Dig a Little Deeper: Using
Knowledge of Sensory Processing to
Respond to Challenging Behaviors
Heather Kennell OTR/L
& Amy Russell Yun, OTD, MS, OTR/L
“You can’t make
children grow faster by
pushing them, just as you
can’t make flowers grow
faster by pulling them”
-Otto Weininger
Sometimes “behavior” is just the tip of the
iceberg
Are we missing the remaining 90%?
Behavior is a Form of Communication
It may reflect many things
• Poor quality of life
• Little control in life
• Illness/Pain
• Few choices
• Impairments in social skills or
communication
skills
• STRESS
Factors that Affect Behavior
External Influences
Internal Influences
• Family transitions
• Stress
– Death of a family member/loss
of a pet
– Chronic or serious illness
– Moving…
• Unreasonable expectations
– Heavy academic demands
– Inappropriate educational
placement
• Abuse
– Illness/injury
– Unreasonable
expectations
• Cognitive functioning
• Developmental profile
• Communication
difficulties
• Temperament
• Emotional problems
• Learning difficulties
Challenging Behavior
• Is…
– “Any repeated pattern of behavior, or perception
of behavior, that interferes with or is at risk of
interfering with optimal learning or engagement in
pro-social interactions with peers & adults.
Challenging behavior is thus defined on the basis of
its effects."
• Technical Assistance Center on Social
Emotional Intervention for Young
Children, (2009)
Self-Regulation
• Ability to regulate emotions & behavior
• Ability to maintain physiological homeostasis
• Who still needs to learn this?
Domains of Selfregulation
Behavioral selfregulation
Ability to adjust one's
activity (level) to
contextual demands
of environment.
Cognitive selfregulation
Ability to
generate/maintain
attention skills that
meet needs of
environment
Emotional selfregulation
Generating &
maintaining
suitable
affect or
emotional
expression
“appropriate”
to demands
of social
environment
Physiological
self-regulation-
Ability to
maintain
stable
physiological
processes
(Als, Schore,
2001)
Self Regulation
Involves skills that develop over
time
• Cortex, particularly frontal &
pre-frontal areas
•
Typically older children & adults
have these skills
Self-regulation skills can be
developed &/or improved
through interventions
Designed to recognize & manage
internal arousal states, thoughts,
feelings, triggers…
Mindfulness-Based Stress Reduction
“How Does Your Engine Run?”
(Shellenberger & Williams, 2007).
Self Regulation Involves
Psychobiological Factors
• Body functions- anatomical & physiological interconnections
amongst brain & body
– External (the world)
– Internal –thoughts, emotions, & perceptions
• Biological
– Cardiovascular & respiratory
– Endocrine (e.g., hormones)
• Psychological components
– Cognitive
– Emotional
• Sensory
– Pain, touch, visual, auditory, vestibular, olfactory, oral, proprioception
• Biological Responses
– Internal bio-physiology arise from
body's interactions with the
external environment
If I go to Aspen (high altitude)
Base elevation: 8,040 ft
Summit elevation: 11,675 ft
• Nervous system arousal, engagement,
brain response, neurotransmitters &
hormone response…
– Allows person to adapt
• Immediately
– My cardiovascular system adapts
to O² by  heart rate
• Long term
– Experience changes in blood
chemistry (↑hemoglobin to
carry more O² )
Obtained from
http://www.concierge.com/images/destination
s/destinationguide/usa+canada/usa/colorado
/aspen/aspen/aspen_006p.jpg
Psychology Influences Biology
• Cognition, perceptions, & emotions
– May be instead of, or in addition to, environmental demands.
– May/may not include “thinking”- does include reactions within
body
• Emotional reaction to smell of chocolate chip cookies
– Relationships with others trigger emotional responses
• Love is associated with hormone oxytocin in limbic system
• Physical reactions - ↑ heart rate & facial flushing.
– Perceptions influence responses
• Actual experiences
• Thinking about a task/activity…
– Visualization
Regulation of Body Systems & Behavior
• Homeostasis “Rest”
– Homeo, means "same,“ stasis means "stable;"
– Remaining stable by staying the same
• Allostasis “GO!!!”
–
–
–
–
–
Greek allo, means "variable;" stasis means stable
“Remaining stable by being variable"[
Process of achieving stability thru physiological or behavioral change.
