Sensory Processing
Disorder:
Identification and
Intervention
Linda King-Thomas MHS, OTR/L
Developmental Therapy Associates
Durham and Cary
www.developmentaltherapy.com
Sensory Integration
Sensory integration is 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.
Ayres (1972) Sensory Integration and Learning Disorders p.11
Uses of the term
Sensory Integration
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Theory (sensory integration theory)
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Diagnosis (based on an assessment)
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Sensory Processing Disorder (SPD)
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Functional pattern (normal sensory integration abilities)
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Remediation approach (therapy/intervention
Sensory Systems
Vestibular (movement and gravity)
 Tactile (touch)
 Proprioceptive (“heavy work”, input to
muscles and joints)
 Auditory (hearing)
 Visual (sight)
 Olfactory (smell)
 Gustatory (taste)
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Sensory Integration Foundations for
Learning and Behavior
Sensory Processing Disorder
Sensory Modulation Disorder
Sensory Over-Responsivity
 Sensory Under-Responsivity
 Sensory Seeking / Craving
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Sensory Discrimination Disorder
Sensory-Based Motor Disorder
Postural Disorder
 Dyspraxia
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Sensory Modulation Disorder
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Difficulty modulating, discriminating and
organizing sensory input
Difficulty with self-regulation, in terms of arousal
states, may be under or over responsive to
sensory input
Difficulty interacting effectively to demands of
environment, relationships and tasks
Difficulty adapting to challenges in daily life
Sensory Modulation Disorder
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Sensory Over-Responsivity – quick or intense
response to sensory stimuli
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Sensory Under-Responsivity -- slow response to
sensory stimuli, requires a high intensity or
increased duration of stimuli to elicit a
behavioral response
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Sensory Seeking/Craving – actively seeking
sensation often in socially unacceptable way
Alertness / Arousal States
Sensory Over-Responsivity
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Covers ears with loud noises
Is sensitive to bright lights
Fears movement or changes in position
Avoids touching certain textures (grass, sand,
finger paints, squishy)
Does not like to get messy
Has strong clothing preferences
Does not like to be touched unexpectedly
Has a poor tolerance to grooming
Sensory Over-Responsivity
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Is often irritable, aggressive, impulsive, and moody
Has a poor tolerance to transitions
Frequently cries and is hard to console
Does not like to be held or cuddled
Needs help to fall asleep and stay asleep
Exhibits extreme separation anxiety
Has difficulty transitions to new foods
Sensory Under-Responsivity
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Has delayed reaction time
Is slow to respond to name
Seems unaware of environment, wanders
Has a high pain tolerance
Does not sense when diaper is wet
Does not feel clothing twisted on body
Does not feel food on face or in mouth, or dirt
on hands
Sensory Under-Responsivity
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Does not seem to notice when touched
Has flat affect much of the time
Is hard to engage, may observe but not participate
Is unaware of body sensations (temperature, hunger)
Does not seem to notice noxious odors
Appears slow, unmotivated, unaware,or withdrawn
Seems to be ‘lost in fantasy world’
Sensory Seeking
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Has a high activity level, seldom sits still
Touches everything
Hangs on people/objects
Smells or mouths everything
Takes excessive risks that compromise personal
safety
Prefers foods with strong flavors
Often mouths or licks non-food items
Sensory Seeking
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Seeks out loud noise
Likes to watch bright/spinning objects
Is excessively affectionate
May be demanding or hard to calm
Is a risk taker
Intrudes on others
May be kicked out of child care or expelled from
preschool
Influence on Play Skills
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Avoidance of handling toys and typical play materials
Withdrawal from noisy play, toys that make sounds
Fearfulness of movement limits desire for exploration of the
physical world
Avoidance or lack of registration reduces vital developmental
stimulation
Withdrawal from special childhood events such as birthday
parties, dressing up for Halloween and holiday parties
Influence on Self-Care and Feeding
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Avoidance and/or rejection of food textures,
tastes, smells, temperature
Avoidance and/or rejection of tooth brushing
and bathing
Avoidance and/or rejection of hair brushing,
hair washing, hair cutting
Avoidance and/or rejection of clothing textures
