Keeping It Together at School: Sensory, Emotional and Behavioral Self-Regulation Karen R. Gouze,...

Keeping It Together at School: Keeping It Together at School: Sensory, Emotional and Behavioral Sensory, Emotional and Behavioral

Self-RegulationSelf-Regulation

Karen R. Gouze, Ph.D.Karen R. Gouze, Ph.D.Children’s Memorial HospitalChildren’s Memorial Hospital

Northwestern University Feinberg School of MedicineNorthwestern University Feinberg School of MedicineFebruary 25, 2011February 25, 2011

Self-RegulationSelf-Regulation

Definition:Definition:– The individual’s ability to actively control The individual’s ability to actively control

arousal and one’s responses to itarousal and one’s responses to it– Self-regulation occurs in the context of Self-regulation occurs in the context of

goal attainmentgoal attainment– Mental health is the ability to love well, Mental health is the ability to love well,

play well, work well, and expect wellplay well, work well, and expect well– Ability to self-regulate is critical to all Ability to self-regulate is critical to all

areasareas

Developmental Progression of Self-Developmental Progression of Self-Regulatory ProcessesRegulatory Processes

Infants have basic self-regulatory Infants have basic self-regulatory mechanisms—perhaps best captured in mechanisms—perhaps best captured in notions of temperament notions of temperament Sensory reactivity has long been Sensory reactivity has long been subsumed under the construct of subsumed under the construct of temperament.temperament.CFA of Rothbart temperament, sensory CFA of Rothbart temperament, sensory regulation yielded three distinct factors—regulation yielded three distinct factors—negative affectivity, effortful control, negative affectivity, effortful control, sensory regulation (Gouze et al., 2010) sensory regulation (Gouze et al., 2010)

Regulation MilestonesRegulation Milestones

At 6 months-At 6 months- Babies should be able to Babies should be able to tolerate and enjoy being moved and tolerate and enjoy being moved and touched. They can sustain interest in an touched. They can sustain interest in an object or person for more than a minute. object or person for more than a minute. Can usually self console.Can usually self console.A 9 month old A 9 month old – should be able to play – should be able to play with one toy for two to three minutes, and with one toy for two to three minutes, and attend to a speaking person or look at attend to a speaking person or look at pictures in a book.pictures in a book.


At 12 months-At 12 months- an infant should be moving an infant should be moving to musical rhythm and sleeping twelve to to musical rhythm and sleeping twelve to fourteen hours at night with naps once or fourteen hours at night with naps once or twice daily.twice daily.

At 18 months-At 18 months- A toddler should enjoy A toddler should enjoy messy play and be demonstrating messy play and be demonstrating preferences for toys. They should be preferences for toys. They should be sleeping ten to twelve hours and napping sleeping ten to twelve hours and napping one time for three hours.one time for three hours.


At 24 months-At 24 months- a toddler should be playing a toddler should be playing by self for a few minutes, as well as freely by self for a few minutes, as well as freely playing with playdoh, paint or other such playing with playdoh, paint or other such substances. They should enjoy rough substances. They should enjoy rough house play, most playground equipment.house play, most playground equipment.Three year olds-Three year olds- Should show strong Should show strong independent drives. May not nap anymore. independent drives. May not nap anymore. They should be able to participate in circle They should be able to participate in circle time and interactive games. time and interactive games.

Areas of Self-RegulationAreas of Self-Regulation

Behavior RegulationBehavior Regulation

Emotion RegulationEmotion Regulation

Attention RegulationAttention Regulation

Sensory RegulationSensory Regulation

Behavior RegulationBehavior Regulation

The ability to inhibit inappropriate The ability to inhibit inappropriate behavioral responsesbehavioral responsesThe ability to choose appropriate behavioral The ability to choose appropriate behavioral responsesresponsesInhibiting or choosing behaviors in Inhibiting or choosing behaviors in response to internal emotional states response to internal emotional states (Eisenberg, et. al., 2000)(Eisenberg, et. al., 2000)Early social information processing models Early social information processing models of externalizing disorders focused on this of externalizing disorders focused on this approachapproach


Definitional disagreementsDefinitional disagreements

Garber & Dodge (1991)-Garber & Dodge (1991)-

– ““Emotion is like pornography: The Emotion is like pornography: The experts have great difficulty defining it experts have great difficulty defining it but we all know it when we see it”but we all know it when we see it”


Cole et. al. (2004)Cole et. al. (2004)– Changes associated with activated emotionsChanges associated with activated emotions– Valence of emotion is irrelevantValence of emotion is irrelevant– Can include changes in the emotion itself Can include changes in the emotion itself

(intensity, frequency)(intensity, frequency)– Also includes changes in other psychological Also includes changes in other psychological

processes-e.g. memoryprocesses-e.g. memory

Emotion as regulating and emotion as Emotion as regulating and emotion as regulatedregulated

Attention RegulationAttention Regulation

Ability to focus and sustain attentionAbility to focus and sustain attention

Ability to shift attention when appropriateAbility to shift attention when appropriate

Sensory RegulationSensory Regulation

““The ability to regulate and organize The ability to regulate and organize reactions to sensations in a graded and reactions to sensations in a graded and adaptive manner” (McIntosh et al., 1999)adaptive manner” (McIntosh et al., 1999)Includes sensory modulation primarily but, Includes sensory modulation primarily but, more broadly speaking, sensory more broadly speaking, sensory processing disorder includes:processing disorder includes:– Sensory modulationSensory modulation– Sensory discriminationSensory discrimination– Sensory-based motor disorderSensory-based motor disorder

Sensory Processing is an important aspect of Sensory Processing is an important aspect of normal brain function, enabling us to take in normal brain function, enabling us to take in and make sense of many different kinds of and make sense of many different kinds of sensation coming into the brain along different sensation coming into the brain along different sensory channels at the same time. The ability sensory channels at the same time. The ability to make adaptive responses is dependent upon to make adaptive responses is dependent upon adequate sensory processing. (Hanschu, p.6)adequate sensory processing. (Hanschu, p.6)

““We live on the leash We live on the leash of our senses”of our senses”

Diane AckermanDiane Ackerman

A Natural History of the Senses, A Natural History of the Senses, 19901990

Relationships Between Self-Regulation Relationships Between Self-Regulation and Adaptive School Functioningand Adaptive School Functioning

Behavior RegulationBehavior Regulation– The ability to suppress an inappropriate The ability to suppress an inappropriate

behavioral response. behavioral response. – The ability to sit still, follow directions, inhibit The ability to sit still, follow directions, inhibit

impulsive responses (including hitting, impulsive responses (including hitting, shouting out answers, etc.).shouting out answers, etc.).

