To find sensory integration
practice in
your area, look in your online yellow pages for occupational
therapy,
find the
ones who work with children, and then call and find out if they
use
sensory integration theory in their practice. Have them explain
a
little of what they do, since that can mean totally different
things to
different people. To study up a little on the terminology, look
at
Sensory 101.
WPS
used to maintain a list
of therapists who completed SIPT training through them, but I
can't
find it now. OTs who have completed this program are known as
"Certified
in Sensory Integration," and "SIPT certified," because part of
the
training is in the administration and interpretation of the
Sensory
Integration and Praxis Test or
SIPT.
Not
every therapist who has completed this certification is listed,
however. And many therapists who are very active in using
sensory
integration therapy have not completed this certification.
In the Richmond, Virginia area I have had experience with the
sensory
integration practices at Geri Allen's Integrated
Therapy Services (Geri Allen passed away, sadly, and this clinic
is
closed). Therapists from Integrated Therapy Services
have started two different clinics,
Spot On Therapy
and
Tree
House Pediatric Therapy. Between them they currently have
at least
three OT's who are
SIPT-certified
working there. I know there
are other local practices
that do
some amount of SI therapy, but those are the two big ones that I
know
of near me. When I lived in California, I worked for Fourt
Therapy Center (now
Play Steps, as Barbara
partiall
retired) and can very highly recommend them. I learned a LOT
from
Barbara Fourt. There are several other
well-reputed clinics in that area who work with children with
sensory
integration difficulties.
Sensory
Integration
International
(SII),
aka The Ayres Clinic, is now kaput. There is no central
"ownership" of
Sensory Integration, and things seem to be going through a
new
organization of sorts. Stay tuned.
The Sensory Processing
Disorder
Foundation is
a project of the nonprofit
organization KID Foundation in Littleton, Colorado. It is
designed to
serve as a resource to parents of children with sensory
processing
difficulties, which they term "sensory processing disorder
(SPD)."
There is a Parent Connection, a Resource Directory, and
articles on
sensory integration and processing. http://www.spdfoundation.net/
The SI
Network is in UK/Ireland.
The Alert Program is
a
program that was designed by two occupational therapists for
OTs,
teachers, and parents to use in working with children. It
can be
adapted to use with children of a wide age range, but is
ideally suited
for children who function at about a typical seven to
thirteen-year old
level, in my experience. The program, outlined in the
guidebook How
Does
Your Engine Run? uses the
analogy of a car engine to explore the concepts of levels of
alertness
and how each person can use sensory strategies to change
their own
levels for different tasks. I often loan the Introductory
Booklet
(the first chapter of the guide book; can be purchased
separately)
to
parents and teachers as a great explanation of one way of
looking at
sensory processing and how it can affect children's daily
lives. There
is also a book of activities that incorporate sensory
strategies,
mostly for Kindergarten through second grade classrooms,
called Take Five.
http://www.alertprogram.com/
The
Zones of Regulation program takes some of the Alert
Program approaches, and adds in some concepts from Social
Thinking and from The Incredible 5 Point
Scale. So it adds in Executive Function/ cognitive
therapy ideas as well as emotional regulation ideas to the
sensory processing ideas. I have been using it over the last
couple of years and I like it especially with the very
concrete children who reject an engine concept.
Professional
Development Programs sponsors what they term "cutting
edge" courses
in the area of sensory integration. I have attended several.
Anything
that is "cutting edge" is by definition not yet
well-researched and
well-established, right? In other words, I would advise you to
take
what you learn at these courses with a grain of salt. I do
think that
they share some information that is very useful at many of the
courses,
but at one I attended several years ago they were still
touting that
autism
is linked to vaccines and has to do with heavy metal build-up
in the
body. I find this irresponsible and dangerous ground and do
not feel
comfortable with occupational therapists who advise on
treatments to
move heavy metals about in children's bodies.
I have also attended courses that taught how to use
Therapeutic
Listening® from Vital Links. This
is a program which uses Vital Links' own proprietary compact
discs of
music as well as cd's from other sources for "therapeutic use
of
sound." I have helped set up families to use this
program, and
again I would say to take it with a grain of salt, but I
believe that
music can have some very dramatic effects on children ~ if
nothing
else, it can be very focusing! There are a bunch of other
listening therapies, but I haven't done any training or
reading up on them. These don't get used much in school-based
OT.
