1 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
2 Todays WorkshopToday 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 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
4 AgendaDifferentiate sensory processing, sensory integration, and regulationDiscuss relationship between sensory processing/regulation and developmentDiscuss tools used to identify sensory processing challenges in your childrenDiscuss 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 ForeverWhat are your hopes and dreams for the young children in your life?They have friendsThey are successfulAsk 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 activitiesUse developmental strengths functionallySocial and emotionalCognitionLanguageMotorUse compensations, modifications, accommodations as needed
7 What may prevent us from becoming happy & successful? DisabilityASDDevelopmental delay (esp. language)Physical disabilityBehaviorADHDOCDDepressionBi-polarAggressionNon-complianceFamilyMaternal depressionHarsh parentingStressful family lifeLow social supportFamily instabilitySocietyLack of accommodationAttitudesLack of knowledgeIntolerance
8 How we PROCESS, INTEGRATE, REGULATE and USE sensation Sensory Processing, Sensory Integration, and Regulatory DisorderLearning and healthy behavior is influenced byHow we experience sensory input from the environmentHow we interpret that inputHow we organize itHow we use itHow we PROCESS, INTEGRATE, REGULATE and USE sensation
9 Processing, Integrating, Regulating allows us PerceiveSenseRecallRememberThinkPlanPerformDoExplore and playComplete every day activitiesBe available for learningMaintain focus and attentionManage our emotions
10 Apply this to your life? Recall Perceive Sense Perform Do Remember ThinkPlanPerformDoWHO HAS A 4 YEAR OLD—GETTING COAT ON TO GO TO SCHOOL---
11 Sensory ProcessingThe ability of the central nervous system to receive sensory information, interpret that information, and make a behavioral response that is consistent with the sensory informationEffective Sensory Processingleads to a response that is appropriate or well matched to the situation!Ineffective Sensory Processingleads 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, aggressivemovement 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)
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 InfantsToddlersPreschoolersFussyColicPoor feedingIntolerance to formulaShort sleep periodsHyperalertArches away when heldDifficulty self calmingFalls more oftenPrefers soft foods (white diet)Difficulty sleepingSeems weak/low toneLethargicDoesn’t like finger foodsClumsyDifficulty using crayons/arts and craftsBumps into things and peopleMay get to closeArguesDifficulty with dressingUnintentionally aggressive
18 What do we know about kids with certain disabilities and SP? Autism Spectrum Disorders (ASD)Social-Emotional Difficulties (SED)Infants with Regulatory DisordersAttention Deficit Hyperactivity Disorder (ADHD)ADLPicky eaterDislike hair brushing/hair cuts/washingSensoryUnder responsiveLess sensory seekingDistracted by noiseInattentionDevelopmentMotor planning challengesLanguageSocial interactionsPoor modulation of language, behavior, motorBehaviorImpulsiveArgue, AggressiveDisruptive, StubbornAnxious, DepressionLearningMay have cognitive, language, motor delaysSocialFew friendsMay have disruptive sleepMay have food preferencesCrying3 hours/dayHigh pitchedStart suddenlyHas frantic qualitySleepShort burst of sleepsAwaken suddenlyDifficulty transitioning to sleepFeedingDifficulty nipplingIntolerance to formulasPrefers soft/white foodInattentiveDisruptiveMay have behavior issueArgueAggressiveAnxiousDepressionMay have LD
19 How we can we tell? Infants Red Flags Checklists IT 3 Infant Toddler Sensory ProfileEarly InterventionToddlersPreschoolersScreeningSensory ProfileChild Find
20 IT 3: Infant Toddler Temperament Tool Temperament: 9 common traits (handout)Goodness of Fit: Compatibility between adult and childAdults expectations and caregiving strategies match child’s personal style (temperament)“Participation Period”Activity LevelDistractibilityIntensityRegularitySensitivityApproachabilityAdaptabilityPersistenceMood
21 How the sensitivity impacts every day expectations What will we learn?IT 3 : Goodness of Fit concernsChecklists: Child may have sensitivity to certain senseMovementProprioceptionTouchAuditoryTasteSmellVisualSensory Profile: Intensity of response to sensation: under overHow the sensitivity impacts every day expectations
23 Well-maybe not that Sensory diets Sensory friendly environments By ProfileBy SenseSensory friendly environmentsAccommodationsModificationsRoutinesEspecially 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 SoooooooEvidence to support sensory modulation and responsive differences in children with a variety of challengesLittle evidence to support effectiveness of interventionNo evidence indicating sensory motor strategies are harmful
26 Seeker Sensor Avoider Bystander Active, engaging, disruptive Require noveltyFidgets, explore objectsConstantly increasing sensory inputAvoiderLimits sensationsDisruptiveMay have routines, rituals, rulesRigidAvoids or withdrawsSensorAware of surroundsDistractibleMay be hyperactiveDifficulty maintaining attentionBystanderAppears disinterestedLow energy levelsAppears self-absorbedFlat affect
27 Sensory Diets By Sense By Profile Movement Swinging Toss infants in air (very gently!)Use linear movement to rock babiesSit n SpinProprio.Carry pot/panWheel barrel walkingWrap in blanket during TVWear a back packCrawl on hands and knees Under tablesPush small grocery cartPop bubble wrapTouchScrub with wash cloth during bath timeDeep massageSeekerJumping gamesPush pull gamesSwinging, trampolinesMake a child sandwichRed light-Green lightSensorLimit sensations during interactions (only touch not talk)Avoid heavy perfume, detergents, spicesMaintain structureBystanderActively encourage (not force)Provide crunchy food to increase alertnessTake stretch breaksAvoiderUse slow, rhythmic movementsPlay calming, gentle musicQuiet environmentLess distractions
28 Sensory Friendly Environments De-clutter Maintain arrangement of furnitureUnambiguous definition of spacesKeep noise level down: radio with gentle music rather thanTV or rock musicDo NOT watch TV during meals or when you want to interactWhite noise can be calming Natural lighting as much as possible Maintain temperature between 68-72o Greens/blues are calming; reds/pinks alertingKeep an activity schedule posted and refer to it on a regularbasis
29 Direct Sensory-Motor Activities Incorporated into Day Infant Position:Infant MassageInfant Interaction/BundlingPreschoolers: 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 playSwimming, 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 StrategiesNow 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 careYou are an Important Person in the Life of an Infant or Toddler
34 Connect With FamiliesFamilies 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 experiencesAffirm 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 childrenMaintain a predictable schedulePlan routines around each child’s needs and abilitiesEnsure time for quiet and active playTalk, read and sing with children every day
37 Provide Responsive Caregiving Hold, cuddle and rock childrenRespond to cues (coos, smiles, cries, etc)Talk to infants and toddlers about their emotionsStay close by as children interact with one anotherObserve each child’s skills
38 Provide Safe and Nurturing Learning Environments Create a homelike environmentHave duplicates of favored toysDisplay toys within reachAllow children to have and use comfort itemsKeep the room and materials safeMake sure there are enough adults to safely care for children
40 SummaryAll of us perceive sensory input differentlyThat’s OK!Sometimes the way we respond to sensory input get’s in the way of learning, interacting, and behavingThat’s not OK!Strategies embedded into the daily routine are our first choice in helping kidsSome kids may need moreKey Resources