– The ability to stand in line, walk down the The ability to stand in line, walk down the halls quietly, take out the appropriate work, halls quietly, take out the appropriate work, follow teacher directions.follow teacher directions.


Emotion RegulationEmotion Regulation– The ability to tolerate frustration (e.g. a The ability to tolerate frustration (e.g. a

difficult assignment)difficult assignment)– The ability to delay gratification—to wait for The ability to delay gratification—to wait for

something you want (e.g. wait your turn to something you want (e.g. wait your turn to speak).speak).

– The ability to modulate your emotional The ability to modulate your emotional responses to others—manage feelings of responses to others—manage feelings of anger, sadness, happiness.anger, sadness, happiness.


Attention RegulationAttention Regulation– Ability to maintain and focus attention is Ability to maintain and focus attention is

critical to school success- (e.g. to attend to critical to school success- (e.g. to attend to lessons, complete assignments, etc.) lessons, complete assignments, etc.)

– Ability to shift attention as needed is critical to Ability to shift attention as needed is critical to school success (e.g. to transition from one school success (e.g. to transition from one subject to another or one task to another)subject to another or one task to another)

– Many believe that the ability to regulate Many believe that the ability to regulate attention is also critical to the regulation of attention is also critical to the regulation of emotion (Posner & Rothbart, 2000)emotion (Posner & Rothbart, 2000)


Sensory Regulation:Sensory Regulation:

– Related to most aspects of adaptive Related to most aspects of adaptive functioning.functioning.

– The ability to respond in behaviorally The ability to respond in behaviorally appropriate ways.appropriate ways.

– The ability to manage one’s emotional The ability to manage one’s emotional responses.responses.

– The ability to regulate one’s attention.The ability to regulate one’s attention.

Sensory Regulation and the School Sensory Regulation and the School EnvironmentEnvironment

Sensory Regulation:Sensory Regulation:

– Difficulty managing the noise, smells, Difficulty managing the noise, smells, movement, textures of everyday life.movement, textures of everyday life.

– Difficulty standing in line, staying seated, Difficulty standing in line, staying seated, managing lunch room noise and jostling.managing lunch room noise and jostling.

– Difficulties in the classroom, the gym, the Difficulties in the classroom, the gym, the lunchroom, the hallways lunchroom, the hallways

The Relationship Between SPD and The Relationship Between SPD and Emotional and Behavior Disorders Emotional and Behavior Disorders

Increasing evidence for a relationship Increasing evidence for a relationship between poor sensory processing and:between poor sensory processing and:

– ADHD (Dunn & Bennett, 2002; Mangeot et ADHD (Dunn & Bennett, 2002; Mangeot et al., 2001; Parush et al., 1997).al., 2001; Parush et al., 1997).

– Externalizing disorders (Ben-Sasson et al. Externalizing disorders (Ben-Sasson et al. 2009; Gouze et al., 2009; Gunn, 2008).2009; Gouze et al., 2009; Gunn, 2008).

– Internalizing disorders (Goldsmith et al., 2006; Internalizing disorders (Goldsmith et al., 2006; Gouze et al. 2009).Gouze et al. 2009).

– Later fearfulness (Calkins et al., 1996).Later fearfulness (Calkins et al., 1996).

Relationships between Self-Regulation and Relationships between Self-Regulation and Adaptive FunctioningAdaptive Functioning

Parents of children with SPD report impaired Parents of children with SPD report impaired daily functioning across a range of daily daily functioning across a range of daily activities (Dunn, 1997, 2001).activities (Dunn, 1997, 2001).

Parents of children with sensory over-Parents of children with sensory over-responsiveness report more early and responsiveness report more early and concurrent socio-emotional problems and lower concurrent socio-emotional problems and lower levels of adaptive skills than parents without levels of adaptive skills than parents without these problems (Ben-Sassoon et al. 2009)these problems (Ben-Sassoon et al. 2009)

Relationships Between Self-Regulation and Relationships Between Self-Regulation and Adaptive School FunctioningAdaptive School Functioning

Sadhwani and colleagues (2006) found a strong Sadhwani and colleagues (2006) found a strong positive relationship between good sensory positive relationship between good sensory processing and the development of effortful processing and the development of effortful control.control.

Effortful control is critical in school to the ability Effortful control is critical in school to the ability to apply oneself persistently to a difficult task to apply oneself persistently to a difficult task and manage one’s emotions.and manage one’s emotions.

Relationships between Self-Regulation and Relationships between Self-Regulation and Adaptive FunctioningAdaptive Functioning

Children with SPD show a range of problems Children with SPD show a range of problems with other aspects of self-regulation including with other aspects of self-regulation including attention and emotion regulation, differential attention and emotion regulation, differential physiological reactivity and emotional and physiological reactivity and emotional and behavior problems.behavior problems.

The Relationship Between SPD and The Relationship Between SPD and Emotional and Behavior DisordersEmotional and Behavior Disorders

PACT PACT (NIMH RO1- MH063665, PI- John (NIMH RO1- MH063665, PI- John

Lavigne, Ph.D. )Lavigne, Ph.D. )

Findings:Findings:– 33%- 63% of 4 year old children with SPD 33%- 63% of 4 year old children with SPD

(based on a short sensory profile) have (based on a short sensory profile) have another psychiatric disorder—ODD, ADHD, another psychiatric disorder—ODD, ADHD, depression, or anxiety.depression, or anxiety.

– 37%-67% have only SPD37%-67% have only SPD

Aims of PACT StudyAims of PACT Study

– To examine the constitutional To examine the constitutional (temperament, sensory regulation) and (temperament, sensory regulation) and psychosocial (attachment, parenting) psychosocial (attachment, parenting) factors contributing to externalizing and factors contributing to externalizing and internalizing disorders in 4-year-olds.internalizing disorders in 4-year-olds.

– To determine whether psychosocial To determine whether psychosocial variables mediate the relationships variables mediate the relationships between constitutional vulnerability and between constitutional vulnerability and disorderdisorder. .

