of bodynot stabilizing paper to write
28How Do You Feel About… Cold shower Wool clothing Panty hose Sweatpants The feel of Jell-O in your mouthThe sound of birdsBright colored walls in the bedroomThe smell of perfumeElevatorsRoller Coasters
29Support Groups Moms Connect About Autism-MoCAA Sensory Planet Social NetworkSPD Parent SHARE
30ReferencesAmerican Occupational Therapy Association. (2008). Occupational therapy practice framework: Doman and process (2nd ed.). American Journal of Occupational Therapy, 62,Baranek, G., Foster, L. & Berkson, G. (1997) Tactile defensiveness & stereotyped behaviors. Am J. of Occupational Therapy, 51, 91-95Bundy, A., Lane, S., Murray, E. (2002). Sensory integration theory & practice. Philadelphia: F.A. Davis Company.Dunn, W., Myles, B. & Orr, S. (2002). Sensory processing associated with Asperger syndrome: A preliminary investigation. AJOT, 56,Kimball, J. (1999). Sensory integrative frame of reference. In Kramer, P. & Hinojosa, J. Frames of Reference for Pediatric Occupational Therapy. Baltimore: Williams & Wilkins.Kranowitz, C. (2004). The out-of-sync child: Recognizing and coping with sensory processing disorder 2nd ed. New York: Berkley.Miller, L. Anzalone, M., Lane, S., Cermak, S. & Osten, E. (2007). Concept evolution in sensory integration: A proposed nosology for diagnosis. Am J of OT, 61, (2),Henry, D. A, Kane-Wineland, M., & Swindeman, S. (2007). Tools for Tots: Sensory Strategies for Toddlers and Preschoolers 2007.
31Review of challenges/characteristics….. Slow Processing - Difficulty shifting attentionInattentive, Difficult to arouseDoes not like change or transitions Rigid – Demands routine
32Difficulty with, or seeks out, certain types of foods/textures Smells all food before eating - smells objectsUnable to sit with anyone behind them in classDifficulty attending from the back of the roomExplosive emotions or lack of emotions or incongruent emotional responses
33Aggression to self or others Compulsive BehaviorsDifficulty with clothing, type of clothing, and change of clothing
34Perseveration on topic or activity - Fixation on sensory stimuli Clumsy, awkward, difficulty in sportsOver or Under-reaction to painUnsure of group situations, cautious, or a loner2
35Work SheetWhich is your student/child? Identify the sensory type (or types) that you observe to be true of your student or child
37The “Sensory Diet” includes…. PROVIDING SENSORY EXPERIENCESA combination of sensory experiences needed by a person to adaptively interact with the environment (“make it through the day”).MAKING ENVIRONMENTAL MODIFICATIONSModification and organization of the environment in order to decrease stress on a fragile sensory system.
38Those with sensory processing challenges May not be able to filter and focusMay attempt to adjust in a maladaptive way(Ex: Escalation of Mood, Shutting Down)Will require a “sensory diet” enriched with unique sensations and experiences
39Creating The Sensory D.I.E.T. D …..Do an Informal Assessment I …..Individualize E …..Environmental Supports T …..The Power Senses
40Do an Informal Assessment Assess the Environment and the Individual’s response to a variety of sensory experiencesSeeker?Active Avoider?Under-Responder?Overwhelmed
41Individualize the Sensory Diet What has worked for one person may not work at all for someone else!
42Considerations for the Sensory Diet UNDER-RESPONDERIncrease the use ofvisual supports and routines.Structure the environment.Time to respondCareful encouragement totry new experiencesSEEKERProvide sensoryexperiences frequently &proactivelyMay need to limitexcitatory experiencesConsiderations for the Sensory DietACTIVE AVOIDERModify the environmentto reduce the needto escapeGentle introduction tonew experiencesOVERWHELMEDControl the environmentLimit stimulationLimit change butprepare for changeswhen they need to occur.
43Environmental Supports OrganizationPredictable, Structured, Consistent EnvironmentTask or CurriculumVisual SupportsEscape Environments
44Proactively Schedule Sensory Activities Use the Power Senses throughout the day in order to help a person alert, attend, act, and reactAt times, additional activities or input may be needed based on the behaviors observed
45Proprioceptive System The Power SensesTactile SystemProprioceptive SystemVestibular System
46The Power Senses Vestibular Movement Proprioception Input through joints and musclesTactileDeep Pressure Touch
49Pertains to the sense of touch Helps provide a basis for body image Tactile SystemPertains to the sense of touchAlerts to dangerGives body boundariesHelps provide a basis for body image
50Protective System Activates “Fight, Fright, or Flight” Born with this system- “Primal”Stimulated by light touch, pain, temperatureProcessed through the emotional, excitatory portion of the limbic system NOT a cognitive response
51Discriminative : Pressure Touch Deep touch/pressure, and vibrationActivates Parasympathetic SystemCalms and organizesAllows for more cognitive responseHelps us learn and think
52Dysfunction of the Tactile System DistractibilityHyperactivityOver/Under SensitivityHyper-vigilantInappropriate pain sensationAvoids getting hands dirtyDifficulties with clothing/texturesAvoids whole handDisorganized when touchedIntolerant of wearing glasses/hearing aideDifficulty with Social Space
53Tactile Defensiveness is when… - Sensitive to light touchTouch causes difficulty organizing behavior and concentrationTouch causes negative emotional responsesCan become aggressive, if feeling threatened or stressed
54Interventions for Tactile Defensiveness Brushing ProtocolsWilbarger ProtocolPRRBrushing over arms, legs, back with a soft brush , followed by joint compressionsCautionA brushing protocol should only be implemented after an assessment and training by a qualified professional
56Sensory Bucket Three Power Senses will provide: more input To“fill the sensory bucket” quickly use the Power SensesThree Power Senses will provide:more inputmore quicklyto make changes that are more rapidSensory BucketBased on Work of Bonnie Hanshu
57Environmental Supports Access to an escape/private areaCaution with placement Student may want to sit where no one is behind himSome feel secure with boundaries that keep others at a distance…..Others need space in order to make a “quick escape”
67People Supports: What Others Can Do Avoid unnecessary touch and Ask PermissionAvoid touching face to gain attentionMove slowly and provide “Waiting Time” up to 10 secondsWhen touch is necessary, use Deep Pressure Touch
68Proprioceptive System The Power SensesProprioceptive System
69Proprioceptive System Muscles, joints, and tendons provide a person with a subconscious awareness of body position via the feedback from receptors in the muscles, tendons and joints.