Adaptive in the short term
Proposed by Sterling & Eyre (1988) to describe process of reestablishing
homeostasis in response to challenge
• Allostatic load
– Cumulative cost to the body of allostasis
(McEwen & Wingfield, 2003)
Co-regulation
• Two branches of Autonomic Nervous System co-regulate each
other (Kandel, Schwartz, & Jessell, 2000).
– Sympathetic Branch (SNS)/Sympathetic-adrenomedullary system
[SAM])-Allostasis
– Parasympathetic branch (PNS) -homeostasis
• They act opposite of each other & one system dominates the
other at a particular time
• Work together to fine tune responses to allow us to adapt &
survive
• Pretty much unconscious process through the ANS
AUTONOMIC NERVOUS SYSTEM
Each organ receives
sympathetic &
parasympathetic
pathways!!!
SYMPATHETIC
thoracolumbar
PARASYMPATHETIC
Craniosacral
Sympatheticadrenomedullary system
[SAM]
• Connections between
– Sympathetic Nervous System
– Adrenal medulla (adrenal
gland)
• Produces primary stress
hormones
– Epinephrine (adrenalin)
– Norepinephrine
(Noradrenalin)
• Fast response (millisec)
• Designed to be short-lived
& highly responsive.
• Drives the fear/flight or fight
response-GO!
– ↑ respiration, cardiac activity,
& metabolic activity
Hypothalamic-Pituitary-Adrenal (HPA) Axis
• Releases
– Cortisol, a corticosteroid
– Raises blood sugar
• Triggers release of stored fats
• Breaks down stored proteins
from tissue
• Triggers liver to covert them
into blood glucose.
– Suppresses immune system
– Puts homeostatic functions on
hold
• Digestion
• Cell replenishment & repair.
• Response
– Within minutes of perceived
stress
– Sustained body mobilization
Parasympathetic Nervous System
• Concerned with generalized homeostasis
– “Feed & Breed”– Primary goals revolve around conservation &
restoration of energy
•
•
•
•
Digestion & absorption of nutrients
Body repair & healing
Sexual reproduction
Excretion of waste
– Preserves the system
Stress
• Describes
– Subjective experience
induced by a novel,
potentially threatening or
distressing situation
– Behavioral or
neurochemical reactions
to it
• What is stressful for a baby?
– Inability to regain homeostasis
• State changes
• Bodily needs-hunger, thirst…
– Novelty
• Transitions
• Unpredictability
Limbic System
•
•
•
•
•
•
Important
Motivation
Emotion
Memory
Stress response
Function
– Emotion formation
– Emotional behavior
– Complex cognitive
thought processing
(memory)
(Kandel, Schwartz, & Jessell, 2000)
Emotions, learning & memory

THE PAPEZ CIRCUIT
CINGULATE CORTEX
HIPPOCAMPUS
FORNIX
HYPOTHALAMUS
ANTERIOR THALAMUS
Emotions, learning & memory

THE STRESS RESPONSE
REGULATION OF THE “HPA” AXIS BY
THE AMYGDALA AND HIPPOCAMPUS
THE AMYGDALA STIMULATES THE “HPA” AXIS
THE HIPPOCAMPUS INHIBITS THE “HPA” AXIS
Stress Responses in the Brain
• Mediated by CNS & ANS
– Energy-expending SNS
– Energy-conserving PNS
}
Regulate autonomic, somatic aspects of
stress responses & emotional states.
stress  neurochemicals
CNS
ANS
Limbic system (Seyle, 1956)
Sympathetic– adrenomedullary
(SAM) axis
Processes emotions
Low threshold for activation
Appraises social info from facial
(Malarkey, Lipkus, & Cacioppo, 1995)
expressions w/o awareness (Critchley et
Regulated by corticotropin
al., 2000a)
releasing factor -regulates
Represents motivationally salient
catecholamine release in SNS
stimuli to adapt to environment
(Brown, Fisher, Spiess, Rivier, Rivier & Vale.
changes (Mesulam, 1998)
1982)
Alters activity of neuro-modulatory
Hypothalamo–pituitary–
systems responsible for emotional
adrenocortical (HPA) axis.
states & arousal (Tucker, 1992).
Regulated by cortisol (Yehuda,
1999).
