SensoryIntegration - IactiveLearning · While this book concerns children with sensory integration...

Sensory Integration

AGuide for Preschool Teachers

Christy Isbell and Rebecca Isbell

Sample provided by iActiveLearning.com, all rights reserved.

Dedication

This book is dedicated to our family. Their love and support has madethis book and many other projects in our lives possible. Thank you.

—Christy and Rebecca

Acknowledgments

Special thanks to the preschool teachers of the East Tennessee StateUniversity Child Study Center and Little Buccaneers Student ChildcareCenter for their willingness to allow us to visit their classrooms and takephotographs for this book.

Disclaimer

While this book concerns children with sensory integration disorders,the photographs used in the book do not necessarily include childrenwith the specified disorder.

Special Thanks

We would like to thank some very special people who have workeddiligently on the development of this book. Sheila P. Smith was the finalperson in the office to put her finishing touches on the words andorganization of the content. Her questions and careful editing have madeher an essential person on this project. Michael O. Talley has contributedthe many fabulous photographs that are used in our book. These visualswill help you “see” what is being described in the text. Roxanne K.Stanley has been invaluable for the work she has done related to themany details that must be completed, including research, reviewingphotographs, and photo releases. Rhonda Harper, OTR/L reviewed thetext and provided us with guidance on terminology that would be usefulfor preschool teachers. Our thanks are given to these four highlycompetent individuals.


Sensory Integration:A Practical Guide for Preschool Teachers

© 2007 Christy Isbell and Rebecca IsbellPhotographs by Michael Talley

Published by Gryphon House, Inc.PO Box 207, Beltsville, MD 20704800.638.0928; 301.595.9500; 301.595.0051 (fax)

Visit us on the web at www.ghbooks.com

All rights reserved. No part of this publication may be reproduced, storedin a retrieval system, or transmitted in any form or by any means,electronic, mechanical, photocopying, recording or otherwise, withoutthe prior written permission of the publisher. Printed in the United Statesof America. Every effort has been made to locate copyright andpermission information.

Cover Art: Straight Shots Product Photography, Ellicott City, MD;www.get-it-shot.com.

Library of Congress Cataloging-in-Publication

Isbell, Christy.Sensory integration : a practical guide for preschool teachers / Christy

Isbell and Rebecca Isbell ; photographs by Michael Talleyp. cm.

Includes bibliographical references and index.ISBN: 978-0-87659-060-7

1. Children with disabilities--Education (Preschool) 2. Sensorydisordersin children. I. Isbell, Rebecca T. II. Title.LC4019.2.I82 2007371.9'0472--dc22

2007000885

Bulk purchaseGryphon House booksare available for specialpremiums and salespromotions as well asfor fund-raising use.Special editions or bookexcerpts also can becreated to specification.For details, contact theDirector of Marketing atGryphon House.

DisclaimerGryphon House, Inc.and the authors cannotbe held responsible fordamage, mishap, orinjury incurred duringthe use of or because ofactivities in this book.Appropriate andreasonable caution andadult supervision ofchildren involved inactivities andcorresponding to the ageand capability of eachchild involved, isrecommended at alltimes. Do not leavechildren unattended atany time. Observesafety and caution at alltimes.


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Table of ContentsChapter 1:What Are Sensory Integration and Sensory

Processing Disorder?...................................................11

Sensory Integration ...................................................................................12Development of Senses.............................................................................13Background on Sensory Integration .........................................................15What Is Sensory Processing Disorder? .....................................................15Responses to Sensory Input ......................................................................17Sensory Processing Disorder and Related Terms.....................................18Impact of Sensory Processing Disorder on Learning ...............................19

Chapter 2: Sensory Avoiders, Sensory Seekers, and

Sensory Under-Responders . . . . . . . . . . . . . . . . . . . . . .21

Preschoolers with Sensory Processing Disorder (SPD)............................22Sensory Avoider ..................................................................................22Sensory Seeker ....................................................................................23Sensory Under-Responder ..................................................................24Comparison of Sensory Avoiders, Sensory Seekers, and Sensory

Under-Responders.........................................................................25Identifying Sensory Seekers and Sensory Avoiders.................................26Visual Avoider: What Does This Child Do? ............................................27