ParticipantsParticipants

N = 796 children and their parentsN = 796 children and their parentsAge 4-5 years (mean = 4.6)Age 4-5 years (mean = 4.6)GenderGender– 389 (48.8%)boys389 (48.8%)boys– 401 (50.3%) girls401 (50.3%) girls

EthnicityEthnicity– 451 (56.6%) Non-Hispanic White children 451 (56.6%) Non-Hispanic White children – 136 (17.1%), African American children136 (17.1%), African American children– 158 (19.8%), Hispanic children158 (19.8%), Hispanic children

MeasuresMeasures

TemperamenTemperament:t: Child Behavior Questionnaire ( Child Behavior Questionnaire (CBQ; CBQ; Rothbart, Ahadi, Hershey & Fisher, 2001Rothbart, Ahadi, Hershey & Fisher, 2001 ) )

Sensory RegulationSensory Regulation: Short Sensory Profile : Short Sensory Profile (McIntosh (McIntosh et. al. 1999)et. al. 1999)

AttachmentAttachment:: Attachment Q-Sort ( Attachment Q-Sort (AQS; Vaughn & Waters, AQS; Vaughn & Waters, 1990) 1990)

ParentingParenting– Parenting Behavior InventoryParenting Behavior Inventory (Lovejoy et al., 1999) (Lovejoy et al., 1999)

– Three Boxes TaskThree Boxes Task (NICHD Early Child Care Research (NICHD Early Child Care Research Network, Network, 1999)

Symptoms of disorders Symptoms of disorders :: Child Symptom Inventory Child Symptom Inventory ((Gadow &Sprafkin, 2002Gadow &Sprafkin, 2002))

Reducing Measure ContaminationReducing Measure Contamination

Expert ratings were used to reduce item Expert ratings were used to reduce item overlap on temperament, sensory overlap on temperament, sensory regulation and symptom measures.regulation and symptom measures.

Items on each measure were rated on Items on each measure were rated on Likert scales.Likert scales.

Mean ratings were used to eliminate Mean ratings were used to eliminate overlapping items from each scale.overlapping items from each scale.

Sensory Items Retained After Sensory Items Retained After Expert RatingsExpert Ratings

13 Pure Sensory Items were retained from 13 Pure Sensory Items were retained from the following scales:the following scales:– TactileTactile– MovementMovement– Low energyLow energy– Visual-auditoryVisual-auditory– TasteTaste

Sensory Items Eliminated by Sensory Items Eliminated by ExpertsExperts

Two scales were eliminated as containing Two scales were eliminated as containing items that were more closely related to items that were more closely related to temperament or emotional/behavior temperament or emotional/behavior disorder:disorder:– Seeks sensationSeeks sensation– Auditory sensitivityAuditory sensitivity

Predictors of ODD SymptomsPredictors of ODD Symptoms

Overall model contributed 33% of the Overall model contributed 33% of the variancevariance– (F= 54.45 (7,788), p<.0001)(F= 54.45 (7,788), p<.0001)

Significant predictorsSignificant predictors– Sensory Regulation (Sensory Regulation (ββ =-.34) =-.34)– Effortful Control (Effortful Control (ββ = -.19) = -.19)– PBI Hostile/Coercive Parenting (PBI Hostile/Coercive Parenting (ββ =.23) =.23)– AQS (AQS (ββ =-.10) =-.10)

Mediators of Constitutional Mediators of Constitutional VariablesVariables

Mediators of relationship between SR and Mediators of relationship between SR and ODDODD– PBI Hostile/coercive parentingPBI Hostile/coercive parenting– AttachmentAttachment

Mediators of relationship between EC and Mediators of relationship between EC and ODDODD– PBI Hostile/coercive parentingPBI Hostile/coercive parenting– AttachmentAttachment

Predictors of ADHD SymptomsPredictors of ADHD Symptoms


Significant predictorsSignificant predictors– Sensory Regulation (Sensory Regulation (ββ =-.35) =-.35)– Effortful Control (-.33)Effortful Control (-.33)– PBI Supportive/Engaged Parenting (PBI Supportive/Engaged Parenting (ββ = .07) = .07)– Positive Parenting (Positive Parenting (ββ = -.07) = -.07)– PBI Hostile/Coercive Parenting (PBI Hostile/Coercive Parenting (ββ =.16) =.16)– AQS (AQS (ββ =-.12) =-.12)


Mediators of relationship between SR & Mediators of relationship between SR & ADHDADHD– Positive parenting, Positive parenting, – PBI Hostile/Coercive Parenting PBI Hostile/Coercive Parenting – AQSAQS

Mediators of relationship between EC & Mediators of relationship between EC & ADHDADHD– Positive parenting, Positive parenting, – PBI Hostile/Coercive Parenting PBI Hostile/Coercive Parenting – AQSAQS

Predictors of GAD SymptomsPredictors of GAD Symptoms


Significant predictors Significant predictors – Sensory Regulation (Sensory Regulation (ββ = -.46) = -.46)– Effortful Control (Effortful Control (ββ = -.19) = -.19)– PBI Hostile/Coercive Parenting (PBI Hostile/Coercive Parenting (ββ = .13) = .13)– AQS (AQS (ββ = -.09) = -.09)


Mediators of relationship between SR & Mediators of relationship between SR & GADGAD– PBI Hostile/coercive parentingPBI Hostile/coercive parenting– AttachmentAttachment

Mediators of relationship between EC & Mediators of relationship between EC & GADGAD– PBI Hostile/coercive parentingPBI Hostile/coercive parenting– AttachmentAttachment

Predictors of MDD SymptomsPredictors of MDD Symptoms


Significant predictorsSignificant predictors– Sensory Regulation (Sensory Regulation (ββ = -.38) = -.38)– PBI Supportive/Engaged Parenting (PBI Supportive/Engaged Parenting (ββ = -.08) = -.08)– PBI Hostile/Coercive Parenting (PBI Hostile/Coercive Parenting (ββ =.14) =.14)– Positive Parenting (Positive Parenting (ββ = -.07) = -.07)– AQS (AQS (ββ = -.09) = -.09)


Mediators of relationship between SR & MDDMediators of relationship between SR & MDD– PBI Supportive/Engaged Parenting; Positive PBI Supportive/Engaged Parenting; Positive

parentingparenting– PBI Hostile/Coercive ParentingPBI Hostile/Coercive Parenting– AttachmentAttachment

Mediators of relationship between EC & MDDMediators of relationship between EC & MDD– PBI Supportive/Engaged Parenting; Positive PBI Supportive/Engaged Parenting; Positive

ParentingParenting– PBI Hostile/Coercive ParentingPBI Hostile/Coercive Parenting– AttachmentAttachment

DiscussionDiscussion

Both constitutional and psychosocial variables Both constitutional and psychosocial variables are related to concurrent measures of are related to concurrent measures of internalizing and externalizing disorders but internalizing and externalizing disorders but different patterns emerge.different patterns emerge.

Sensory regulation was the only variable related Sensory regulation was the only variable related to every disorder.to every disorder.