General Adaptation Syndrome
• Stages of response
– Alarm
• Person identifies threat
(stressor)
– SAM & HPA (stress
responses) activated
– Resistance
• If stressor persists, person
needs to attempt to cope
body tries to adapt to
demands of environment,
• Cannot keep up indefinitely
& resources are depleted
– Exhaustion
• Body's resources are
depleted
• Unable to maintain normal
function.
– If person spends extended
time in this stage, long
term damage results
(Selye, 1950 )
Yerkes-Dodson Principle
Self Regulation Involves
Skills
• Relates to capacity to tolerate sensations of
distress that accompany unmet needs
– When an infant initially feels an unmet need such as
hunger, s/he feels discomfort & distress & cries
– Attuned caregiver responds & this cycle gets repeated
multiple times.
– Infant learns that feelings of discomfort & distress,
will pass
– Later child learns to interpret & respond to inner cues
– Child becomes able to tolerate discomfort & distress
– Child can tolerate a certain level of anxiety &
becomes less reactive & impulsive.
– This enables child to feel more comfortable & behave
in a more "mature" manner when faced with physical,
emotional, social, & cognitive challenges
Ayres Hypothesized Integration
Neuro
Early Brain Development Concepts
• Brains are built over time, from the bottom up
Early Brain Development Concepts
• The brain is shaped by the influence of genes,
the influence of experience, and their
interactions
Early Brain Development Concepts
• Although the brain is continually changing and
adapting, its capacity for change decreases
with age
Early Brain Development Concepts
• Cognitive, emotional, and social abilities are
intertwined throughout the life span
Early Brain Development Concepts
• Toxic stress damages developing brains, which
can lead to chronic problems in learning,
behavior, and physical and mental health
Radley et al. (2004), BOCK ET AL. (2005)
Early Brain Development Concepts
• Early experiences can have both cumulative
and delayed effects on development
What is Sensory Integration?
• “Sensory integration is the process of
organizing sensory inputs so that the brain
produces a useful body response and also
useful perceptions, emotions, and thoughts.”
• -Ayers, 1979, p. 28
In a sensory processing model, our
approach changes:
• Instead of a ‘top down’ approach where
where we address the visible behavior,
In a sensory processing model, our
approach changes:
• We adopt a ‘bottom-up” approach where we
look closely at the underlying neurological
factors that influence those visible behaviors
we see
Liam’s got the right idea!
Moving Beyond the 7 Senses…
Vision
• Functions:
• What is vision?
©2010 Lil’ Munchkins
What is involved in vision?
• Ability to register visual info
• Ability to attend to visual info
• Ability to move eyes in a
coordinated fashion
• Ability to discriminate amongst
different stimuli
• Ability to perceive movement
• Ability to move eyes with head
VISION
Eyes
•
Photoreceptors
•
Convert light into
neural activity
Visual Pathway
• Optic nerve brings
information to
occipital lobe of brain
where it is processed
VISUAL SYSTEM
PRIMARY VISUAL CORTEX (V1) 3°
(area 17; occipital cortex)
optic radiations
LATERAL GENICULATE NUCLEUS 2°
(LGN; visual thalamus)
optic tract
optic chiasm
optic nerve (CN II)
RETINAL GANGLION
CELLS
1°
VISUAL SYSTEM
PATHWAYS IMPORTANT FOR GENERATING EYE MOVEMENTS
SUPERIOR COLLICULUS
superficial layers: visual
• superficial layers: integrates
multisensory information
• generating spatially
directed head turns
• arm-reaching
movements
• shifts in attention not
involving movements
Vision Affects Behavior…
Child might..
 Avoid or daydream during activities
requiring close visual attention
 Be clumsy
 Have difficulty judging distances
…targets/catching
 Tilt head or assume atypical
postures or positions
 Make odd facial expressions during
work at different distances (esp.
close)
 Experience - nausea, dizziness,
fatigue, head aches
Caregivers might report
• Inattention
• Clumsiness
• Avoidance
• “Behavioral problems”
• “Poor work skills” or habits
• Low frustration tolerance
Visual Attention
Awareness & Attention to Objects
– Hold interesting object close to child (arms reach or less)
– Move object (activate it or talk about it)
– Observe child's response to see if it was noticed.
– Practice until visual fixation is maintained.
•
•
•
•
↑ length of visual fixation
↑ distance
Work to develop reach (2 handed, then 1 handed)
↓contrast between object & environment
Visual Form Recognition
Auditory
• Location: inner ear
• Function: provides
information about
sounds in the
environment
• What is involved?