Here
is a
link to the website of an OT who uses many modalities
in her
treatment
and has written several books. She bases all of her
"information" on
her own experiences in treatment, and seems to sort of disdain
actual
research, but I like her accessible and seemingly sensible
discussions
of sensory processing topics, and I haven't found information
that I
entirely disagree with (so much grey area!). http://asensorylife.com/
Sensory
Evaluation Tools
Sensory processing is not something that can be directly
measured,
since it is a purely subjective area. We cannot see how things
appear
to another person, or hear how different noises sound. Children
often
lack the vocabulary and the point of reference to describe how
they are
experiencing the world. Therefore, we are limited to observing
responses to different sensations and looking for evidence of
difficulty making good use of sensory input. For example, if a
child
has a hard time standing on one foot, we can theorize that they
may not
be integrating their sense of gravity's pull, or of their
awareness of
their own position in space, or both. We can then further
investigate
similar areas through other observed activities and assemble a
picture
of ability and difficulty, "detective-style." There are very few
standardized or normative tests that assess sensory integration
or
processing:
The Sensory Integration and Praxis Test (SIPT) is a
standardized
battery of tests to get an in-depth look at various aspects of
sensory
processing in order to assess sensory integration dysfunction.
It can
be used on children four 8 years, 11 months of age. It takes
several
hours to administer the whole test and requires extensive and
expensive
training to learn to administer it. Therapists who complete this
training (through Western Psychological Services) are certified
and
listed in a database. Because of the commitment required to
become
certified, it can be difficult to find a therapist in your area
who is
trained to administer this test. Some therapists use subtests
from this
tool (or from its precursor, the Southern California Test of
Sensory
Integration) as informal tools to look at specific aspects of
sensory
processing such as motor planning or bilateral integration in
motor
skills.
The
Sensory
Profile is a standardized tool for measuring sensory
abilities and
the effect those abilities have on functional performance in
children
three to ten. It is a judgment-based questionnaire that
evaluates
how a child responds to visual, auditory, touch, taste,
movement, and
multi sensory stimuli. A classification system based on means is
used
to rate the child’s responses in comparison to a normative
sample of
children. It is helpful in determining whether there is a strong
pattern of over- or under-responsiveness to sensory input in
general,
as well as in which areas those atypical responses are most
often seen.
There is also a
School
Companion
Sensory Profile which is usually given to teachers; it
doesn't include a lot of the questions that would be seen at
home but
not at school ("exhibits distress during grooming," for
example).
Now there is also an Adult/Adolescent Sensory Profile, which I
sometimes use interview-style with young teens or pre-teens to
assess
their awareness and perception of their own sensory preferences,
as
well as an Infant/Toddler Sensory Profile.
Many therapists prefer the
Sensory
Processing Measure. This comes with various questionnaires
for different environments, from classroom to PE class to the
bus. They
are meant to be used to compare and contrast to do the detective
work
of sensory assessment.
The
Test
of Sensory Functions in Infants was developed by early
childhood specialists Georgia DeGangi, PhD, OTR and Dr. Stanley
Greenspan, (well known for his approach in working with children
called
DIR,
commonly
often called "floor time"). It assesses five areas
of sensory function (reactivity to tactile deep pressure,
adaptive
motor functions, visual-tactile integration, ocular-motor
control, and
reactivity to vestibular stimulation) in children from four to
eighteen
months of age. Each item is scored via a numerical rating scale
and
results in "normal," "at risk," or "deficient" scores (an older
test
with not-so sensitive terms).
In addition, therapists often use standardized motor skills
tests such
as the Peabody Developmental Motor Scales, 2nd ed. (PDMS-2), for
children birth to six years of age, or the Bruininks-Oseretsky
Test of
Motor Performance (TMP-2). I have used the
M-FUN
by
Lucy Jane Miller (ages 2-8 roughly).