Visual Avoider: Red Flags....................................................................27Visual Seeker: What Does This Child Do? ..............................................28

Visual Seeker: Red Flags......................................................................29Visual Under-Responder: What Does This Child Do? ............................29

Visual Under-Responder: Red Flags....................................................30Auditory Avoider: What Does This Child Do? .......................................30

Auditory Avoider: Red Flags...............................................................31Auditory Seeker: What Does This Child Do? .........................................31

Auditory Seeker: Red Flags.................................................................32Auditory Under-Responder: What Does This Child Do? .......................32

Auditory Under-Responder: Red Flags...............................................33Tactile Avoider: What Does This Child Do? ...........................................33

Tactile Avoider: Red Flags...................................................................34


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Tactile (Touch) Seeker: What Does This Child Do?................................35Tactile Seeker: Red Flags .....................................................................36

Tactile Under-Responder: What Does This Child Do? ...........................36Tactile Under-Responder: Red Flags...................................................37

Vestibular Avoider: What Does This Child Do?......................................37Vestibular Avoider: Red Flags .............................................................38

Vestibular (Movement and Balance) Seeker:What Does This Child Do?...................................................................39Vestibular Seeker: Red Flags ...............................................................40

Vestibular Under-Responder: What Does This Child Do? .....................40Vestibular Under-Responder: Red Flags .............................................41

Proprioception Avoider: What Does This Child Do?..............................42Proprioception Avoider: Red Flags .....................................................43

Proprioception (Body Awareness) Seeker: What Does This Child Do?.43Proprioception Seeker: Red Flags .......................................................44

Proprioception Under-Responder: What Does This Child Do?..............44Proprioception Under-Responder: Red Flags .....................................45

Summary .................................................................................................46Observing Children...................................................................................46When to Refer and to Whom ...................................................................48Talking with Parents/Guardians ...............................................................49

Chapter 3:Design the Environment to Support the

Sensory Development of All Children .......................51

Positive Effects of the Environment .........................................................52Role of the Teacher ...................................................................................53

Monitor Your Voice Level...................................................................53Follow a Routine .................................................................................53Simplify Instructions ...........................................................................54Offer Appropriate Choices .................................................................54Prevent Problems.................................................................................55

Promote Self-Awareness ...........................................................................56Respect the Child’s Emotions.............................................................57Provide Consistency............................................................................57

Visual Environment ...................................................................................58Encourage Child’s Sense of Space ......................................................58Use Proper Lighting.............................................................................59Organize the Classroom.....................................................................60



Reduce Clutter.....................................................................................60Display Children’s Work ....................................................................62Document Progress .............................................................................63Provide Personal Space........................................................................63

Auditory Environment ..............................................................................63Tactile (Touch) Environment ....................................................................65

Use Firm Touches................................................................................66Introducing Touch Input .....................................................................66“I Touch” Center .................................................................................67Help for Picky Eaters...........................................................................68

Vestibular (Movement and Balance) Environment ..................................69Rotating Activity Level .......................................................................69Gross Motor Center ............................................................................70Proprioception (Body Awareness) Environment ...............................70Heavy Work Activities........................................................................72

Chapter 4:Help for Preschoolers with Sensory Processing

Disorder........................................................................75

Modifying the Environment .....................................................................76Sensory Diet ..............................................................................................76

Case Study: Riley ................................................................................77Calming and Organizing Activities ..........................................................79Alerting Activities......................................................................................79Suggestions for Preschoolers with Visual Processing Problems..............80

Visual Avoiders....................................................................................81Visual Seekers ......................................................................................82Visual Under-Responders....................................................................82

Suggestions for Preschoolers with Auditory Processing Problems.........83Auditory Avoiders...............................................................................83Auditory Seekers .................................................................................84Auditory Under-Responders...............................................................85

Suggestions for Preschoolers with Tactile (Touch)Processing Problems ...............................................................................85

Tactile Avoiders (Tactile Defensiveness)............................................86Tactile Seekers .....................................................................................87Tactile Under-Responders...................................................................89

Suggestions for Preschoolers with Vestibular (Movement andBalance) Processing Problems .............................................................89


8

Vestibular Avoiders .............................................................................90Vestibular Seekers ...............................................................................91Vestibular Under-Responders .............................................................93

