Sensory Regulatory Processing – Bodies That Tell Stories
DIR® Regional Institute Session 3 Milagros J. Cordero, EdD, OTR/L
What Do We Want for Our Children?
Axis III – Regulatory-Sensory Processing Capacities
Type I - Sensory Modulation (challenges)
Type II - Sensory Discrimination (challenges)
Type III - Sensory Based Motor (challenges) Abilities, including postural control and motor planning
Regulatory Sensory Processing Capacities - Definition ď‚—
is a term that refers to the way the nervous system receives messages from our senses and turns them into appropriate motor and behavioral responses
Sensory Processing Development – A Continuum
The behaviors observed in a child will exist in a continuum ◦ from within typical guidelines and its variations to From newborn until toddler – In alertness / Diffuse From toddler to pre-school – Transitional Period By kindergarten – Discriminatory/Manual dexterity established
◦ disorders
Master Observer: A.J. Ayres
“The child’s innate ability drives and neural capacities lead him to an abundance of responses, many of them involving maximal effort, that enable him to master those demands and result in experiences that foster his development.”
Master Observer: J. Piaget ď‚—
J. Piaget - stressed that the early sensorimotor (including reflex) stages of infant development extends into reflective intelligence through process of accommodation and assimilation
Master Observer: M. Levine ď‚—
Multiple forces (genetic factors, environmental influences, family factors, cultural values, educational experience, physical health, influence of peers, temperament/emotional factors) determine a child’s neurodevelopmental profile.
Master Observer: S. Greenspan
S. Greenspan – In discussing areas that influence the child’s development, he identifies them as: ◦ Biological and genetic factors ◦ Cultural, environmental, and family factors ◦ Child/caregiver interaction patterns
It is this interaction patterns that then determines the child’s capacity for relative mastery
Sensory Processing Development According to Ayres, sensory integration (the term) is the organization of sensation for use. We need to have this skill so as to: ◦ Play ◦ Engage and maintain social interaction ◦ Have the ability to stay modulated ◦ Completion of activities of daily living ◦ Development of new skills – including academics
Development of Sensory Integration
Sensory Integration is a normal process that supports all our behavior and actions. (Influenced by the developmental level) –
S. Szklut, 1999
It involves not only the 5 senses we learn at school, but also the vestibular and the proprioceptive systems
It is also influenced by the environment
It is influenced by the individual presenting the stimuli
D.I.R.速/Floortime & Sensory Processing Models MC, EdD, OTR/L
Logical & Abstract Thinking
Cognitive
Symbolic and Creative Use of Ideas
Language
Complex Presymbolic , shared social communicati on
Ideation,
Two Way Communicat ion
Proprioceptiv e
Engagemen t Shared Attention & Regulation
Tactile Muscle Tone & Muscle Strength
Motor Planning
2009
Emotions
& Execution
Vestibular
Taste
Vision
Smell
Auditory
Range of Motion
Primitive Reflexes
Protective Reactions
&
Balance
Equilibrium
Development of modulation
“When inhibition and facilitation are balanced, we can make smooth transitions from one state to another.” “Modulation determines how efficiently we self-regulate, in every aspect of our lives.” –
C. Kranowitz
How is Regulation Accomplished?
It is the “capacity to regulate and organize the degree, intensity, and nature of responses to sensory input in a graded and adaptive manner. …to achieve and maintain an optimal range of performance and to adapt to challenges in daily life.” ●
Miller & Lane, 2000
What is meant by Regulation/Modulation? Co-regulation? How Does it Look?
