Running Head: SP IN CLASSROOM

The Effectiveness of Sensory Processing Intervention in Improving Classroom Occupational

Performance for School Aged Children in the Fourth Grade

Angie Blaser, Kayla Burton, Jilianne Normandy, & Lindsey Ward

University of Utah
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The Effectiveness of Sensory Processing Intervention in Improving Classroom Occupational

Performance for School Aged Children in the Fourth Grade

In order to interact with the environment, one must first make sense of the environment.

Each individual notices and responds to sensory stimuli with varying levels of sensitivities and

optimal thresholds. Sensory processing refers to the ability to receive and utilize sensory

information for functional performance within the environment. When an individual is unable to

perceive or discriminate sensory input, sensory processing dysfunction exists. When sensory

processing deficits are severe, sensory processing intervention (SPI) is commonly implemented

by pediatric occupational therapists (Anzalone & Lane, 2012; Dunn, 2007). Although sensory

processing is a component of our daily lives, little research supports the usefulness of SPI within

the general population. Currently, only significant evidence supporting SPI exists for children

with a specific diagnosis, such as fetal alcohol syndrome disorder (FASD) and autism spectrum

disorder (ASD) (Bagatell, Mirigliani, Patterson, Reyes & Test, 2010; Jirikowic, Olson, & Kartin,

2008). Further research is needed to support how SPI can benefit typically developing children

within the classroom.

Background

Sensory processing

Winnie Dunn hypothesized that sensory processing is the interaction between an

individual’s nervous system and their self-regulation. Through research targeting the lifespan of

individuals with and without disabilities, four patterns of sensory processing have been found.

The four patterns of sensory processing are sensation seeking, sensation avoiding, sensory

sensitivity, and low registration. Self-regulation is based on a continuum of an individual’s ability

to control their own emotions, behaviors, or thoughts and adapt them appropriately to a specific

situation. Research has found that individuals with disabilities typically demonstrate more

distinctive and more intense sensory processing behaviors than those without a disability (Dunn,

2007).
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Individuals that are sensation seeking have a high threshold, and actively seeks out

sensations in everyday life. Individuals that are sensation seeking, typically seek and construct

additional sensory experiences within their environment to meet their sensory needs. An

example of sensation seeking would be when someone is seeking tactile input, they actively

touch everything within their environment. Individuals that are sensation avoiding have a low

threshold, meaning that very little input is needed to meet their threshold and they will actively

withdraw from sensory input. Lastly, an example of sensation avoiding, is a child leaving the

classroom to avoid the classroom noise level (Dunn, 2007).

Individuals with sensory sensitivity have a low threshold and tend to notice multiple

things within the environment; however, these individuals stay within the environment rather

than withdraw from the sensory input. An example of a passive approach for sensory sensitivity

is when the child stays in the classroom and covers their ears. Low registration is when an

individual has a high threshold, this means that they have a difficult time noticing objects within

their surroundings and seeing what others typically see. An example is when a child is oblivious

to a classroom discussion until the teacher physically places a hand on their shoulder to obtain

their attention (Dunn, 2007).

Dunn (2007) stated that everyone, from infancy to adulthood, has specific ways of

responding to sensory input and events in everyday life. When people are able to comprehend

their own sensory processing patterns, they can enhance their participation in everyday life by

creating consistent life routines that correspond with their sensory processing patterns in natural

environments. Research has confirmed the validity and reliability of the four patterns of sensory

processing through use of the Infant/Toddler Sensory Profile, the Sensory Profile, and the

Adolescent/Adult Sensory Profile for people with and without disabilities across the lifespan

(Dunn, 2007). Lastly, replications of SPI highlight the importance of matching sensory needs for

effective intervention outcomes (Ashburner, Ziviani, & Rodger, 2008; Bagatell et al., 2010; Hall

& Case-Smith, 2007; Yunus, Liu, Bissett, & Penkala, 2015).

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Most researched populations pertaining to sensory processing

Most of the current research addressing sensory processing difficulties has focused on

children who have various diagnoses such as autism spectrum disorder (ASD), attention-

deficit/hyperactivity disorder (ADHD), fetal alcohol syndrome disorder (FASD), and a few others.

Although research shows that these populations are at increased risk to fall behind in academic

performance due to lack of appropriate sensory stimulation (Koenig & Rudney, 2010), we also

see from research that there are others who experience difficulty processing sensory input who

do not meet the criteria for a diagnosis (Yunus et al., 2015). Sensory dysregulation and atypical

sensory responses have a significant negative influence on classroom performance (Ashburner,

Ziviani, & Rodger, 2008). Addressing these concerns by offering SPI may reduce the impact of

the many distractions or various sensory stimuli that can arise in an academic setting. Studies

that utilized SPI for these populations have found improvements in classroom related behaviors.