Suggestions for Preschoolers with Proprioception (Body Awareness)Processing Problems ...............................................................................94

Proprioception Avoiders .....................................................................94Proprioception Seekers .......................................................................95Proprioception Under-Responders .....................................................96

Chapter 5: Practical Solutions toMeet the Needs of

Individual Children During the Daily Routine...........99

Transitions ...............................................................................................100Prepare Ahead ...................................................................................100Picture Schedule ................................................................................102

Circle Time ..............................................................................................103Maintaining Children’s Attention ....................................................103Tactile Considerations ......................................................................104

Manipulatives/Fine Motor Activities......................................................105Sensory-Smart Materials...................................................................105FUNctional Work Space....................................................................106

Learning Centers .....................................................................................108Encouraging Movement Experiences ...............................................108Incorporating Proprioceptive and Tactile Input ...............................109Facilitating Self-Awareness and Organization.................................110

Snack/Lunch ............................................................................................111Sensory-Smart Foods ........................................................................112

Toileting ...................................................................................................112Rest...........................................................................................................113

Calming Environment.......................................................................113Simple Rest-Time Modifications......................................................114

Playground or Gym.................................................................................115Sensory-Smart Equipment for the Playground or Gym..................115Heavy Work/Play ..............................................................................116Keep Your Feet on the Ground, Please!............................................116Let the Child Be Your Guide.............................................................117

What Have You Learned? .......................................................................117

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Chapter 6: Building and Creating Low-Cost Items.......119

Body Sock.................................................................................................120Carpet Roll ...............................................................................................121Crash Pad .................................................................................................122Incline Board............................................................................................123Picture Schedule ......................................................................................124Plexiglas Painting Wall ............................................................................125Sand Pillow ..............................................................................................126Sound Panel .............................................................................................127Tire Swing................................................................................................128

References and Resources .............................................129

Glossary...........................................................................131

Appendix.........................................................................136

Index................................................................................141


11

What Are SensoryIntegration and SensoryProcessing Disorder?

C H A P T E R 1


W h a t A r e S e n s o r y I n t e g r a t i o n a n d S e n s o r y P r o c e s s i n g D i s o r d e r ?12

Sensory Integration

Some children in your classroom may respond to their environment inways that seem confusing or worrisome, and you may not be sure howto handle their behavior. Some unusual behaviors may be similar tothese:� Thomas covers his ears when the children are singing.� Temple rolls all over the floor while others are sitting in circle time.� Brianna refuses to touch playdough, sand, or paint.� Miguel climbs on top of tables and jumps off.� Cassandra often falls down and skins her knees.� William refuses to play on outdoor playground equipment.

All of these children are demonstrating signs of problems with sensoryintegration (SI). So, how can you design or change your environment sothat these children can learn and function effectively in the classroom?

This book explains why children with sensory integration problemsbehave differently in the preschool environment. “Red flags” in eachchapter help identify children who have difficulties with sensoryprocessing, also known as Sensory Processing Disorder (SPD), andsimple, easy-to-use solutions are provided to address the sensory needsof young children in preschool. Many of the ideas offered will improvethe environment for all children, not just those who have sensoryprocessing problems.

Sensory integration is the neurological process of organizing sensoryinputs for function in daily life. Our brains take in information from thebody and interpret that information so that we can survive and makesense of our world. We use our senses to learn and develop. We also useour senses to help us interact appropriately within the environment.

We learn early about the five senses of touch, sight, hearing, taste, andsmell. However, most of us are not aware of two additional senses thatare just as important. Our sense of movement and balance (vestibularsense) interprets information through our inner ears to determine if ourbodies are moving or standing still. Our vestibular sense tells our brainsthat our bodies are moving through space even while we are riding arollercoaster through a completely dark indoor area where our visioncannot provide information. Our sense of body position (proprioceptive

Sensory

integration

is the neurological

process of

organizing sensory

inputs for function

in daily life.


13

sense) provides our brains with information about our body parts andwhere they are in space. Proprioceptive awareness helps us determinewhere our heads, arms, and legs are located at any time, allowing us towalk up stairs without looking down at our feet.

