Chapter 20: Sensory Integration

1. How did A. Jean Ayres use the term sensory integration?

o Ayres used the term sensory integration to refer not only to intricate synaptic connections within the brain,
but also to neuroal processes as they relate to functional behavior. hence, her definition of sensory
integration is “organization of sensation for use” 

2. Describe how sensory integration plays a role in typical development.  

o Provide specific examples of behaviors seen in infancy and early childhood
o Explain how they relate to the development of sensory integration
o Discuss how they support the child’s expanding ability to participate in increasingly more complex
occupations.

3. Identify the four main types of sensory integration problems. Describe some of the ways that each can influence
daily function.

Sensory Discrimination and Perception Problems: 

 Discrimination: Brains ability to distinguish between different sensory stimuli ex. Two points touch on skin
simultaneously
 Perception: Brain's process of giving meaning to sensory information
 Reactivity problems often coexist with perceptual problems - child who has registration problems may have limited
perceptual skills owing lack of experience interacting with sensory information
 Difficulty interpreting the location, intensity, 3D properties, or direction of movement of tactile stimuli precisely and
effectively
 Difficulty with localizing, stereognosis -- fine motor, may occur with visual perception and motor planning problems
 Problems with play, precise hand/finger movements, writing, using spoon, buttons Proprioceptive Perception
 Difficulty interpreting body position and the position and movement of muscles and joints
 Appears clumsy, awkward, excessive input, breaks toys, too much or too little force, relies on visual guidance or
cognitive strategies
 Participation in school and sports impacted Visual Perception
 Difficulty interpreting features of visual stimuli such as shape, size, direction, figure-ground despite adequate acuity
 Difficulty with visual perception, visual-spatial, visual construction, visual motor tasks
 May affect grasp, balance, locomotion
 Play may be limited ex. Puzzle, crafts, handwriting, Auditory Perception
 Difficulty discriminating and interpreting sounds but hearing not impaired
 Difficulty localizing, following directions, understanding conversations, focusing on sounds or words
 Difficulty with social play, sports, activities at home and school

Sensory Modulation Problems: 

 Refers to the tendency to generate responses that are appropriately graded in relation to incoming sensory stimuli,
rather than under-responding or over-responding to them
 Hyper-responsiveness – A sensory modulation condition in which the individual is disturbed by ordinary sensory
input and reacts to it defensively or fearfully, often with strong negative emotion, avoidance, and activation of the
sympathetic nervous system.
 Used interchangeably with the terms over-responsiveness and defensiveness.
 Hypo-responsiveness – A sensory modulation condition in which the individual tends to ignore or be relatively
unaffected by sensory stimuli to which most people respond.
 In some cases, the person may have an excessive craving for intense stimuli.. Used interchangeably with the term
under-responsiveness

Vestibular-Bilateral Functional Problems 

 Refer to pattern which includes difficulty with head and trunk control, vestibular-ocular functions, balance, bilateral
coordination
 Balance and equilibrium -- riding a bike, playing hopscotch Bilateral coordination -- cutting with scissors, buttoning
shirt Few or no signs of other sensory integration difficulties Table 20.3
 Problems in vestibular-bilateral integration
 Inefficient processing of vestibular sensory information needed for postural and ocular control, bilateral coordination,
midline integration, optimal muscle tone
 Disorganized tracking, poor balance, trouble with extensor position while prone, frequent tripping, avoidance of
reaching across body, difficulty leaning to grasp object
 Difficulty participation in sports, dance, social, pedaling bike, tying shoes

Praxis Problems
 Praxis: ability to conceptualize, plan, execute a nonhabitual motor act
 Dyspraxia: refers to condition characterized by difficulty with motor planning that emerges in early childhood and
cannot be explained by medical diagnosis, developmental disability, environmental constraint
 Somatopraxis: aspect of praxis that is sensory integrative in origin and grounded in somatosensory processing
Somatodyspraxia: SI deficit that involves poor praxis and impaired tactile and proprioceptive process
o Appear clumsy, awkward, difficulty transitioning from one body position to another
o Difficulty imitating, unintentially knocking stuff down, poor oral praxis affects eating and speech
Visuodyspraxia: visual perception and visually directed praxis difficulties
 Ideation: children with dyspraxia have difficulty generating ideas for what to do in a novel situation or when
presented with unfamiliar toys -- pat or push toys around
o Difficulty planning and performing new sequence of movements to achieve goal or how to move in new way
o Difficulty learning new motor skills or new ways to play with toy
o Difficulty learning to dress, imitate other, poor timing, sequencing, trouble manipulating, drawing, building
o Limited participation  
 Chapter 30: Autism Spectrum Disorder