Negative affect was not related to any of the Negative affect was not related to any of the disorders.disorders.

Effortful control was related to both externalizing Effortful control was related to both externalizing disorders and GAD, but not to MDDdisorders and GAD, but not to MDD

AcknowledgmentsAcknowledgments

ThisThis research wasresearch was supportedsupported by NIMH by NIMH grantgrant #RO1MH063665,#RO1MH063665, PI: PI: JohnJohn LavigneLavigne, , Ph.D. Ph.D. Research assistantsResearch assistants– KylaKyla Aimone, Hyo Bae, Karyn Brasky, Aimone, Hyo Bae, Karyn Brasky, Elisabeth Elisabeth

Carrigg, Carrigg, Helen Chee, Vanessa Christian, Maria Helen Chee, Vanessa Christian, Maria D’Aniello, D’Aniello, Carly Demopoulos, Carly Demopoulos, Ilana Gonik, Bryce Ilana Gonik, Bryce Hella, Jamie Howard, Jen Keller, Lindsay Pate, Hella, Jamie Howard, Jen Keller, Lindsay Pate, Ginger Robinson, Edna Romero, Joshua Shulruff, Ginger Robinson, Edna Romero, Joshua Shulruff, Jen Strickland, Roberto UribeJen Strickland, Roberto Uribe

Thanks to the parents and children who Thanks to the parents and children who graciously allowed us into their homes.graciously allowed us into their homes.

The Relationship Between SPD and The Relationship Between SPD and Emotional and Behavior DisordersEmotional and Behavior Disorders

Are SPD and emotional and behavior Are SPD and emotional and behavior disorders separate?disorders separate?– Yes, remember 37%-67% of SPD children in Yes, remember 37%-67% of SPD children in

this sample did not have any emotional or this sample did not have any emotional or behavior problems BUT:behavior problems BUT:

– SPD is clearly a significant risk factor for the SPD is clearly a significant risk factor for the development of emotional and behavior development of emotional and behavior problems AND:problems AND:

– SPD and emotional and behavior problems SPD and emotional and behavior problems often occur co-morbidly.often occur co-morbidly.

So, how do we understand and clinically So, how do we understand and clinically address these relationships?address these relationships?Sensory regulation is critical for healthy Sensory regulation is critical for healthy child development—for the development child development—for the development of self-efficacy, feelings of mastery, of self-efficacy, feelings of mastery, identity and understanding one’s place in identity and understanding one’s place in the world.the world.Self-regulation is critical for adaptive Self-regulation is critical for adaptive functioning.functioning.

Meet Jorge, age 6Meet Jorge, age 6

Problems at homeProblems at home

– UncooperativeUncooperative– UnresponsiveUnresponsive– Hard to move through the dayHard to move through the day– Moody and anxiousMoody and anxious– DisorganizedDisorganized

Problems at school:Problems at school:

– Incomplete workIncomplete work

– DisorganizedDisorganized

– Difficulty “getting started”Difficulty “getting started”

– Uneven academic skillsUneven academic skills

– ClumsyClumsy

Problems with peers:Problems with peers:

– Difficulty making friendsDifficulty making friends

– Perceived as aggressivePerceived as aggressive

– Left behind in group settingsLeft behind in group settings

– Withdrawn on playgroundWithdrawn on playground

School ObservationSchool Observation

Thinking About Jorge Through a Thinking About Jorge Through a Sensory LensSensory Lens

Who He IsWho He Is

What He Must DoWhat He Must Do

Where He IsWhere He Is

WhatWhat

HappensHappens

SuccessSuccess

oror

FailureFailure

Looking at Jorge Looking at Jorge Through the Sensory LensThrough the Sensory Lens

Who He Is:Who He Is:

– Auditory defensivenessAuditory defensiveness

– Poor proprioceptive discriminationPoor proprioceptive discrimination

– Proprioceptive insensitivityProprioceptive insensitivity

– Poor tactile discriminationPoor tactile discrimination

Other LensesOther Lenses

Attentional LensAttentional LensInattentive ADHDInattentive ADHD

Learning LensLearning LensVisual-spatial deficitsVisual-spatial deficits

Slow processing speedSlow processing speed

Where He Is:Where He Is:

– Loud classroomLoud classroom

– Restricted desktop spaceRestricted desktop space

– Crowded classroomCrowded classroom

– Cluttered visual environmentCluttered visual environment

What He is Expected to Do:What He is Expected to Do:

– Work independentlyWork independently– Cut, paste, assemble project parts in sequenceCut, paste, assemble project parts in sequence– Look up/down and back/forth from board to Look up/down and back/forth from board to

desktop to copy model of projectdesktop to copy model of project– Stay seatedStay seated– Screen out irrelevant noise and movementScreen out irrelevant noise and movement– Keep materials organized on desktopKeep materials organized on desktop

Jorge: It’s Not That SimpleJorge: It’s Not That Simple

Multiple lenses are required to understand Multiple lenses are required to understand Jorge:Jorge:– Sensory challengesSensory challenges

At homeAt home

At schoolAt school

With peersWith peers

– Attentional challengesAttentional challenges– Family issuesFamily issues

Helping the Dysregulated ChildHelping the Dysregulated Child

The role of the occupational therapistThe role of the occupational therapist– Experts in the treatment of sensory regulationExperts in the treatment of sensory regulation

The role of the educatorThe role of the educator– Experts in learning and the technology of Experts in learning and the technology of

instructioninstruction

The role of the psychologistThe role of the psychologist– Experts in the treatment of behavioral and Experts in the treatment of behavioral and

emotional regulationemotional regulation

Quick Review of the Basics of SPDQuick Review of the Basics of SPD

Three areas of sensory processing disorder:Three areas of sensory processing disorder:

– Sensory modulationSensory modulation– Sensory discriminationSensory discrimination– Sensory-based motor planningSensory-based motor planning

Dysfunctional Modulation:Dysfunctional Modulation:HypersensitivityHypersensitivity

Sensory ExperienceSensory Experience

too loudtoo loud

too roughtoo rough

too brighttoo bright

too spicytoo spicy

too “scratchy”too “scratchy”

too fasttoo fast

Observable BehaviorObservable Behavior

hyper-responsivehyper-responsive

overwhelmedoverwhelmed

anxiousanxious

holds back, withdrawsholds back, withdraws

resistantresistant

overstimulatedoverstimulated

Dysfunctional Modulation:Dysfunctional Modulation:

SensorySensory InsensitivityInsensitivity

Sensory ExperienceSensory Experience

too softtoo soft

too lowtoo low

too slowtoo slow

too blandtoo bland

too loosetoo loose

Observable BehaviorObservable Behavior

tuned out tuned out

sensory-seekingsensory-seeking

hypo-responsivehypo-responsive

clumsyclumsy

messymessy

overactiveoveractive

risk-takingrisk-taking

Remember:Remember:

Dysfunctional modulation can be either Dysfunctional modulation can be either over- or under-sensitivity.over- or under-sensitivity.