Sensory integration occurs in the central nervous system (brain, spinalcord, and nerves). The process occurs automatically as the body gathersinformation through the skin, muscles, joints, inner ear, eyes, nose, andmouth. As you read this book, your brain works to integrate the manysensory inputs from your body. For example, you are reading the wordson this page while you process other sensory informationsimultaneously: you might see the background view of the surroundingroom; hear the sounds of an air conditioner, the television in the nextroom, and children talking; feel a blanketwrapped over your legs; taste the lemonadeyou are drinking; and smell a candle burning.You might also feel that you are sitting on thecouch (vestibular) with your head up and yourlegs crossed (proprioceptive). The brainconstantly focuses on sensory information—screening, organizing, and responding toinput—so that the body can function. This issensory integration (SI).

Development of Senses

Sensory processing begins in the womb andcontinues to develop throughout childhood. Asa child’s central nervous system matures, sodoes the child’s sensory system. Infants can usetheir senses at a very young age, although thesenses are not refined. Most people have fullyfunctioning sensory systems by the time theyreach adolescence.

A newborn infant’s sensory skills are quitedifferent from those of a preschooler. Anewborn reacts to most types of touch with

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14

protective responses. For instance, a newborn will withdraw his leg inresponse to a touch on the sole of his foot. By three years of age, he willlearn to differentiate types of touch and will laugh when his foot istickled or will pull his foot away from a toy that he steps on. A younginfant can identify his mother by smell, but appears unaware of mostother smells in the environment. Most preschoolers can identifycommon smells, such as muffins baking in the kitchen, and they can alsotell you that muffins taste sweet.

Each of the seven senses develops at its own rate. Vision, hearing,movement, and body position sensations typically take more time tomature. A newborn infant lacks the ability to identify colors or shapes.By three years of age, many children can see objects at far distances andcan tell the difference between shapes and colors. And although anewborn can hear, he is not capable of identifying a sound or itslocation. Most preschoolers can identify and localize distant sounds,such as their teacher’s voice from across the playground.

Each child will develop sensory skills at hisown pace. However, there is a wide range of“typical” sensory development and skills.Genetics and environmental influences play arole in sensory development. For instance,some children are more prone to ear infectionsbecause of the way their inner ears are formed(genetics). Other children are more likely tohave ear infections because they live inenvironments where they are exposed tosecond-hand smoke. It is common for both ofthese influences to cause young children tohave problems with the sense of hearing. Allthe senses need to work together so thatpreschoolers can reach their fullest potential.Preschoolers must be able to coordinate allseven senses to learn about their world andfunction effectively.

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S e n s o r y I n t e g r a t i o n | C h a p t e r 1 15

Background on Sensory Integration

A. Jean Ayres, Ph.D., was an occupational therapist and educationalpsychologist who researched sensory integration in the mid 1900s. Ayresidentified the diagnosis of sensory integration dysfunction, developedSensory Integration Theory, and, in 1973, published her groundbreakingbook, Sensory Integration and Learning Disorders. Ayres designedassessment tools for sensory integration dysfunction and taught manyoccupational therapists how to assess and treat children with sensoryintegration dysfunction. Sensory Integration Theory remains the basis ofassessment and intervention of children with sensory integration (SI)problems.

Many occupational therapists have continued the work that Ayresbegan, as health professionals, parents, and educators have becomeaware of the diagnosis and its treatment. Carol Kranowitz’s (2006) book,The Out-of-Sync Child: Recognizing and Coping with Sensory Processing

Disorder, Revised Edition, helped many people, including early childhoodeducators, to become more aware of how deficits in SI can impact youngchildren’s daily lives.

What Is Sensory Processing Disorder?

Sensory Processing Disorder (SPD) is difficulty in using the informationthat is collected through the senses (vision, hearing, touch, taste, smell,movement, and body awareness) in daily life. Most people are born withthe ability to take in sensory information, organize the information, andrespond appropriately. For example, when you smell cookies burning inthe oven, see smoke, and hear the oven timer buzzing, you go to thekitchen and remove the cookies from the oven. This is an appropriateresponse to the sensory information that the brain receives through yournose, eyes, and ears. SPD occurs when a person’s brain does notorganize those sensory signals and he is unable to respond effectively.Using the same example, if a person responded to the cookies burningby placing his hands over his ears and yelling, this would be adisorganized and ineffective response and would make it difficult forhim to function effectively in his environment.