and dressing process
Influence on School Related
Activities
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Avoidance of classroom tools and materials
Difficulty with participation in group activities
which involve movement, touch or sound
Difficulty staying in line
Difficulty self-regulation attention in the
classroom
Influence on Social Participation
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Disruption of attachment relationships due to
approach/avoidance conflict
Avoidance of a need to be in control, or aggression
towards peers
Disruption in ability to develop and maintain
friendships and love relationships in adults
Decreased perception of social acceptance which leads
to decreased self-esteem
Sensory-Based Motor Disorder
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Postural Disorder: difficulty stabilizing the body during
movement or at rest to meet demands of a motor task
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Dyspraxia: difficulty translating sensory information
into planning and/or sequencing movement, especially
new or unfamiliar
Postural Disorder
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Fears movement due to inadequate postural control
Does not like ‘tummy time’
Has decreased muscle tone
Seems weak compared to peers
Loses balance easily
Tires easily, has poor endurance
Frequently trips and falls
Appears lazy and unmotivated
Has difficulty using both hands and feet at the same
time (bilateral coordination)
Dyspraxia
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Difficulty translating sensory information into
ideas for movement, planning, organizing
and/or sequencing movement, especially new
and unfamiliar actions
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Can manifest as gross motor, fine motor and/or
oral-motor problems
Dyspraxia
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Is clumsy
Eats messily
Has a disheveled appearance
Uses toys the same way over and over
Is rigid in play/routines
Frustrates easily
Has trouble maneuvering around obstacles
Breaks things unintentionally
Dyspraxia
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Has difficulty following directions for activities
that require more than one step
Has trouble learning new skills
Is disorganized
Prefers ‘fantasy games’ over physical games
Prefers sedentary activities
Has delays in speech and/or motor skills
ranging from mild to severe
Influence on Play Skills
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Difficulty with playground activities
Difficulty with manipulative and construction toys
Difficulty with the sequence and rules of play
Difficulty with timing and sequencing of body parts in
sports and motor activities
Directional confusion leads to poor spatial organization
with team sports.
Poor ideation leads to decreased play possibilities
Influence on Self-Care and Feeding
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Slow in managing dressing fasteners and shoe tying
Difficulty in mastering the spatial organization of
clothing
Problems managing tools for self-care (hairbrush,
washcloth, utensils)
Difficulty with food wrappers
Messy eater
Disorganization with personal belongings
Influence on School Related
Activities
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Poor and/or slow handwriting and drawing
skills
Difficulty using classroom tools and materials
effectively (scissors, glue bottle)
Disorganization of work space (desk, locker)
Difficulty learning new skills through imitation
Influence on Social Participation
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Social rejection by peers during games due to poor
motor skills
Withdrawal from social situations due to poor selfesteem
Difficulty discerning social and physical boundaries;
poor social judgment
Disorganized peer interactions due to poor ability to
read non-verbal cues
Tendency to be rigid and controlling
Intervention
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Education/awareness
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reframe behavior (view) from a new perspective
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Individual therapy using a sensory integrative approach
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Consultation model for home and school
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Develop new strategies – sensory diet
Research
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Roberts, J. E., King-Thomas, L., & Boccia, M. L. (2007).
Behavioral indexes of the efficacy of sensory integration
therapy. AJOT, 61, 555-562
Single subject ABAB design: subject diagnosed with sensory
modulation disorder and delayed communication skills
Behavioral data collected by preschool teachers who were
blind to the timing of sensory integration therapy
Improvements in behavioral regulation noted: increased
engagement & decreased aggression, less need for intense
teacher direction, decreased mouthing objects
Research
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Miller, L. J., Coll, J. R., & Schoen, S. A. (2007). A
randomized controlled pilot study of the effectiveness
of occupational therapy for children with sensory
modulation disorder. AJOT, 61, 228-238.