It can also be a problem of It can also be a problem of dysregulation,dysregulation, a shifting between the two extremes.a shifting between the two extremes.

Like poor radio reception, the signal does Like poor radio reception, the signal does not come in clearly or consistently.not come in clearly or consistently.

Some Daily Challenges for the Child Some Daily Challenges for the Child with Poor Sensory Modulationwith Poor Sensory Modulation

Tolerating noise, making noise.Tolerating noise, making noise.

Personal space.Personal space.

Seeking stimulation in inappropriate ways or at Seeking stimulation in inappropriate ways or at inappropriate times.inappropriate times.

Staying seated, postural control.Staying seated, postural control.

Interpreting the emotions and reactions of others Interpreting the emotions and reactions of others accurately.accurately.

Dysfunctional DiscriminationDysfunctional Discrimination

Difficulties telling whether sensory input is Difficulties telling whether sensory input is near/far, hard/soft, coming from the near/far, hard/soft, coming from the left/right or front/back, threatening/benign, left/right or front/back, threatening/benign, relevant/irrelevant.relevant/irrelevant.

These mis-interpretations can interfere These mis-interpretations can interfere with fine-motor skills, early learning, social with fine-motor skills, early learning, social functioning and appropriate behavior.functioning and appropriate behavior.

Some Daily Challenges for the Child Some Daily Challenges for the Child with Poor Sensory Discriminationwith Poor Sensory Discrimination

Finding things in a cluttered desk.Finding things in a cluttered desk.Tying shoes.Tying shoes.Recognizing ABCs.Recognizing ABCs.Picking out an object in a large array, e.g. Picking out an object in a large array, e.g. on a bulletin board or worksheet.on a bulletin board or worksheet.HandwritingHandwritingInterpreting social cuesInterpreting social cues

Dysfunctional Motor PlanningDysfunctional Motor Planning

When sensory modulation or When sensory modulation or discrimination are compromised, a child discrimination are compromised, a child cannot efficiently conceptualize, plan, or cannot efficiently conceptualize, plan, or carry out (and remember) motor carry out (and remember) motor movements.movements.

Her behavior may appear disorganized, Her behavior may appear disorganized, erratic, clumsy, off-task or uncoordinated. erratic, clumsy, off-task or uncoordinated.

Ideational dyspraxia: difficulty “knowing Ideational dyspraxia: difficulty “knowing what to do” or getting started on unfamiliar what to do” or getting started on unfamiliar or complicated motor tasks.This leads to or complicated motor tasks.This leads to trouble with self-directed and self-initiated trouble with self-directed and self-initiated activities.activities.

Some Daily Difficulties forSome Daily Difficulties for the Child With Poor Motor Planning the Child With Poor Motor Planning

Learning to talkLearning to talk

Riding a bicycleRiding a bicycle

Cutting and pasting Cutting and pasting

Team sportsTeam sports

Getting dressedGetting dressed

Getting started on a school projectGetting started on a school project

Learning a line danceLearning a line dance

School: A Continuous Sensory School: A Continuous Sensory AssaultAssault

School is a potential nightmare for the child School is a potential nightmare for the child with sensory processing problems.with sensory processing problems.

Poor Sensory RegulationPoor Sensory Regulation at Schoolat School

A student with inefficient sensory processing A student with inefficient sensory processing is likely to have trouble:is likely to have trouble:

Learning new informationLearning new information

Demonstrating what she knowsDemonstrating what she knows

Behaving appropriately in the classroomBehaving appropriately in the classroom

Moving herself through the daily routines.Moving herself through the daily routines.

Sensory Processing and LearningSensory Processing and Learning

The relationship between sensory processing and The relationship between sensory processing and academic achievement has not been well studied but academic achievement has not been well studied but large numbers of sensory dysregulated children large numbers of sensory dysregulated children have learning disabilities.have learning disabilities.

It is reasonable to assume that sensory processing It is reasonable to assume that sensory processing problems will affect learning in both direct and problems will affect learning in both direct and indirect ways.indirect ways.

The more “mismatches” between a child and her The more “mismatches” between a child and her school environment, the greater the potential for school environment, the greater the potential for interference in learning.interference in learning.

Types of HelpTypes of Help

This child will need help from teachers and This child will need help from teachers and other school personnel in these areas:other school personnel in these areas:

Decreasing sensory arousalDecreasing sensory arousal

Organizing herself/focusing on work Organizing herself/focusing on work

Following directionsFollowing directions

Managing her emotionsManaging her emotions

Getting along with peersGetting along with peers

Using the Sensory LensUsing the Sensory Lens

Use the sensory lens to look for Use the sensory lens to look for “mismatches” between:“mismatches” between:

the child’s sensory capacitiesthe child’s sensory capacities

the sensory characteristics of the the sensory characteristics of the classroomclassroom

the sensory demands of the activity she the sensory demands of the activity she has been assigned.has been assigned.

Remember……….Remember……….

Looking Through a Sensory LensLooking Through a Sensory Lens

Who He IsWho He Is

What He Must DoWhat He Must Do

Where He IsWhere He Is

WhatWhat

HappensHappens

SuccessSuccess

oror

FailureFailure

Distinguishing SPD, Emotional and Distinguishing SPD, Emotional and Behavior ProblemsBehavior Problems

Evan’s storyEvan’s story

Distinguishing Sensory, Emotional and Distinguishing Sensory, Emotional and Behavioral ProblemsBehavioral Problems

Not always possible.Not always possible.

Think of a key and its many notches.Think of a key and its many notches.

Try using a good functional behavior Try using a good functional behavior analysis.analysis.

Using the Behavioral LensUsing the Behavioral Lens

Use the behavioral lens to look for Use the behavioral lens to look for “mismatches” between:“mismatches” between: the child’s behavioral capacities (e.g. self-the child’s behavioral capacities (e.g. self-control, ability to inhibit)control, ability to inhibit) the behavioral characteristics of the the behavioral characteristics of the classroom (e.g. clear vs. unclear rules)classroom (e.g. clear vs. unclear rules) the behavioral demands of the activity she the behavioral demands of the activity she has been assigned (requires quiet, sitting has been assigned (requires quiet, sitting still, etc.).still, etc.).