Self regulation is the nervous system’s ability to attain, maintain, and change levels of arousal or alertness ◦
(William & Shellenberger, 1994)
Body Centered vs. Far Centered Senses
Interoceptive (body centered) senses - tactile, vestibular, and proprioceptive senses - operate without conscious thought - includes state of arousal
Far senses - responds to external stimuli - sight, sound, taste, smell, and touch - respond to external stimuli from the environment ●
C. Kranowitz
Mechanisms to Self Regulate
Modulation - brain will turn switches on or off to regulate its activity and our activity level
Inhibition - brain will reduce connections between sensory intake and behavioral output when information is not needed
Habituation - when we become accustomed to familiar sensory messages our brain automatically tunes them out
Facilitation - brain will promote connections between sensory intake and behavioral output by sending messages - it lets us known when we need to stop or continue activities –
C. Kranowitz
Importance of Arousal
Arousal is our level of alertness
The ability to maintain appropriate states of arousal develops from our ability to balance the sensory input from our environment
With adequate arousal, we can then attend and learn
How is a Disorder Identified? ď‚—
A disorder is identified when a behavior interferes with the age expected performance of the individual
ď‚—
A disorder can appear in one or more of the developmental areas of: physical, emotional, social, cognitive, learning
The Range of Challenges
None
Challenges but with normal range of variation
Mild to Moderate Impairments
Severe Impairments
Sensory Modulation Patterns
201 – Over-Responsive, Fearful, Anxious
202 – Over-Responsive, Negative, and Stubborn
203 – Under-responsive, Self-Absorbed ◦ 203.1 – Self Absorbed and Difficult to Engage Type ◦ 203.2 – Self-Absorbed and Creative Type
204 – Active, Sensory Seeking Pattern
Using the Functional Developmental Growth Chart Questionnaire
By 3 Months – Focusing and Attention/ Shared Attention and Regulation ◦ Does your infant usually show an interest in things around him/her by looking at sights, turning towards sounds?
By 5-6 Months – Engaging in Relationships ◦ Does your baby seem happy or pleased to see you and / or other favorite people: looking and smiling, making sounds or some other gesture, such as moving arms, that indicates pleasure or delight?
Early Identification of Regulatory and Sensory Processing Problems
Sleep Disturbances
Eating Problems
Sensory Reactivity
Attentional Problems
High Irritability
Levels 1 & 2 Attention and Engagement
“These first two crucial thinking levels, attention and engagement, are exactly where the trouble shows up first.” –
S. Greenspan. The Learning Tree, 2010
Experience shows us that even as children continue to grow and develop, we often need to revisit these areas since they are the first ones to be affected when the individual faces other challenges.
Questions to keep in Mind When Playing with an Infant/Child
How does the infant/child respond to movement?
How does the child deal with transitions?
What is the quality of their motor planning at the gross and at the fine motor level?
Is the intensity and frequency of the behaviors demonstrated at par with the child’s age?
What strategies does the child use to calm herself?
Interaction with dad at 10 weeks
Interaction With Mom and Dad at 8 Weeks
Sensory Profile
A profile is not always obvious because it can vary according to ◦ Circumstances ◦ Who is with the child
Therefore, good observations are very important
According to S. Greenspan, “As you play, talk, or interact with your child, no matter how old, always remember to check whether he is calmly engaged and in control of his emotions and behavior.” The Learning Tree, pp.160
Identifying a Child’s Sensory Profile
How would you describe the sensory profile for Child #1, for Child #2?