Twenty-four children assigned to 1 of 3 treatment groups:
OT-SI, Activity Protocol, and No Treatment
Significant changes noted in OT-SI group on GAS (goal
attainment scaling), attention, Cognitive/Social
composite of Leiter-R parent rating
Sensory Diet
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The daily intake of sensory and motor
experiences needed by a person to adaptively
interact with the environment
Sensory and motor experiences help maintain
optimal arousal and attention for learning
Sensory diet formula: intensity, frequency,
duration, rhythm of input is varied to achieve
optimal performance
Sensory Diet Activities
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Specific to the individual based on assessment
Planned throughout the day to help maintain
optimal level of organization
Most powerful and long lasting include:
movement, heavy work, deep touch pressure
Sensation can have calming or alerting effect
Sensory Diet Activities
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Structure activities in a playful, non-threatening
manner
Closely monitor for an adaptive response -more organized behavior
More sensation in not always better --observe
for signs which might indicate an overstressed
nervous system
Movement
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Unstable surfaces: therapy ball, air pillow,
air cushion
Games and calisthenics
Jumping, swinging,
Rocking, rolling,
Bouncing,
Marching, dancing
Heavy Work
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Carrying heavy objects
Wheelbarrow walk, animal walks
Backpack
Digging in a garden
Working out on weight machines
Pulling friend in a wagon
Pushing heavy grocery cart
Sports
Deep Pressure Touch
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Weighted vest, weighted
blanket
Firm hugs, massage
Lycra exercise shorts or
tights under clothing
Games:
rough house play
 tactile sandwich
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Oral Motor
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Suck: long straw or thick liquids; sour, sweet,
spicy hot candy
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Blow: whistles; bubbles
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Chew and crunch: gum, popcorn, dried fruit,
bagel, pretzels; chewy tube, straws
Womb Spaces
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Under a table or desk
Tent or sleeping bag
Inside a closet or other small space (box)
Pillow in a corner of the room
Creating small space feeling with furniture
position
Tactile
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Hand toys to fidget: koosh balls, silly putty,
bendable figures, small stuffed animals, pieces
of soft fabric
Extra toweling after the bath
Tactile fine motor activities
kneading bread
 sand play
 bean play
 finger painting
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Tactile Strategies
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Temperature: cool is alerting, warm is calming
Clothing preferences: long sleeve, short sleeve,
cut out tags, sport socks (no seams)
Bed clothes: flannel sheets, heavy blanket, light
sheet
Light touch (tickling): alerting
Auditory Strategies
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Soft music-- Mozart, fast music -- driving beat
Ear muffs, headphones
White noise machine, water fountain, soft
background music
Voice quality -- high or low pitch
Visual Strategies
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Soft dim lights
Natural light, avoid fluorescent light
Muted colors and plain walls
Bright lights
Movement in peripheral visual field
Lots of color
Resources Books
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Heller, S. (2002). Too Loud, Too Bright, Too
Fast, Too Tight. New York: HarperCollins
Publishers.
Henry, D., Kane-Wineland, M., Swindeman, S.,
(2007). Tools for Tots: Sensory Strategies for
Toddlers and Preschoolers. Glendale, AZ:
Henry OT Services.
Isbell, C. & Isbell, R. (2007). Sensory Integration
A Guide for Preschool Teachers. Beltsville, MD:
Gryphon House.
Resources Books
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Kranowitz, C. (2005). The Out-of-Sync Child.
New York: Penguin Group.
Miller, L. J. (2006). Sensational Kids. New York:
Penguin Group.
Williams, M. S., Shellengerger, S. (2001). Take
Five! Staying Alert at Home and School.
Albuquerque, NM: TherapyWorks, Inc.
Yack, E., Aquilla, P. & Sutton, S. (2002).
Building Bridges through Sensory Integration.
Las Vegas: Sensory Resources.
Resources catalogs
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Abilitations 1-800-850-8602
www.abilitations.com
Fun and Function 1-800-231-6329
www.FunANDFunction.com
Sensory Critters 1-866-749-2737
www.SensoryCritters.com
Southpaw Products 1-800-228-1698
www.southpawenterprises.com
Therapy Skill Builders 1-800-872-1726
www.psychcorp.com
Resources on the web
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Sensory Processing Disorder Foundation
 www.spdfoundation.net
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SI Focus magazine
 www.sifocus.com
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Developmental Therapy Associates
 www.developmentaltherapy.com