Using the Emotional LensUsing the Emotional Lens

Use the emotional lens to look for “mismatches” Use the emotional lens to look for “mismatches” between:between:

the child’s emotional capacities (e.g. frustration the child’s emotional capacities (e.g. frustration tolerance, tolerance of disappointment)tolerance, tolerance of disappointment)

the emotional characteristics of the classroom the emotional characteristics of the classroom (e.g. affectively charged vs. affectively neutral)(e.g. affectively charged vs. affectively neutral)

the emotional demands of the activity she has the emotional demands of the activity she has been assigned (task that causes strong arousal).been assigned (task that causes strong arousal).

Using the Attentional LensUsing the Attentional Lens

Use the attentional lens to look for “mismatches” Use the attentional lens to look for “mismatches” between:between:

the child’s attentional capacities (e.g.persistent the child’s attentional capacities (e.g.persistent focus, attentional shifting))focus, attentional shifting))

the attentional characteristics of the classroom the attentional characteristics of the classroom (e.g. lots of distractions)(e.g. lots of distractions)

the attentional demands of the activity she has the attentional demands of the activity she has been assigned (e.g. amount of focused attention been assigned (e.g. amount of focused attention required for task completion).required for task completion).

Individual SolutionsIndividual Solutions

How to analyze a situation to determine How to analyze a situation to determine sensory, behavioral, emotional sensory, behavioral, emotional contributions to the problem.contributions to the problem.

Functional Behavior AnalysisFunctional Behavior Analysis

Looks beyond the behavior itself.Looks beyond the behavior itself.

Identifies child specific cognitive, Identifies child specific cognitive, emotional, social and\or environmental emotional, social and\or environmental factors associated with the occurrence or factors associated with the occurrence or non-occurrence of a behavior.non-occurrence of a behavior.

Functional AnalysisFunctional Analysis

Day and timeDay and time

Problem incidentProblem incident

Behavioral, emotional, sensory Behavioral, emotional, sensory characteristics of the environmentcharacteristics of the environment

Behavioral, emotional, sensory Behavioral, emotional, sensory characteristics of the taskcharacteristics of the task

Already identified behavioral, emotional, Already identified behavioral, emotional, sensory characteristics of the child.sensory characteristics of the child.

The Sensory DiaryThe Sensory Diary

Child’s responseChild’s response

Teacher’s response Teacher’s response

Recovery--how long it took and how it was Recovery--how long it took and how it was accomplishedaccomplished

Think about using different lenses--who Think about using different lenses--who the child is, where he is, what he is being the child is, where he is, what he is being asked to do. What fits best?asked to do. What fits best?

Program for JorgeProgram for Jorge

Must take into account:Must take into account:

Looking at Jorge Looking at Jorge Through the Sensory LensThrough the Sensory Lens

Who He Is:Who He Is:

– Auditory defensivenessAuditory defensiveness

– Poor proprioceptive discriminationPoor proprioceptive discrimination

– Proprioceptive insensitivityProprioceptive insensitivity

– Poor tactile discriminationPoor tactile discrimination

Looking at Jorge Through a Looking at Jorge Through a Behavioral LensBehavioral Lens

After sensory issues not too many After sensory issues not too many behavioral issues left—aggression (the behavioral issues left—aggression (the major behavioral issue) appears to be major behavioral issue) appears to be related to sensory issues.related to sensory issues.

Looking at Jorge Through an Emotional Looking at Jorge Through an Emotional LensLens

Gets flooded emotionally when he cannot Gets flooded emotionally when he cannot be successful.be successful.

Feels inadequate leading to emotional Feels inadequate leading to emotional “shut-down”“shut-down”

Looking at Jorge Through an Looking at Jorge Through an Attentional LensAttentional Lens

Inattentive ADHD—difficulty sustaining Inattentive ADHD—difficulty sustaining focus even in quiet situations.focus even in quiet situations.

Where He Is:Where He Is:

– Loud classroomLoud classroom

– Restricted desktop spaceRestricted desktop space

– Crowded classroomCrowded classroom

– Cluttered visual environmentCluttered visual environment

What He is Expected to Do:What He is Expected to Do:

– Work independently with sustained focus.Work independently with sustained focus.– Cut, paste, assemble parts in sequence.Cut, paste, assemble parts in sequence.– Look up/down and back/forth from board to Look up/down and back/forth from board to

desktop to copy model of project.desktop to copy model of project.– Stay seated.Stay seated.– Screen out irrelevant noise and movement.Screen out irrelevant noise and movement.– Keep materials organized on desktop.Keep materials organized on desktop.

Proposed InterventionsProposed Interventions

Desk organizerDesk organizerCome in earlier than the crowd of Come in earlier than the crowd of classmates.classmates.Organize area for entire class for Organize area for entire class for backpacks and coats.backpacks and coats.Give Jorge work packet at his desk to Give Jorge work packet at his desk to minimize looking up and down.minimize looking up and down.Sensory shelter area for work/noise Sensory shelter area for work/noise blocking headphones.blocking headphones.

Proposed InterventionsProposed Interventions

Additional time for writing/ability to take Additional time for writing/ability to take unfinished assignments home without penalty.unfinished assignments home without penalty.

Lots of praise for progress.Lots of praise for progress.

Medication for inattentive ADD.Medication for inattentive ADD.

Family therapy with behavioral/emotional Family therapy with behavioral/emotional emphasis to manage tasks of daily living and emphasis to manage tasks of daily living and provide a sense of positive self worth.provide a sense of positive self worth.

Occupational therapy in and out of school for Occupational therapy in and out of school for sensory and fine motor issues.sensory and fine motor issues.

School Based InterventionsSchool Based Interventions

Be preventiveBe preventive

Use a collaborative problem solving approach Use a collaborative problem solving approach (see Ross Greene: “The Explosive Child”, “Lost (see Ross Greene: “The Explosive Child”, “Lost at School”)at School”)

Use a functional analysis to determine when and Use a functional analysis to determine when and how to intervene.how to intervene.

Think “multi-determined”.Think “multi-determined”.

The Sensory DietThe Sensory Diet

Be preventive—use a sensory dietBe preventive—use a sensory diet

The Sensory DietThe Sensory Diet

A sensory diet is the assortment of A sensory diet is the assortment of sensory experiences a child (or grown up) sensory experiences a child (or grown up) is exposed to on a regular basis. The type, is exposed to on a regular basis. The type, timing, intensity and duration of these timing, intensity and duration of these experiences determine their influence on experiences determine their influence on the child’s mind, body, behavior and the child’s mind, body, behavior and emotions.emotions.