Sensory Processing

Disorder (SPD)

occurs when a

person’s brain

does not organize

sensory signals and

he or she is

unable to respond

appropriately.



Categories of Sensory Processing Disorder

SPD is an all-inclusive term for a group of neurological disorders. Thereare three main categories of SPD: Sensory Modulation Disorder (SMD),Sensory Discrimination Disorder (SDD), and Sensory-Based MotorDisorder (SBMD) (see Figure 1).

Figure 1: Types of Sensory Processing Disorders

Miller, L. J., Cermak, S. A., Lane, S. J., Anzalone, M. E. & Koomar, J. A.(Summer 2004). Position statement on terminology related to Sensoryintegration dysfunction. S.I. Focus magazine.

Sensory Modulation Disorder (SMD) is the most common type ofSensory Processing Disorder (SPD), and the signs and symptoms arerecognizable by many educators and parents. Preschoolers who havethese types of sensory problems are most likely to make teachers andparents concerned. Preschoolers who have a Sensory ModulationDisorder (SMD) will often have difficulties in areas of development suchas social-emotional skills, gross motor skills, fine motor skills, play skillsand self-help skills. These children may also demonstrate behaviorproblems and show signs of low self-esteem secondary to their sensorydisorders. Deficits in these areas of development can have a significant,negative impact on a preschooler’s ability to learn and participate inpreschool. Therefore, the focus of this book will be on young childrenwho have SMD. Early childhood educators can use the information thatfollows to identify children who are in this category of SPD. Preschool

SensoryProcessingDisorder(SPD)

SensoryDiscriminationDisorder(SDD)

SensoryModulationDisorder(SMD)

Sensory-BasedMotor Disorder

(SBMD)


17

teachers can also use this resource to help select and implement sensory-based methods that will allow young children to succeed in the learningenvironment.

For the purpose of this book, Sensory Discrimination Disorder (SDD),and Sensory-Based Motor Disorder (SBMD) will not be presented (seeFigure 1). These two categories of Sensory Processing Disorder (SPD) areless common and very difficult for those without advanced training insensory integration to identify. Assessment and intervention for childrenwho fall into these two categories are typically designed andimplemented by pediatric occupational therapists.

Responses to Sensory Input

Everyone experiences occasional sensory difficulties. Most people learnhow to adjust and manage sensory input so their response to the inputbecomes “adaptive” and does not cause difficulty during daily activities.For example, someone who does not like the feeling of tags in the backof his shirts will simply cut the tags off of his clothing. Or, a person whogets carsick while riding on a winding road may choose to drive so thathe can visually focus on the road. These are not examples of SPD; rather,they demonstrate isolated problems with sensory processing. Thesepeople have learned how to change or adjust to the situation so that theydo not feel uncomfortable.

Our ability to understand sensory input and respond in a functionalmanner follows a developmental progression. For example, Caroline, atypically developing six-year-old, is over-sensitive to certain sounds inher environment. At bedtime, if the television is too loud in the nextroom, Caroline is unable to calm down enough to fall asleep. When shewas two years old, Caroline would cry and whine if the TV was tooloud. Now that she is six, Caroline has learned to simply ask her fatherto lower the volume and close her door before climbing into bed. This isan effective response to her inability to process the auditory input; she isnot demonstrating SPD.

Many children are unable to produce an adaptive or effective response tosome types of sensory input. Some children are easily over-stimulated by

Our ability to

understand

sensory input and

respond

in a functional

manner follows a

developmental

progression.

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18

certain sensory inputs and try to avoid them. Other children are on theopposite end of the spectrum. These children are under-stimulated bysome sensory inputs. Some need stimulation but don’t know how to getit. Others crave more input than the typical child. Children on either endof the spectrum have sensory processing problems that hinder theirparticipation in learning and life activities.

