THE ASD NEST INCLUSION MODEL

Sensory issues and interventions: Contributions of the O.T. to classroom operation and child functioning

The ASD Nest Model YAI International Conference 2013

Kristie Patten Koenig, PhD, OTR/L, FAOTAChristene Maas, MS, OTR/LDora Sarkodie, MS, OTR/L

Learning Objectives• Understand the role of OTs within the ASD Nest Program• Understand types of sensory issues that may be seen• Discuss and demonstrate the use of sensory strategies that can be universally applied to facilitate participation in the the classrooms.• Describe the process and benefit of team collaboration

DSM V…..sensory reactivity returns• Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects).

The ASD Nest Model YAI International Conference 2013

Sensory Processing• The ability to take in information through our senses (touch, movement, smell, taste, vision, and hearing), organize and interpret that information and make a meaningful response

Challenges with Sensory Processing• Individuals with SPD are unable to process sensory information correctly. SPD affects the way their brains interpret the information they take in and also how they act on that information with emotional, attentional , motor and other responses• A comment about normal variations• What individuals with autism have taught us…

Challenges to Sensory Processing in Context • What is the impact of sensory modulation disorders in home, school, work, community environments and how does it vary?• To what extent does it impact the individual?• Are their goodness or poorness of fit characteristics between sensory processing and environment?• How can we obtain the optimal level of arousal?

Sensory Processing Disorders(Miller, L.J. et. al. SI Focus, 2004)

Learning is Impaired

Defective Attending Behaviors“Spacey”

“Slow”

Needs

Stimulation

for Arousal

Attends to all Stimuli

“Distractible”

“Fragmented”

Misses Cues,

Slow Affect

Overreacts

Anxious

Impaired

Social

Interactions

L.J. King, 1982

Dunn’s Model of Sensory Processing

Threshold Passive Response Active Response

High Low Registration Sensory Seeking

SUR/Hypo

Low Sensory Sensitivity Sensory Avoiding

SOR/Hyper

UNIQUE ROLE OF OTS IN THE ASD NEST PROGRAM

Unique Role of OTs in the ASD Nest program

• Similar to other programs, address educationally relevant areas in which OTs can provide interventions and strategies to help promote student success• Functional fine motor skills (grasp of pencil, fine motor

dexterity) Visual motor/perceptual skills affecting school

participation Activities of daily living (self-care skills)

Unique Role of OTs in the ASD Nest program

• Provide sensory strategies for improving academic and social participation that generalize in classroom

• Incorporate principles of the program through sessions and during Social Development Intervention (SDI)

• Attending weekly team meetings, and professional development

What does OT look like in the ASD Nest Program?

•Have groups for the whole class• Complete the mandate in the least restrictive environment• The general education children have indirect benefit of the activity, although focus of the group is the mandated child/children • Administrative support • Can provide a letter to ALL children in the class to

inform all parents/guardians

What does OT look like in the ASD Nest Program? (cont’)

• Examples of groups• Fun Fridays (Fine motor group on Fridays)• Yoga• How Does Your Engine Run? (Self- regulation• S’Cool Moves (Academic activities to address

sensorimotor needs) • Handwriting Without Tears (Handwriting group)• Self-care groups • Lunch groups (lunch club)• Cooking groups• Courageous Pacers

Unique Role—Push In’s• Frequent “Push ins” for individual sessions• Providing service in least restrictive and natural

environment• Providing service where the student is having educational

or social participation issue• Supported by IDEA, current practice trends, and

evidenced based practice

Unique Role-- SDI• If caseload permits, attend Social Development Intervention (SDI) session• At least one time per week; prefer 2 times per week for

Kindergarten & 1 time per week for 1st grade and up

• Allows for transdisciplinary involvement

• Can plan for sensory strategies for individuals or sensorimotor games for groups

• OTs observe pragmatic language to use

• Teachers/SLP can observe OT strategies that work

• Can address issues in SDI in individual sessions if needed

Expanding our Unique Role

SENSORY STRATEGIES

Sensory Strategies that can be Universally Applied

Importance of addressing sensory processing issues:-affects classroom participation-affects social participation-affects self-care-affects fine motor/gross motor development

Sensory strategies for the classroom

•Sensory Diet•Use of various schedules•Power cards (See example done by OT/teacher)•Posters or visual cues for self-directed activity

•Self-regulation programs•The Alert Program®: How Does Your Engine Run?•S’Cool Moves: activities for learning and self-regulation

•Movement Breaks•Quiet Areas•Universal Design Sensory Strategies

MOVEMENT BREAKS

These are some activities to help enhance your student’s attention:

• Chair push ups• Wall push ups• Jumping Jacks• Pushing down into the top of the table• Getting a drink of water and/or using the bathroom• Movement to Head, Shoulders, Knees and Toes song• Doing a silly movement• Transition movements, i.e. swimming like a fish while

transitioning from rug to desk• Allow child to be teachers assistant and pass out papers

Classroom Movement Breaks • Before the first “lesson” (writer’s workshop, math workshop, etc.) or right after morning meeting• Before lunch• Hour before dismissal

Universal Design-Sensory Strategies

• Environmental Modifications• Lights – turning off/dimming after lunch, PE, and/or

afternoons• Avoid florescent lights• Play music after students return from lunch and PE

• Deep breaths • Yoga poses • Head on desk

Universal Design-Sensory Strategies

• Head phones- to help with auditory distractions, sudden or unexpected noises

• Placing plain cover pages on children’s hanging work, so that one must lift it in order to see

• Office- creating private work space for children at their desk using tri-fold poster board or blank/empty folder.

TEAM COLLABORATION

Team Collaboration • Required whole team case conference weekly which is supported by administration • Plan with teacher, OT’s , SLP, PT’s • Plan for SDI

Team Meetings

• Case Conferencing:• Hear from all professionals working with the student • Consider the social: SDQ goals, SDI unit, strategies,

relationships• Discuss behavioral, academic, sensory, and parent

concerns• Generate specific plan for follow-up• Work collaboratively as a TEAM

Parent Communication • The purpose of the home/school notebook is to foster communication between home and school, supporting collaboration to help the child be successful. • Parent Meetings with Social Worker

Parent Communication-Notebook

• Help undo negative associations from the past • Create new and positive association with their child in the educational program• Success stories • Ideas for how school content can be explored and practiced at home • Information about upcoming events that the children will be participating in and/or that the parents might want to attend

For more information:• http://steinhardt.nyu.edu/asdnest/• cmaas@schools.nyc.gov• dsarkodie@schools.nyc.gov• kpk3@nyu.edu