70Proprioceptive System Motor PlanningAwareness of body intime and space withoutconstant visually monitoring
71Dysfunction of Proprioceptive System Clumsiness, a tendency to fallLacks awareness of body position/odd postureDifficulty with small objects (buttons/ snap)Disorganized….. Materials & ThoughtsPoor or resistance to handwritingEats in a sloppy mannerResists new motor movement activities
72 Activities that provide proprioceptive input Joint compression or extension“Heavy work” activitiesThe larger the joint, the more proprioceptive input
73Examples of “Heavy Work” Passive Joint CompressionsJumping/Trampoline (floor may be better..)Stacking ChairsWeight Lifting“Bungee Cord” on ChairsChewing Gum“Pretzel Hugs”
74Fine Motor Supports “Hand-prep” exercise Limit Handwriting RequirementsAlternatives to handwritingKeyboardingSoftwareSet of notesGripsVelcro on ShoesAlternatives & AccommodationsOptions in Word and PowerPointSensory Breaks between tough fine motor activities
75ALL will need environmental supports Organizational SupportsVisual SupportsColor codingTimers/WatchesWritten directionsWritten rule remindersUnder-Responders will needclear and noticeable supports
76Stay on schedule Pace language Use Concrete Language Use Wait Time What Can Others DoStay on schedulePace languageUse Concrete LanguageUse Wait Time
78Vestibular SystemThe vestibular system refers to the structures within the inner ear (the semi-circular canals) These structures detect movement and changes in the position of the head.
79The brain needs vestibular input in order to function Vestibular input provides the Strongest Sensation
80Movement can change an individual’s attention, arousal and alertness in the shortest period of time The effects from vestibular input can last longer than any other input.
81Hypersensitive: Active avoider and overwhelmed Fearful reactions to ordinary movement activitiesApprehensive walking or crawling on uneven or unstable surfacesSeem fearful in open spaceAppear clumsyWant their feet on the ground!These folks need gentle experiences and support as they become more comfortable
82Hypo-sensitive Under-Responders and Seekers Seeker: Actively seek and demonstrate a need for intense movement experiences (whirling, jumping, spinning, spinning objects, pacing)May includes visual stimBe aware: Seeker can become over-excitedNeeds monitoring“Cap-off” vigorous vestibular activity with proprioception (“heavy work” or joint compression)Under-Responder may need gentle encouragement to engage in movement activities
83 Activities that provide vestibular input Seeker/Avoider/OverwhelmedLinear, Calm, Slow, Controlled movement to gain attentionUnder-ResponderUnpredictable, multi-directional, spinning (if individual requests), to alert and orient someone who is under-responsiveBe very cautious imposing vestibular movement – can be very frightening
84Selected Strategies Swinging Rocking Chair Sit & Spin/Dizzy Disc Therapy Balls as ChairsMoveable Cushions or Deflated Beach Balls as Chair Cushions
85Selected StrategiesDelivering Messages or Packages (or any job that requires walking, moving, bending, etc.)Running Track or possible a TreadmillMovement breaks placed proactively in the day
86Remember……Do NOT withhold recess/gym based on the child’s behavior or inability to complete workMovement and activity may be the input the child needs in order to maintain behavior, concentrateand learn!
87Environmental Supports Firm Supportive seatingFeet on floorDesk and chair that fitRailings on stepCushion for movementSpace to move and pace
88Creating The Sensory D.I.E.T. D …..Do an Informal Assessment I …..Individualize E …..Environmental Supports T …..The Power Senses
89How can a therapist help my child? School-based therapistPart of a full evaluation or pre-referral toolAssist with program planningEducate staff and personnelCollaboration between school and clinicClinic-based therapistObtain observations of participation in school and homeEducate the parent/caregiverCollaborate with the school therapist and school teamResearch
90How can we help optimize the learning experience?? By knowing what type of strategies/activities to do with your child that will help the body organize and interpret sensory information to the brain.
91Activities for tactile sense: Shaving cream (unscented, if possible)PlaydoughTheraputtyTextured foodFinger paintingHair gelTactile roadPlaying dress-upBall pitBlanket wrappingPressure vestGentle but firm massageVibrating toys
92Activities for Vestibular sense: SwingsScooter boardsWagon ridesSelf propelling toy carsSlidesObstacle coursesMonkey barsTrampolineRolling on matNOTE: This must be slow and brief at first, in very secure positions.
93Activities for proprioceptive sense Crash padCrawling (can crawl through tunnel, over beanbags or pillows)RunningClimbingMarchingWall push-upsWeighted garmentsPressure garmentsHeavy workScooter boardTherapy ballJumping on a trampolineWheelbarrow walks
94Activities for auditory sense Soft musicSoft voiceWhite noiseQuiet roomUp beat musicLoud voiceInstruments/noise makersWhite noiseClassical music
96If you have any questions or concerns regarding your child development and sensory processing 1- Contact your pediatrician/primary care physician 2- Get a referral for skilled therapy services 3- Contact your therapy provider of choice