Lilli Nielsen, Jan van Dijk, and Jean
Ayres - 3 Great Gurus and What I
Have Learned From Them
David Brown
Educational Specialist
California Deaf-Blind Services
San Francisco State University
The contents of this PowerPoint presentation were developed under a
grant from the US Department of Education, #H326C080009.
However, those contents do not necessarily represent the policy of
the US Department of Education, and you should not assume
endorsement by the Federal Government. Project Officer, Jo Ann
McCann.
Common to all 3 gurus
•Child focused
•Child led
•Hands off
•Meticulous observation
•Meticulous interpretation
•Focus on guaranteed success (but with a
challenge)
•Focus on the child’s positive self-image
& self-confidence
•Recognition that sensory functioning depends upon
many issues
•Opposed to received opinions of the time
10 Basic Principles of Active Learning
• Everyone can
learn
• Mix variety and
constancy
• Active Learning is • Emotional development
involves mastery
hands off
• Auditory primacy
• Learning by repetition allow to fail
• Work up to weight
• Talk & reward at the
bearing
end of play
• Responsive
environment
• Limit input, wait for
response
My take on Active Learning & Lilli Nielsen
• Hands off
• Focus on self-image & self-esteem
• TIME!
• Close observation of the child
• The concept of changing the environment to
help the child to change
• The concept of the Little Room and (especially)
the Resonance Board
• The concept of developmental stages in spatial
awareness
Useful Websites
• www.lilliworks.com
• http://nationaldb.org/dbp
• http://www.tsbvi.edu/outreach
• www.visionkits.com
“Sensory Integration” means…
1. A neurological process
2. A theory developed by Jean
Ayres
3. A treatment approach
developed from Ayres’
theory
Jean Ayres defines Sensory Integration (1989)
“..the neurological process that organizes
sensation from one’s own body and from the
environment and makes it possible to use the
body effectively within the environment. The
spatial and temporal aspects of inputs from
different sensory modalities are interpreted,
associated, and unified. Sensory integration is
information processing…The brain must
select, enhance, inhibit, compare, and
associate the sensory information in a flexible,
constantly changing pattern; in other words,
the brain must integrate it.”
Ayres’ theory
That the environment has a
crucial impact on brain
development, that the brain
changes in response to external
stimuli, and that experiences
resulting from sensory inputs
and the child’s responses to
them affects brain development.
‘A sensory integrative approach to
treating learning disorders differs from
many other approaches in that it does
not teach specific skills… Rather, the
objective is to enhance the brain’s…
capacity to perceive, remember, and
motor plan… Therapy is considered a
supplement, not a substitute to formal
classroom instruction… ‘
Jean Ayres, 1972
Examples of behaviors indicating possible
sensory integration dysfunction in children
with deafblindness (1)
• repeatedly seeking strong stimulation
through particular sensory channels.
• sensory defensiveness.
• abnormally low or high pain thresholds.
• apparent variability or inconsistency in
sensory perception abilities.
• unusual postures.
• distractibility.
Examples of behaviors indicating possible sensory
integration dysfunction in children with
deafblindness (2)
• disturbed sleep patterns.
• problems with regulating arousal
levels.
• postural & gravitational insecurity if
moved by others, but pleasure in
rhythmic movement.
• inconsistent or inappropriate use of
pressure when grasping, tapping,
kicking etc.
The specific objectives of sensory
integration therapy are: (Karen Nagel)
• To achieve an alert, calm state.
• To promote the organization of the
Central Nervous System.
• To enhance the child’s ability to
regulate and adjust the sensations
from their environment.
• To increase conceptual development.
Key principles of Sensory Integration
Therapy
• The Just Right Challenge
• The Adaptive Response
• Active Engagement
• Child Directed
Possible suggestions may include…
• Brushing
• Rhythmic joint
compression
• Deep tissue
massage
• Vibro-tactile input
• Objects to chew
• Sucking and/or
blowing activities
• Textured bed sheets
and/or heavy bed
covers
• Lycra clothing or
sleeve
• Swinging (forward &
back or side to side)
• Rocking (forward &
back or side to side)
• Weighted clothing
Sensory Issues
o Information may be missing, partial, distorted, or
fragmented
o Over-sensitivity &/or under-sensitivity
o Processing time may be very extended
o Confusion & the need for consistency &
predictability
o But…..think about consistency versus variety
o Fatigue
o Communication issues (receptive & expressive)
o Movement & postural differences
o Idiosyncratic behaviors & misinterpretation
o Developmental delay
The Senses and Deaf-blindness
When there are multiple sensory impairments, it is
important to consider the impact on the child’s:
– Self-awareness
– Body-awareness
– Voluntary movement abilities
– Health (especially pain and discomfort)
– Attention
– Memory, Prior Knowledge
– Intentions, Tasks, Goals
– Motivators
– Emotion and Behaviour
16
“After air to breathe,
postural security is our next
most urgent priority.”