Areas that Support Development
Areas that Hinder Development
Sensory Modulation Pattern .201 – Over-Responsive, Fearful, Anxious
Characterized by responses that are larger than the ones expected
Individuals are often seen to over-react to stimuli or to the possibility there will be a stimuli coming their way
Sensory Modulation Pattern .201 – Over-Responsive, Fearful, Anxious
Sensory Modulation Pattern – .202 – Over-Responsive, Negative, and Stubborn (Sensory Avoiding)
Respond to touch with aggression or withdrawal Afraid of or becomes sick with movements and heights Cautious or unwilling to take risks Uncomfortable in loud or busy environments Very picky eater and/or overly sensitive to food smells
Negative and Stubborn
Overly Sensitive
Sensory Modulation Pattern .203 – Under-responsive, Self Absorbed
Sensory Modulation Pattern – .204 Sensory Seeking Behaviors Hyperactivity – as they seek more input Unawareness of touch or pain or touching others too often or too hard Engaging in unsafe behaviors Being too loud/too soft spoken or enjoying the extremes in volume
Sensory Seeking
Co- Regulation
Accompanying Emotional States
Anxiety
Depression
Anger hostility
Functional performance
Attentional concomitants ◦ Distractibility ◦ Disorganization ◦ Impulsivity ◦ Hyperactivity –
Miller, 2000
Other Identified Behaviors Expressions
Parents have reported concerns related to: ◦ Poor social participation ◦ Insufficient self regulation ◦ Inadequate perceived competence ◦ Inadequate self esteem ●
Cohn & Miller, 2000
Strategies to Support Levels 1 & 2
fromPfeiffer, Koenig, Kinnealey, Sheppard, Henderson – Effectiveness of Sensory Integration Intervention in Children with Autism Spectrum Disorders: A Pilot Study. AJOT January/February 2011, Vol 65, Number 1
Arrange the room to entice engagement
Ensure physical safety
Present sensory opportunities
Attain and maintain optimal arousal level
Taylor activity to present just right challenge
Ensure that activities are successful
Guide the self-regulation of behavior
Create a playful context
Collaborate in activity choice
Foster therapeutic alliances
Supporting Each Other‌ quietly
And in a more active Environment
Type II – Sensory Discrimination
Defined as “inability to distinguish one type of input from another.”
Discriminatory skills include: different weights, different temperatures, different
How Sensory and Regulatory Issues Affect Interaction
Need to ‘express’ versus ‘control’ the Sensory Input – How it affects engagement
Many individuals engage in self stimulatory behaviors to either calm or arouse themselves
These behaviors are looked at as negative or inappropriate by other neurotypical individuals
The relationship between those that need this input and those that observe it but do not need it do not support engagement
All I can Do is “Concentrate”
Peers may be Interested, but not Understand‌
Teaser… Moving into Motor Planning
“…that neurological process by which cognition defines motor action…” ●
Ayres 1985
Maintaining High Self Esteem
Difficulties in understanding the environment will affect higher levels of motor planning
The child has the choice of showing frustration, or withdrawing
Other children may express activities are too babyish, ‘stupid’ and refuse to complete them
Child may keep from participating in group/team activities
Remember… it is a Family Affair…
Suggested Readings
Delaney, T. The Sensory Processing Disorder Answer Boook. Naperville, Ill: Sourcebooks, Inc, 2008
Greenspan, S., Greenspan, N. The Learning Tree. Cambridge, MA: Da Capo Press, 2010
Miller, L.J. with Doris A. Fuller. Sensational Kids. New York, NY: Perigee Book, 2006
ICDL Diagnostic Manual
ICDL Clinical Practice Guidelines
Goals for the Presentation
On viewing video, identify strengths and constrictions within FEDM 1 and 2
Describe strategies to support FEDM 1 and 2
Describe regulatory-sensory processing capacities (DMIC Axis III)
Identify and describe a child’s sensory profile and how it supports or hinders a child’s development
Describe the role of affect in understanding and working with a child with regulatory and sensory processing concerns.
*Provide in-depth discussion of Regulatory-Sensory Processing Disorders (DMIC Axis I) * For DIR C
Outline of the Presentation
Review of Axis III – Regulatory Sensory Processing Capacities
Sensory Processing Development as a Continuum
Importance of Sensory Processing/ Integration Capacities
Development of Modulation
Identifying a Child’s Sensory Profile ◦ Supports development ◦ Hinders development
Identifying early markers of sensory processing development
Identifying difficulties/ patterns of difficulty in sensory processing capacities
Discussion of how these difficulties affect development of Functional Developmental Levels
Role of affect in our work with children with SPD