Often, therapists will use informal assessment methods to
investigate
sensory processing and integration. These can include structured
observations, such as asking a child to try to imitate
positions, hand
placements, or gestures without looking at their own body. Or
watching
a child navigate an unfamiliar obstacle course while noting how
quickly
and adeptly he is able to move himself under/over/through the
equipment. Both of these observations would assess motor
planning, and
both would require familiarity with typical development of motor
skills
for comparison. As a guide to assessing sensory integration
through
observation, A. Jean Ayres published a form called "Clinical
Observation of Sensory Integration" in 1975. It includes such
observations as eye movements across body midline, holding of
trunk
flexion and extension against gravity, and the presence or
absence of
tonic neck reflexes. More recently, Winnie Dunn, M.Ed.,
OTR
incorporated some of these observations and used a normative
population
of 263 children to come up with some broad guidelines for
Kindergarten-aged children, published as A Guide to Testing
Clinical
Observations in Kindergarteners. Pretty sure all such things are
out of
print, but still useful if you've got a copy!
Other observations could include directly observing responses to
typically non-aversive sensations. For example, if a child
covers her
ears when the bathroom fan goes on, comments on the ticking of a
quiet
clock, seems afraid of a fuzzy stuffed animal, or strongly
avoids
letting his feet come off the ground while sitting on a swing, a
therapist would note that and look for patterns.
Last but not least, an interview with caregivers and/or teachers
about
their observations, concerns, and reports of typical behaviors
and
abilities can be an important piece of the puzzle. No one knows
a child
better than the people who spend every day with her. This is
usually
where I
start my whole
assessment process, not an afterthought. Asking the right
questions and
just
listening can save
a
therapist lots of time as she gathers information and helps with
the
detective work of assessing sensory processing.
Books
(see
below
for books specific to oral
motor work)
Speaking of books, I LOVE Oh
Behave! and recommend it to
teachers all the
time. It is a booklet that summarizes/reviews the basics of
behavioral
management in a classroom (or with your own children) and
then talks
about when and how you can tell if behavior is due to
sensory issues or
not. There are guides and worksheets for the
"detective work" of
identifying the triggers and reasons for a particular
behavior and then
assistance to what to do about it once you've figured it
out. It
answers questions like, "how do I offer sensory strategies
without
rewarding the negative behavior." Unfortunately, this
booklet only
comes in packs of 10 (for about $45 per pack). You may
find, as I
do, that you can easily find 9 other people who you think
could benefit
from it! It is only available at Pearson
Assessments/PsychCorp (along with lots of other
interesting
sounding books that I haven't read).
Sensory
Integration
and the Child by
A. Jean Ayres. This is the classic explanation of SI for the
layperson
by the mama of sensory integration herself. Clearly written.
Doesn't
offer any do-it-yourself strategies to speak of, it aims at
explaining
clinic-based SI therapy.
Link to book at
The Out of Sync Child
by Carol Kranowitz
is a
popular-press
book that introduces sensory integration and sensory
processing
disorder to the lay person. It is an easy read that uses
lots of "case
studies" as examples of what sensory processing disorder can
look like.
It does tend to use somewhat extreme examples and presents
things in
black and white rather than getting into the complex
interplay of
sensory processing, mood, personality, other reasons for
behavior, family dynamics etc. etc. The
follow-up book, Th
e
Out of Sync Child Has Fun,
is
full of activities for children with
sensory processing problems. Available in many
bookstores and at
amazon.
I actually like Raising
A
Sensory Smart Child, by an O.T. and a mother of a
child with SPD,
better than The Out of Sync Child. It does more to
explain each of the
sensory systems and how therapists might work on them.
It also has lots
of practical methods for dealing with picky eaters,
behavior, speech
problems, sensory sensitivites to clothing, advocating
for sensory
needs in school, organization problems, etc. etc. Here
also is the
author's nifty website:
https://www.sensorysmarts.com/
Too Loud, Too
Bright, Too Fast, Too Tight: What to Do If You Are Sensory
Defensive in
an Overstimulating World
by Sharon Heller. A book by a college professor about her own
experiences with difficulties modulating responses to sensory
stimuli.
I haven't read this one myself yet, but it looks interesting!
There are a few other books and some videos, including a video
of
The
Out
of Sync Child (apparently not available on DVD), but I
haven't
watched any of them myself. Try some
of the catalogs listed below or the links above. I have read
Sensory Secrets: How to Jump-Start
Learning in Children by Catherine Schneider. I didn't
feel that
it added anything not already found in the above books, and went
beyond
what is actually pretty well-established theory in the field, so
I
can't
recommend it.
