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

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 childs 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

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

Multiple forces (genetic factors, environmental influences, family factors, cultural values, educational experience, physical health, influence of peers, temperament/emotional factors) determine a childs neurodevelopmental profile.

Master Observer: S. Greenspan

S. Greenspan In discussing areas that influence the childs 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 childs 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./Floortime & Sensory Processing Models

MC, EdD, OTR/L 2009

Logical & Abstract Thinking Symbolic and Creative Use of Ideas Complex Presymbolic , shared social communicati on Two Way Communicat ion Engagement Tactile Ideation,

Cognitive

Emotions

Language

Motor Planning

& Execution

Proprioceptiv e Taste Vision

Vestibular

Smell

Auditory

Shared Attention & Regulation

Muscle Tone & Muscle Strength

Range of Motion

Primitive Reflexes

Protective Reactions

Balance & Equilibrium Modulation

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 systems 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?

A disorder is identified when a behavior interferes with the age expected performance of the individual 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, SelfAbsorbed

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 childs 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 Childs 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 overreact 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 childs sensory profile and how it supports or hinders a childs 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-

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 Childs 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