A Healthy Sensory DietA Healthy Sensory Diet

Movement and BalanceMovement and Balance

– JumpingJumping

– SwingingSwinging

– Pushing/PullingPushing/Pulling

– RockingRocking

– Sitting assistsSitting assists


TouchTouch

– SwaddlingSwaddling

– Weighted Blankets/VestsWeighted Blankets/Vests

– Bear HugsBear Hugs

– MassageMassage

– Textured PlayTextured Play


Volume ControlVolume Control

– HideawaysHideaways

– Lighting, Colors, Smells, SoundsLighting, Colors, Smells, Sounds

– RelaxationRelaxation

By raising a child’s awareness of her By raising a child’s awareness of her sensory diet, you are teaching her to sensory diet, you are teaching her to tune in to her body and to recognize tune in to her body and to recognize and respect her sensory needs.and respect her sensory needs.

Helping a Child to Help HimselfHelping a Child to Help Himself

Talking honestly about sensory sensitivities and Talking honestly about sensory sensitivities and behavioral and emotional difficulties helps a behavioral and emotional difficulties helps a child become aware of his own needs.child become aware of his own needs.

Problem-solving difficult situations from all Problem-solving difficult situations from all perspectives allows him to accept his perspectives allows him to accept his vulnerabilities and teaches him how to recognize vulnerabilities and teaches him how to recognize and accommodate them.and accommodate them.

Emphasizing his strengths encourages him to Emphasizing his strengths encourages him to persevere.persevere.

Examples of Sensory ModificationsExamples of Sensory Modifications

ChallengeChallenge– Lockers/proximity, Lockers/proximity,

spacing, fine motorspacing, fine motor

– Lunch/noise level, Lunch/noise level, crowds, seating, crowds, seating, carrying traycarrying tray

– Music class/noise Music class/noise level, pitch sensitivitylevel, pitch sensitivity

ModificationModification– Locate locker at end of Locate locker at end of

row, key or additional row, key or additional timetime

– Lunch alternative, Lunch alternative, perimeter seating, perimeter seating, beginning or end of beginning or end of lunch linelunch line

– Sensory shelter or ear Sensory shelter or ear plugsplugs


ChallengeChallenge– Classroom noiseClassroom noise

– Anxiety/stress with Anxiety/stress with changes in routinechanges in routine

– Writing difficultiesWriting difficulties

ModificationModification– Place in quiet Place in quiet

classroom, earplugs, classroom, earplugs, sensory breakssensory breaks

– Early warning for Early warning for changeschanges

– Word processing, Word processing, dictation, notetakerdictation, notetaker


ChallengeChallenge– Seating/furniture Seating/furniture

height, traditional height, traditional posture, movement, posture, movement, spacespace

– Physical Physical education/uniform, education/uniform, changing time, locker, changing time, locker, echoecho

ModificationModification– Seat at perimeter, Seat at perimeter,

cushion, leave room cushion, leave room for minor movement, for minor movement, bands on chair legsbands on chair legs

– Consult with Consult with PE/PT/modification to PE/PT/modification to classes, alternate classes, alternate uniform (or uniform (or undergarment), keyundergarment), key

Behavioral Intervention at SchoolBehavioral Intervention at School

Good behavioral control requires:Good behavioral control requires:

– Building a positive relationship.Building a positive relationship.– Lots of praise.Lots of praise.– Clear and reasonable expectations.Clear and reasonable expectations.– Predictable consequences for misbehavior.Predictable consequences for misbehavior.

Behavioral Interventions at SchoolBehavioral Interventions at School

Behavior management programs:Behavior management programs:

– Select a few target behaviors.Select a few target behaviors.– Make sure the child understands the Make sure the child understands the

behavioral goals.behavioral goals.– Select short time periods—the goal is for the Select short time periods—the goal is for the

child to be successful.child to be successful.– Be consistent with earned rewards.Be consistent with earned rewards.– Communicate with home. Communicate with home.


Stay away from power assertive Stay away from power assertive approaches.approaches.

Plan ahead—avoid situations that create Plan ahead—avoid situations that create sensory or emotional discomfort.sensory or emotional discomfort.

Discriminate between “must do” and Discriminate between “must do” and optional tasks.optional tasks.


Effective consequences are:Effective consequences are:

– ImmediateImmediate– LogicalLogical– Fair (smaller works better than larger)Fair (smaller works better than larger)– Universally appliedUniversally applied– EnforceableEnforceable

Common Behavioral PitfallsCommon Behavioral Pitfalls

Too many target behaviors.Too many target behaviors.Target behaviors are vague or subject to Target behaviors are vague or subject to interpretation.interpretation.Too long a time period until feedback.Too long a time period until feedback.Poor reward structure.Poor reward structure.Rewards are not given or are withheld.Rewards are not given or are withheld.No connection between school and home.No connection between school and home.Child does not understand the program.Child does not understand the program.

Sample Behavioral ProgramSample Behavioral Program

Jorge:Jorge:– Reward task completion.Reward task completion.– Set goal to complete “morning work” in Set goal to complete “morning work” in

packet.packet.– Start with completion of smaller amount of Start with completion of smaller amount of

work.work.– Immediate reinforcement—a sticker on an Immediate reinforcement—a sticker on an

index card that goes home to mom.index card that goes home to mom.– Possible reward in school—special job/help Possible reward in school—special job/help

teacher (requires 80% success in week).teacher (requires 80% success in week).– Gradually increase demands.Gradually increase demands.

Emotional Interventions at SchoolEmotional Interventions at School

Modeling- a calm teacher is the best Modeling- a calm teacher is the best model.model.

Emotional reactivity causes adults to be Emotional reactivity causes adults to be more emotionally reactive.more emotionally reactive.

Down-regulate the emotions in the Down-regulate the emotions in the classroom.classroom.

Allow for emotional “chill-outs”Allow for emotional “chill-outs”

Emotional Interventions in SchoolEmotional Interventions in School

Cognitive-behavioral techniquesCognitive-behavioral techniques

– Teach children to recognize physical cues.Teach children to recognize physical cues.– Teach children the language of emotion.Teach children the language of emotion.– Teach children relaxation techniques.Teach children relaxation techniques.– Thought stopping.Thought stopping.– Changing channels.Changing channels.– Cool tools.Cool tools.