Sources
for
Sensory
Materials and Tools
Southpaw
catalog has lots of large items for use in making up a
sensory gym
(clinic-based OTs often order from them), as well as many
smaller items
for home use.
www.southpawenterprises.com
Integrations
and
Abilitationsare
two catalogs under the School Specialty family of catalogs
that
are have many items for sensory needs. They have fantastic
pieces of
furniture and items to set up a
sensory
room. This stuff is expensive but it is soooo cool. I
have gotten
to visit a sensory area that was set up using these items at
a school
for special needs children in Toronto. It definitely makes
you want to
stay for a while and play! Two items: 1) in the
interest of full
disclosure, Abilitations sells an
item that I invented and that I get royalties from. 2) the
online
catalogs from this company are kind of awkward to use. For
example the
search engines are pretty poor at finding things unless you
have the
exact title, and
it's kind of hard to navigate through to just what you want.
The paper
catalogs are much more fun and easy to look at, though of
course they
eat up trees!
Fun
and Function
is a newer seller of similar items, with less selection but
sometimes
cheaper. I can't speak for their products, haven't seen many
in person.
I don't like that they give misinformation in their blog
(recently
noticed that they touted putting weighted items on low-tone
children to
normalize their tone. Um.... no.)
Acheivement
Products is another source of neat things.
For
oral motor and
oral
desensitization tools,
Professional
Development
Programs
is the place! Their catalog has
ZILLIONS of oral motor tools (whistles, straws, vibrating
things, more
than you could imagine!) as well as various tactile sensory
tools.
www.pdppro.com
Besides sponsoring courses (see above), they have
published an oral issues book for therapists who are
addressing mouth
issues as part of a therapy program (and now a DVD of the
course)
called
M.O.R.E.: Integrating the Mouth With
Sensory and Postural Functions.
Some kids just need to chew
for a period. These are the kids with wet sleeves,
neck
ribbings and hoodie strings, or mangled pencils. I knew
a 1st grader
who "ate" several wooden
rulers before his
teacher figured out where they had gone. Working on
finding more
appropriate sensory outlets/inputs for those kids is
important, but
part of that may be better things
to
chew. PDP, above, has some of these as does
Abilitations,
above. I like best the ones that
look like a
normal piece of jewelry
a pen
lanyard,
or just a tube on a pencil -- a
piece of
medical tubing cut and stuck over the eraser end.

Also,
there is a book called
Just Take
A Bite:
Easy, Effective Answers to Food Aversions and Eating
Challenges
by Lori Ernsperger, Ph.D. and Tania Stegen-Hanson,
OTR/L,(Foreword
by
Temple Grandin ). It purports to have non-confrontational
methods to
work with kids who are picky eaters for whatever reason!
Available at
Amazon.
Movin'sit
cushions (scroll down my list) -- these are
inflatable
wedge-shaped seat cushions that
allow the child who can't sit still to stay in his seat
while getting
the movement he craves. Also promotes good seated posture.
Comes in 2
sizes. Similar but round cushions are called Disc
o'Sits.
Soft Clothing has
socks and clothes for people
with
issues of sensitivity
to such things.
Fidget
toys are little items of any
description that keep hands busy so that kids can stay in their
seats,
wait their turns, keep from blurting out, and listen for longer
than
usual. Different fidget items work for different children; some
can't
have anything in their hands without it commanding their full
attention
(or becoming a projectile), while other children can be
completing a
complex puzzle while actually listening to everything that is
being
said. It's best to experiment with a variety of objects of
different tactile qualities and levels of complexity, and you
WILL need
to teach the difference between a fidget item and a toy. My
approach is to ask for 15 minutes and teach the whole class
about fidgets, the rules of fidgets, what "interesting" means
and that toys are interesting for your eyes and brain, while
fidgets are not. I tell
children, "if it's really fun, then it isn't a good fidget for
you!" Then I leave a basket for the whole class to try out for a
week or 2. In this way I teach the teacher at the same time as
the students, and after a week or so when the novelty wears off,
only the students who need the fidgets will still be using them.
And the teacher can make observations about which ones work best
for the target student(s).
pdppro.com
has a wide assortment. You can also check out
Office
Playground for a wide variety, but not designed for kids
necessarily. Be warned they will send weekly
emails if you purchase from them.