Making Sense of How Sensory Processing Difficulties are Addressed in the Early Intervention System

by Anna Lassman

Sensory Processing and Sensory Integration are hot topics these days, particularly with children who have been identified as being on the autistic spectrum. Sensory issues can also affect kids with motor impairments. Families are often faced with many new and sometimes confusing concepts and terms. I hope to clarify some of the confusion.

Our senses play a big role in how we learn, interpret, adapt and cope within our environment. We take in all the information through our senses into our brain. Sensory Integration is the process by which we take information through our senses. The brain then processes that information and helps us determine how to respond. The responses are behavioral reactions that take the form of learning, inhibition, coping, and adapting. Sensory Processing is simply another term for Sensory Integration.

Our brain acts as a processing plant, finding what is important to pay attention to, what is something we need to ignore, and then planning how we respond. In an educational setting the goal is for kids to be calm, alert, focused, so that they can attend, refine their functional skills and learn.

Other terms relating to sensory processing include: tactile (perception of touch); proprioception (“sense of self” understanding how your body is positioned in space); vestibular (perception of movement in space).

Children with sensory processing difficulties seem to have perceived the information in a different way, and / or the inability to make sense of it. They are unable to adapt their response or have limited coping mechanisms Often the result is to underreact or overreact. For example, a child who has a hard time in a busy, noisy store may either hide, or begin to tantrum. They are unable to filter through the stimulation they are being exposed to. Often they either have a delayed or slow reaction and because of this low reactivity, they may “shut down” or avoid. In other cases, they may have an extreme reaction because of hyper sensitivity.

The most common approaches are described below:

Sensory Integration Treatment Approach – is individual OT treatment that involves a specialized setting with suspension equipment. The program is designed to improve the efficiency of the nervous system in how the use of the sensory system is interpreted for functional use through a child centered approach. The evaluation process requires a Sensory Integration certified therapist to administer.

Neurodevelopmental intervention (NDT)- is an ever evolving approach to enhancing overall motor function of individuals who have difficulty controlling their movement as a result of central nervous system deficits. This theory, as most others do, has evolved as our understanding of the brain and how motor learning works evolves. The focus is on improving motor control and motor output to improve functional skills.

Many children with motor impairments (such as cerebral palsy) do not have the opportunity to learn about themselves and their world through movement. They may develop atypical patterns of movement against gravity, and don’t get to experience body exploration, tactile, proprioceptive and vestibular inputs the way typically developing children do. A good understanding of how our bodies work to move in different ways are important for effective motor planning and use of both sides of our body in a cooperative way. These are important for learning new skills for both the gross motor and fine motor areas, as well as for functional tasks (for example: self-care areas).

Both neurodevelopmental treatment and sensory integration rely heavily on the use of tactile, vestibular and proprioceptive stimulation in accomplishing their specific goals. In the educational model, the approach most often utilized is a sensorimotor approach in both direct services as well as in consultation with class team and family.

Sensorimotor– refers to a broad spectrum of both sensory and motor difficulties, combining both sensory integrative theory and neurodevelopmental theories.

Occupational Therapists tend to have different focus of therapy depending on what model of service they are working in. A model of service helps guide the OT in developing goals and plan for therapy. As Sensory Integration intervention requires special certification for the evaluation process, and a specialized clinic, it is considered a medical model of service. The medical model focuses on rehabilitation or remediation in a clinic (private office, hospital, outpatient center) setting. The focus in an educational model of service is educational access/ adaptation/ compensatory strategies for greater success for learning needs within their educational setting.

In the book Autism, a Sensorimotor Approach to Management, consultative model is defined as: “helping the family understand their child’s behaviors and how it relates to sensory processing; helping the teacher and the family modify the environment so that it matches the child’s sensory needs; helping the child organize responses to sensory input”.

So what does sensorimotor therapy in an early intervention educational model look like? It may differ if the child is seen in a center based special education setting or a community based pre-school, head start or early learning center or daycare. Most Early Intervention center based programs have access to a room with some suspension equipment which gives the opportunity to explore more sensory integrative and neurodevelopmental strategies during direct service.

Out in the community, therapy can be limited by whatever equipment the therapist can carry as it relates to sensorimotor strategies; and if he/she has the room to use more motor based activities. These factors will usually drive the session. More often the role of the therapist in the community is consultative; helping to find toys, equipment/, and movement activities that can be incorporated into the daily class routine to help the child improve his/her attention and task focus so they can get the most out of their learning experience. The consultation is ongoing and meets the child’s ever changing needs. Often the therapist will leave a number of sensorimotor activity ideas with the class team for options for arousal or calming to maximize task focus and learning.

Acknowledgements:

Dr. A. Jean Ayres – researcher and founder of Sensory Integration Theory

Winnie Dunn, PhD, OTR, FAOTA- researcher in the area of sensory processing and creator of the Sensory Profile Questionnaire

Ruth A. Huebner, PhD, OTR- editor of Autism, a Sensorimotor Approach to Management

Colleen Schneck, ScD, OTR/l, FAOTA – contributor to Autism, a Sensorimotor Approach to Management

Anna Lassman has been an OT for 35 years, working in a variety of pediatric settings in New York, California and, for the past 18 yrs, in Pennsylvania. She has been with Easter Seals in the Philadelphia Division as the OT department head for 7 years. She has special interests working with infants and young children with feeding difficulties as well as working with children with neurological impairment. Her favorite aspect of her current job is the ability to mentor new practicing OT’s as they begin their career in the field. Anna loves the ocean and misses easy beach access, but loves the Philadelphia area.

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