RelaxationRelaxation

Breathing exercisesBreathing exercises

Visual imagery—e.g. “turtle”, a “web”, a Visual imagery—e.g. “turtle”, a “web”, a calming placecalming place

Deep muscle relaxationDeep muscle relaxation

Sensory sheltersSensory shelters

Other sensory inputOther sensory input

Thought StoppingThought Stopping

Teach children the relationship between Teach children the relationship between thoughts, feelings, and actionsthoughts, feelings, and actions

Teach them control over their thoughtsTeach them control over their thoughts

Externalizing the problem—”what can you Externalizing the problem—”what can you do to keep anger out when he comes do to keep anger out when he comes knocking on your door?”knocking on your door?”

Changing ChannelsChanging Channels

Thought switching—shifting from negative Thought switching—shifting from negative to positive thoughtsto positive thoughts

Use cartoon imagery and thought bubblesUse cartoon imagery and thought bubbles—have children practice, practice, practice—have children practice, practice, practice

Cool ToolsCool Tools

Have children make a “tool box” with their Have children make a “tool box” with their favorite techniquesfavorite techniques

Reward them for using their “cool tools”Reward them for using their “cool tools”

Use story telling to reinforce the use of Use story telling to reinforce the use of “cool tools”“cool tools”

Identify “Islands of Competence”Identify “Islands of Competence”

Identify children’s strengths.Identify children’s strengths.Provide opportunities for these strengths Provide opportunities for these strengths to flourish and be publicly celebrated.to flourish and be publicly celebrated.Allow child to “shine” in these areas.Allow child to “shine” in these areas.Find adult supports-critical for these Find adult supports-critical for these children. (De-escalation requires a trusting children. (De-escalation requires a trusting relationship).relationship).Children are much less likely to be Children are much less likely to be reactive if they feel appreciated!reactive if they feel appreciated!

Social Challenges in SchoolSocial Challenges in School

For a child with sensory modulation For a child with sensory modulation difficulties:difficulties:

Noise may seem louderNoise may seem louder

Scrapes may be more painfulScrapes may be more painful

Tumbling and jostling may be threateningTumbling and jostling may be threatening

High fives may be too hardHigh fives may be too hard

May always be “in your face”May always be “in your face”


For a child with sensory discrimination For a child with sensory discrimination difficulties:difficulties:

Difficulty with group projects involving Difficulty with group projects involving planning and assembly.planning and assembly.

Difficulty telling when a peer’s touch is Difficulty telling when a peer’s touch is friendly or fearsome.friendly or fearsome.

Difficulty discriminating emotional Difficulty discriminating emotional expressions.expressions.


A child with poor motor planning might A child with poor motor planning might have difficulty with:have difficulty with:

BaseballBaseballBasketballBasketballHopscotchHopscotchFour SquareFour SquareOther recess activitiesOther recess activities

Social Challenges at SchoolSocial Challenges at School

For a child with behavioral regulation For a child with behavioral regulation difficulties:difficulties:

Waiting his turn might be difficultWaiting his turn might be difficult

Not grabbing things that are appealing is Not grabbing things that are appealing is harderharder

Not saying the first thing that comes to his Not saying the first thing that comes to his mind is a challengemind is a challenge


For a child with emotional regulation For a child with emotional regulation difficulties:difficulties:

Tolerating others’ negative emotions.Tolerating others’ negative emotions.

Delaying gratification.Delaying gratification.

Tolerating frustration.Tolerating frustration.

Managing uncomfortable feelings.Managing uncomfortable feelings.

Modulating anger.Modulating anger.


A child with attention regulation issues A child with attention regulation issues might have difficulty:might have difficulty:

Shifting attention to new games or Shifting attention to new games or activities.activities.

Maintaining interest in a given social Maintaining interest in a given social exchange or activity.exchange or activity.

Following quickly paced social interactionsFollowing quickly paced social interactions ..

Being in ControlBeing in Control

Children with self regulation Children with self regulation difficulties often feel assaulted or out difficulties often feel assaulted or out of control. Their response is to be of control. Their response is to be rigid and controlling—a sure fire way rigid and controlling—a sure fire way to alienate their teachers and their to alienate their teachers and their peers.peers.

Difficulties with RecessDifficulties with Recess

Difficulty organizing themselves or Difficulty organizing themselves or others.others.

Difficulty managing more than one Difficulty managing more than one child at a time.child at a time.

Difficulty translating their ideas into Difficulty translating their ideas into action.action.

Difficulties with Structured Group Difficulties with Structured Group ActivitiesActivities

Motor demands may be too difficult.Motor demands may be too difficult.May take them longer than others to May take them longer than others to manage the task so they lag behind manage the task so they lag behind their peers.their peers.For many sensory kids, “two is For many sensory kids, “two is company, three is a crowd”.company, three is a crowd”.

Social Interventions at SchoolSocial Interventions at School

Alternatives to lunch/recess.Alternatives to lunch/recess.

Social skills groups.Social skills groups.

Classroom based bullying interventions.Classroom based bullying interventions.

Help the child select activities at which she Help the child select activities at which she can be successful.can be successful.

The Helping TeamThe Helping Team

Children with sensory, behavioral, emotional Children with sensory, behavioral, emotional and social problems often have multiple and social problems often have multiple needs:needs:They may require extra instructional support.They may require extra instructional support.They may be eligible for special education They may be eligible for special education services.services.They may be on medication.They may be on medication.They may benefit from counseling or social work They may benefit from counseling or social work services.services.


Their team of helpers may include:Their team of helpers may include:– Classroom teachersClassroom teachers– ParentsParents– Occupational therapistOccupational therapist– LD specialistLD specialist– Speech/language therapistSpeech/language therapist– School psychologistSchool psychologist– Behavior specialistBehavior specialist– Private therapistPrivate therapist– Other people at school important to the childOther people at school important to the child


The purpose of the team is to recommend The purpose of the team is to recommend strategies to help the child succeed.strategies to help the child succeed.

Focus on child’s strengths as well as her Focus on child’s strengths as well as her weaknesses.weaknesses.

Improve sensory climate and reduce/alter Improve sensory climate and reduce/alter sensory demands placed on child.sensory demands placed on child.

Implement appropriate behavioral and emotional Implement appropriate behavioral and emotional interventions.interventions.

Work toward the “just-right challenge.”Work toward the “just-right challenge.”

ConclusionsConclusions

There are no magic bullets.There are no magic bullets.The sensory lens can be a helpful guide.The sensory lens can be a helpful guide.Sensory sensitive solutions require Sensory sensitive solutions require stepping back, analyzing the situation, stepping back, analyzing the situation, generating solutions, and trying them out.generating solutions, and trying them out.Behavioral, emotional and social Behavioral, emotional and social interventions are necessary adjuncts to interventions are necessary adjuncts to sensory interventions!sensory interventions!

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