Jean Ayres
17
Three important concepts
• Sensory modulation,
enhancing, inhibiting
• Sensory diet
• Level of arousal
The 9 levels of arousal
(Carolina Record of Individual Behavior)
•
•
•
•
•
•
•
•
•
Uncontrollable agitation
Mild agitation
Fussy awake
Active awake
Quiet awake
Drowsy
Active sleep
Quiet sleep
Deep sleep
[Self-regulation]… “is defined
as the capacity to manage
one’s thoughts, feelings and
actions in adaptive and flexible
ways across a range of
contexts”
Jude Nicholas, CHARGE Accounts, Summer
2007
20
The Senses
Distance Senses Near Senses
• Vision
• Hearing
• Smell
• Taste
• Touch
• Vestibular
• Proprioception
21
My take on Jean Ayres & Sensory Integration
theory & Therapy (1)
The constancy & inter-relatedness of sensory
inputs
The senses connect the brain to the body
Sensory inputs have a significant & direct
impact on arousal levels
Some senses may be more important than
others
Most children with deaf-blindness are not in
touch with/do not feel their bodies very well
My take on Jean Ayres & Sensory Integration
theory & Therapy (2)
We all self-stimulate (all the time?) to maintain
alertness, to wake up, to calm down, to maintain
postural control, to keep/get comfortable, to
occupy our minds, to self-regulate, to fight
boredom, to maintain attention, to keep sane, and
generally to improve our functioning to achieve our
goals
Sensory deficits and poor sensory perception
make children with deaf-blindness self-stimulate in
mostly normal ways – but often with more intensity,
more persistence, and for a longer period of their
lives than “normal”
My take on Jean Ayres & Sensory Integration
theory & Therapy (3)
For various reasons children with deafblindness may have poor social awareness,
so self-stimulation behaviors may be more
obvious
Attempts to stifle and stop self-stimulation
behaviors may result in worse self-regulation
and generally less good functioning
Observing how and when a child selfstimulates will offer invaluable insights into
who they are and how they work, for
assessment, teaching, behavior management,
and relationship building
“Communication,
communication,
communication”
McInnes & Treffry Deafblind Infants &
Children 1982
Communication can be
summed up as our
attempts to obtain
information from and
impose order upon the
world around us
Communication with one’s
own body
∨
Communication with one’s
immediate environment
∨
Communication with the wider
world
Jan van Dijk (1966)
“In the educational atmosphere I
describe, the child holds the
central position, the teacher
‘follows’ the child and, when the
child responds, the teacher is
present to answer the child’s
request”
Van Dijk & Nelson
“Principles of Assessment” (2001)
• Make the child at ease
• Determine the child’s biobehavioral state
• Determine the child’s
interest
• Follow the child’s interest
Van Dijk Approach to Assessment
• Child-guided
• Fluid
• Looks at the processes children
with multiple disabilities including
sensory impairments use to learn &
develop
• Assessment is summarized in
terms of strengths and next steps
for intervention
Areas of the Van Dijk Framework
• Ability to maintain & modulate state
• Preferred learning channels
• Ability to learn, remember & anticipate
routines
• Accommodation of new experiences with
existing schemes
• Problem solving approaches
• Ability to form social attachments and
interact
• Communication modes
Assessment Questions
D Brown “Follow the Child” (1997/2001)
•
•
•
•
How do you feel?
What do you like?
What do you want?
What do you do?
Van Dijk & Nelson
“Principles of Assessment” (2001)
• Make the child at ease
• Determine the child’s biobehavioral state
• Determine the child’s
interest
• Follow the child’s interest
Van Dijk Approach - Evaluation
challenges
• No prescribed protocol
• No specific implementation
order
• No set of testing materials
• Each assessment is unique
• No set interpretation scale
Van Dijk Approach - Quality
indicators
• Respecting the caregiver
• Respecting the child
• Following the child’s lead
• Communicating with the child
• Utilizing turn-taking routines
• Creating of enjoyable routines
•
•
•
•
•
Van Dijk Approach - Fidelity
Utilization of stop-start within
routines
Adding a mismatch with
expectations
Returning to established routines
in order to examine memory
Creating situations that allow for
problem-solving
Utilizing varying sensory channels
My take on Jan van Dijk
•Follow the child
•Observe
•Identify & use motivators
•Time & pacing
•Credit behaviors with meaning
•Respect and seek the opinions of others
•The conversational approach
•The child’s preferred modes of communication
•BUILD relationships
This is normal viewing posture…
…when you have
no vestibular
sense, upper
visual field loss,
poor tactile &
proprioceptive
perception, & low
muscle tone.
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Lilli Nielsen, Jan van Dijk, and Jean Ayres