Under-Stimulated Typical Response Over-Stimulated

Fisher is a three-year-old boy who seems to be in constant motion.While three-year-olds are typically viewed as active individuals, Fisher’sneed for constant motion seems to be well above the normal range. Thisbehavior has an impact on his ability to participate and learn in

preschool. Fisher cannot sit for morethan a minute. He spends circle timerunning around the tables in the backof the room. During center time, hemoves quickly from center to center,without showing much interest inthe materials. Fisher is demonstratingSPD in the area of vestibular(movement and balance) input. He isunder-stimulated by movement andbalance. Therefore, Fisher’s brainneeds more movement input thannormal. Fisher cannot seem to getenough movement, thus seekingmore by moving around constantly.

Sensory ProcessingDisorder andRelatedTerms

Some of the terminology related tosensory integration (SI) can bemisused and confusing. For example,you may have heard a parent say,“My child has sensory integration.”

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Everyone has “sensory integration,” while some children have difficultywith SI. Ayres labeled the group of sensory integration problems sensoryintegration dysfunction, which is sometimes called Sensory IntegrationDisorder. Many researchers in the field of sensory integration use SPD todescribe this group of problems. To be current in the field, the authorsuse Sensory Processing Disorder (SPD) throughout this book.

Impact of Sensory ProcessingDisorder on Learning

The brain of a child with SPD works differently from that of a child whohas no sensory integration issues. Because SPD affects the child’s overalldevelopment, his participation in typical childhood experiences will belacking, inconsistent, or ineffective. Performing ordinary life activitiesmay be challenging for the child with SPD because the child’s brain isunable to organize and process sensory information.

Sensory integration (SI) has an enormous impact on children’s learning.Young children gain an understanding of the world through interactionwith the environment. For example, a child digs a hole in the dirt.Through this process he learns many things, such as the texture andweight of the soil and which animals live in the soil, while he practicessmall motor skills. A child who has SPD is not able to organize sensoryinformation and respond to input in a functional manner. These sensoryprocessing difficulties cause the child to demonstrate negative behaviorsor extreme emotions that are not the result of poor intellectual ability. Asa result of SPD, a number of problems with learning, motordevelopment, or behavior may be observed in preschool children,including the following:� coordination problems;� poor attention span or difficulty focusing on tasks;� academic-related problems such as poor handwriting and difficulty

cutting with scissors;� problems with self-care skills such as tying shoes, zipping, buttoning,

and feeding;� low self-esteem;� over-sensitivity to touch, sights, or sounds; and� unusually high or low activity level.



A child who is overwhelmed by the sensory information from hisenvironment will be unable to learn effectively. On the other hand, achild who is under-stimulated by the environment will also lack theinput necessary to learn. The information in the next chapters willfurther describe sensory processing, which is necessary to provide theoptimum learning environment for a variety of preschoolers. All youngchildren can benefit from an environment designed with an awareness ofthe role that the senses play in their development.


21

Sensory Avoiders, SensorySeekers, and SensoryUnder-Responders

C H A P T E R 2


S e n s o r y A v o i d e r s , S e n s o r y S e e k e r s , a n d S e n s o r y U n d e r - R e s p o n d e r s22

Preschoolers with SensoryProcessing Disorder

The child with Sensory Processing Disorder has a brain that experiencesgreat difficulty with adjusting to or regulating responses to sensoryinputs. This means that a child either does not react strongly enough orreacts too strongly to sensory input from the environment. The childwho does not react strongly enough to sensory information is calledunder-responsive, while the child who reacts too strongly to sensoryinformation is considered over-responsive.

Sensory Avoider

The Sensory Avoider is over-responsive tosensations from one or more sensory systems(touch, visual, auditory, movement andbalance, body position, taste, and smell).Sensory Avoidance is the most common type ofsensory problem. This child’s brain is unable toeffectively reduce sensations. The child may beover-aroused and may respond to certainsensory information as if it were irritating orpainful; this child may even be afraid of manysensations (Miller & Fuller, 2006).

Some Sensory Avoiders are passive and try toget away from objects or activities that arefrightening for them. They may choose to do aless frightening activity or “talk their way outof it.” For example, the Sensory Avoider maystay away from the swings and the slide on theplayground and choose to play in the sandboxevery day.

Other Sensory Avoiders may be overly aggressive or forceful in theirresponses to sensations. They may react with inappropriate behaviors,such as hitting, biting, or kicking. Being removed from a situation due toa negative behavior helps the child avoid overwhelming sensorysituations. The adult removing the child from the situation may be a


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