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Sensory Processing, Sensory Integration, Regulatory Disorder

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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

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

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

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