Outcomes of this intervention include a decrease in self-stimulating and off task behavior (Case-

Smith, Weaver, & Fristad, 2014; Kercood, Grskovic, Lee, & Emmert, 2007) and an increase in

attention, participation, sensory, and emotional processing (Hall & Case-Smith, 2007). This

increase of positive in-class behaviors also improved the children’s social participation and

performance (Yunus et al., 2015).

Other populations

Limited research has been conducted on individuals without disabilities and their

sensory processing. The research that has been done specific to children without disabilities is

outdated (Dunn & Westman, 1997) and limited. Most research compares sensory processing

between children with and without ASD. Research has found that although children with

disabilities tend to have more sensory impairment as compared to typically developing children,

sensory processing deficits can still exist within typically developing children (Johansen, Miller,

& Maddox, Cunningham, 2016). Low registration and sensory seeking behaviors have been

found common in very premature infants within the newborn intensive care unit (NICU). Most of
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the infants in the NICU showed increased sensory processing patterns in one or more

quadrants, the most common sensory pattern impacting their sleep, and therefore development,

was sensory sensitivity (Crozier et al., 2016; Vasak, Williamson, Garden, & Zwicker, 2015).

Sensory processing has been found to significantly impact a child’s social skills and problem

behaviors for children living within low socioeconomic statuses (Rybski, 2015). Overall, these

findings suggest that occupational therapists should address sensory processing needs within

all child populations in order to promote social participation and occupational performance

(Armstrong, 2013; Crozier et al., 2016; Johansen et al., 2016; Rybski, 2015; Vasak et al., 2015).

Objective

The purpose of this study is to increase the research evidence within the area of SPI.

More specifically, this research proposal strives to answer the question as to whether or not SPI

is effective in improving classroom occupational performance for school aged children in the

fourth grade (ages 9-11). We hypothesize that SPI will improve classroom performance, this will

be demonstrated through improved scores on the School Function Assessment and Woodcock

Johnson IV Tests of Achievement, for all children due to the variety and individual processing

abilities and needs regardless of diagnosis. We will also be utilizing the Short Sensory Profile to

inform the intervention as a client centered approach to meet the children’s individual sensory

needs. This research study will help contribute to the research of SPI and its use for typically

developing children in improving occupational performance. Contributing to the body of

evidence for occupation based interventions can promote advocacy for the field of occupational

therapy. By contributing to the research, this will also assist occupational therapists in providing

evidence based practice (American Occupational Therapy Association, 2014).

Methods

Study Design

A quasi-experimental design with mixed methods approach will be implemented using

exploratory research, examining the effectiveness of SPI in improving classroom occupational

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performance in typical children, which has not been studied well. We plan to explore the effects

of SPI in the general population, particularly in a typical classroom. Classrooms will be randomly

allocated to either the SPI group or to the control group. The Child’s Short Sensory Profile,

School Functional Assessment, and Woodcock Johnson IV Tests of Achievement will be utilized

to gather quantitative data. The Short Sensory Profile will be completed prior to intervention,

while the School Functional Assessment and Woodcock Johnson IV Tests of Achievement will

be completed to acquire pre-post data. Qualitative data will be collected through unstructured

interviews and feedback from parents and teachers with open-ended questions. The

independent variable is the in-class SPI, and the dependent variable is classroom occupational

performance.

Participants

Participants will include children that are currently attending the fourth grade within the

Salt Lake City School District. Other inclusion criteria will consist of the following: the school

must be established as a public school, and the children must have an established home room.

Exclusion criteria will consist of the following: children that are in extracurricular classes during

the time of the intervention (such as: P.E., band, etc.), and children that participate in all day

special education classrooms.

Recruitment of these participants will begin by proposing this research idea during

district, school, and teacher meetings. Sufficient information will be provided within these

settings as well as contact information for interested teachers to reach out in order to express

their willingness to participate in the research study. Other opportunities of recruitment include

communication with the school-based occupational therapists in the area and emails to the

fourth-grade teachers. Parents will also be given information in pamphlet/flyer format that

describes the research opportunity. All individuals that show interest and associated personals

will attend a meeting to discuss in-depth the purpose of the research as presented by the

researchers. Official commitment will be finalized by teachers filling out consent forms for
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researchers’ permission to access and intervene within the classroom and parents will complete

consent forms for their students to participate within the study.