1. Describe specific play deficits common in children with ASD and how performance patterns may be affected by
ASD.
2. List and describe 5 standardized assessments that might be used with a child with ASD
3. Describe 3 of the most common interventions designed for children with ASD.
 Chapter 21: Behavioral Interventions

1. What are some reasons for behavioral problems in children and adolescents?

 Many challenging behaviors are reactive and the person performing the behavior usually does not have insight
into the motivation for or purpose of the behavior
 Uncovering the purpose is accomplished by analyzing the antecedent and consequent variables surrounding the
behavior and determining which are connected to the behavior in a manner that strengthens or sustains it

2. How might an occupational therapy practitioner set up an intervention to prevent behavioral problems in
children and adolescents?

The principles and strategies to reduce challenging behaviors include:

 Reinforcement
o Those behaviors which produce results the child finds pleasurable are strengthened and likely to occur
again, while behaviors that lead to unpleasant result our weekend and are less likely to occur again.
o Approaches to reduce challenging behaviors address the underlying causes for the behavior
o Environmental modifications may remove antecedents and result in fewer challenging behaviors
 Positive Reinforcement
o For appropriate behaviors can support development of desired behaviors
o Teaching new skills, modifying contextual factors to support positive behaviors, and intentionally
managing consequences may improve a child's behavioral competence
 Antecedent Intervention
o Are those stimuli that occur prior to behavior and that elicits or trigger the behavior occurrence
o Identifying the antecedents to a behavior helps explain what causes the behavior
o some common antecedent are contextual, including a person, room, visual stimulus, or sound
o other common antecedents are cognitive, motor, cognitive, communicative, or social performance
demands
 Consequences Intervention
o Are those events that occur flat following a behavior in that result in strengthening or maintaining the
behavior

3. What are some behavioral management techniques that may help practitioners and parents support children
and adolescents?

 Positive Behavioral Intervention and Supports(PBIS)

o Initially known as positive behavior support, (PBS)
o PBIS is an approach to managing the behavior of individuals and groups that involve incorporating
principles applied behavior analysis via antecedent approaches
o The primary strategies involve environmental modifications to remove or reduce behavior triggers
 PBIS framework includes 3 tiers of support
o Tier 1-includes school- wide strategies for all students
o Tier 2-This is current occurrences of challenging behaviors for at risk students
o Tier 3-individualized interventions to decrease intense problematic behaviors
4. What are some strategies occupational therapy practitioners can use to prevent behavioral problems in
children and adolescents?

Functional Behavior Assessment (FBA)

 An FBA provides insight into the specific reasons for in variables affecting the child's behavior
 is a systematic process designed to identify the variables in the A- B- C relationship So that they can be analyzed
to determine which are triggering and maintaining a target behavior
 occupational therapists should be part of the FBA process when they have personal knowledge of the child or
adolescent and direct experience with the target behavior Occupational therapists can participate in this process by
contributing their observations of behavior in its relationship to occupational performance and contextual factors
for the individual child
 OT can contribute their observations of the behavior in its relationship to occupational performance and
contextual factors surrounding the individual child
 in addition to external factors, OTs consider internal factors such as physiological arousal, sensory processing
patterns, temperament, volition, and emotional state
 OTs appreciation for the role of sensory processing and sensory integration as factors that influence behaviors are
based on their understanding of the neurophysiological mechanisms involved in processing and integrating
sensation, which have a direct effect on arousal, and which in turn affect behavior
 In behavioral terminology this relationship functions as a setting event. addressing a child sensory need can be a
key part of a program to prevent challenging behaviors
 Behavioral approaches allow occupational therapists and team members to understand a child behavior so that the
team can consistently promote positive behaviors
 understanding the causes of challenging behaviors may help adults avoid introducing unpleasant stimuli or
situations that trigger challenging behaviors and can help support children and adolescents in learning more
effective strategies for communicating their needs
 positive behavior supports a child's participation in everyday occupations including productive engagement in
school, at home, with peers, and in community activities
 Provides insight into the specific reasons for and variables affecting the child's behavior
 FBA involves 5 steps:
o team building and goal setting
o Functional assessment of the behavior
o Hypothesis formulation you line development of the comprehensive support plan
o Implementation and outcome monitoring of the plan including refining the plan as needed