Measures

Sensory processing subtypes will be determined through parental completion of the

Short Sensory Profile (SSP), a shortened version of the Sensory Profile (SP), to determine how

their child processes sensory information in everyday situations and allows the child and parent

to understand how sensory processing affects their functional performance (Dunn, 1999). The

SSP provides a 38-item questionnaire that addresses the individual's sensory processing,

modulation, and behavioral and emotional responses (Bundy, Shia, Qi, & Miller, 2007; Dunn,

1999; Gourley, Wind, Henninger, & Chinitz, 2013). More specifically, the SSP determines the

functional behaviors of a child’s sensory processing difficulties in the following seven domains:

tactile sensitivity, taste/smell sensitivity, movement sensitivity, under-responsive/sensation

seeking, auditory filtering, low energy/weak, and visual/auditory sensitivity (Gourley et al., 2013).

A 5-point Likert scale (always, frequently, occasionally, seldom, or never) is used to describe

the child’s behavior as a result of different sensory events. A child that is more adaptive to

functioning and typical performance is identified by higher scores on the SSP. Construct validity

has been established through rigorous evidence (Gourley et al., 2013).

The School Function Assessment (SFA) is used to measure a child’s performance of

functional tasks that support their participation in the academic and social aspects in elementary

school (grades K-6). The SFA uses a questionnaire completed by school professionals who

know the student well and have observed their typical performance on school-related tasks and

activities, specifically participation, task supports, and activity performance (Pearson Clinical,

2008). The SFA uses a 4-point Likert scale (does not/cannot perform, partial performance,

inconsistent performance, consistent performance) to describe the student's ability to perform a

specific task. A student that performs consistently through initiation and completion of activity

receives a higher score on the SFA. (Coster, Mancini, & Ludlow, 1999). The known-group
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method is used to evaluate the validity of different scores. The SFA scores can be interpreted

by grouping members of children with disabilities into their identified and predicted sections that

usually differ from each other in their capabilities in physical tasks and cognitive/behavioral

tasks. The SFA has been found to be valid as it effectively categorizes children into the

appropriate sensory quadrants (Davies, Soon, Young, & Clausen-Yamaki, 2010).

The Woodcock Johnson IV Tests of Achievement (WJ IV ACH) is individually

administered by therapeutic professionals. The standard battery of the WJ IV ACH will be used

to assess cognitive development and academic achievement in children to identify their

strengths and weaknesses. The standard battery consists of the following subtests: Brief

Achievement, Broad Achievement, Math Calculation Skills, Broad Written Language, Reading

Rate, Reading Comprehension, Basic Writing Skills, Mathematics, and Written Expression

(Schrank, Mather & McGrew, 2014). After the child has completed the paper test record booklet,

the age-equivalent, grade-equivalent, percentile ranks, relative proficiency index scores, W

scores, standard scores, and cognitive-academic language proficiency scores are all calculated

in an online program. A child that performs well within each subtest displays a higher score on

the WJ IV ACH. The multidimensional scaling (MDS) is used to provide a visual representation

of the similarities between individual cases and performance. Content validity is supported by

the Technical Manual through MDS analyses results (Schrank, Mather & McGrew, 2014).

Procedures

We will recruit teachers and gather permission from the children’s parents to conduct the

intervention across several classrooms within one district. The classrooms interested in

participating will be randomly allocated to the intervention or the control group; three classrooms

will be selected to receive the intervention and three classrooms will make up the control group.

Sensory processing intervention will entail the daily provision of various sensory objects and

environments (tactile, vestibular, auditory and visual) to be available to the students as a means

of modulating personal sensory needs within the classroom. This process will be implemented
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through collaboration between an occupational therapist, certified occupational therapy

assistant, and teacher aides for 12 weeks. The control group will participate in a typical

classroom that does not implement sensory processing intervention. There will be a pre-

intervention and post-intervention academic performance assessment for all participants in the

study.

Data Analysis

Quantitative data will be gathered and analyzed using both a paired t-test and

independent t-test, an ANOVA, and by evaluating the information collected from standardized

assessments of academic and classroom participation. These assessments will help us ensure

inter-rater reliability. We will conduct a statistical analysis using IBM SPSS statistics. Descriptive

statistics will include the SSP which will be implemented before the SPI. We will also use the

SFA and WJ IV ACH both prior and after the intervention to gather additional quantitative data.

The results from these will inform us of the differences between the pre/post data of those who

received treatment in comparison to the control group in sensory processing ability and

classroom occupational performance. Qualitative data including interviews with teachers on the

student’s overall performance will be compiled, transcribed, and coded to identify themes across

the available data. The analysis of the data will help us determine the effectiveness of offering a

sensory processing intervention to those who do not have a diagnosis.

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