©2010 Lil’ Munchkins
AUDITORY SYSTEM
AUDITORY SYSTEM
SOUND WAVE ENERGY
MECHANICAL ENERGY
FLUID WAVE ENERGY
AP
(audible variation in air pressure)
CN VIII
AUDITORY SYSTEM
Auditory cortex
Medial geniculate
Ascends to brainDescends to the body
Chemoreceptors
• Gustatory
• Location: chemical receptors in
the tongue
• Function: provides information
about different types of taste
• Olfaction
• Location: chemical receptors in
the nasal structure
• Function: provides information
about different types of smell
©2010 Lil’ Munchkins
Somatosensory Systems
 Tactile
Proprioceptive
 Function: provides
information about the
environment, objects & their
properties
Function: provides information
about where a certain body part
is how it is moving
• changes in angle & position
• calibration of force
• tension in specific parts of
muscle
 What is this information?
©2010 Lil’ Munchkins
©2010 Lil’ Munchkins
SOMATOSENSORY Senses
Pain (sharp & localized, or diffuse & deep); Nociceptors
 Temperature (sharp & localized, or diffuse & deep); Thermoreceptors

- can be noxious at extremes (<5°C and >45 °C)
 Discriminative touch
 Vibratory sense
 Proprioception
FIRST AND SECOND PAIN
SOMATOTOPIC MAP
NOT ALL SENSATION IS EQUAL
• Note the relative size of the cortex
devoted to different body parts
• This correlates to the density of sensory
input from that area
• Reflects the importance of that part
HOMUNCULUS
Somatosensory Input
• Comes from different
receptors
Where does
proprioception
come from?
DESCENDING PAIN-MODULATORY PATHWAYS
Thankfully, tracts from a number of brain regions
INHIBIT dorsal horn cells from conveying
nociceptive (PAIN) information to higher brain
centers
MODULATORY FUNCTION• Tell us what to attend to & what to ignore
Vestibular
• Location: inner ear
• Function: provides
information about
where our body is in
space
©2010 Lil’ Munchkins
VESTIBULAR SYSTEM
1 OTOLITH ORGANS (UTRICLE & SACCULE): detect forces of gravity & linear acceleration
of head
2 SEMICIRCULAR
CANALS: sensitive to head
rotation- angular acceleration
VESTIBULAR SYSTEM
1°
VESTIBULAR GANGLIA
(SCARPA’S)
2°
VESTIBULAR NUCLEI
CN VIII
3°
VPL
4°
VESTIBULAR CORTEX
(THALAMUS)
ON POSTCENTRAL
GYRUS NEAR FACE
REPRESENTATION
• Tectospinal tract
• Coordinates eye & head
movements
• Mediate postural
reflexes in relation to
visual & auditory input
• Vestibulospinal tract
• Alter muscle tone
• Extend limb & head
position
• Alter posture
VESTIBULAR SYSTEM
VESTIBULO-OCULAR REFLEX (VOR)
 Allows eyes to move automatically to compensate for
head movement
 This allows you to keep your eyes fixed on a stable
target
MOTOR: HIGHER CENTERS
 MOTOR CONTROL HIERARCHY
Ideation: a movement plan that best achieves a goal
Motor Planning: the sequences of muscle contractions, arranged in time & space, required
to smoothly & accurately achieve the strategic goal
EXECUTION: activation of the motor neuron and interneuron pools that generate the goaldirected movement & make any necessary adjustments of posture
Working Together
Let’s consider how
sensory information
contributes to
development
* Activity
Observations reflecting increased or decreased
levels of arousal in young children
• Autonomic
•
•
•
•
Yawning & sneezing
Hiccuping
Sweating
Changes in skin color
– Flushing
– Palor
– Mottling
•
•
•
•
Spitting up/gagging
Breathing changes
Rapid state changes
Losing bowel/bladder control
• Behavioral
–
–
–
–
–
–
Fussiness
Crying
Startling
Becoming stiff
Sighing
Extension/ arching
back/splaying of fingers
& toes
– Averting gaze
Spitzer & Smith Roley, (2002).
Sensory Thresholds & Behavioral
Responses (Winnie Dunn)
Neurological Thresholds
Behavior Responses
In accordance w/threshold To counteract Threshold
Poor registration
Sensation
Seeking
Sensitivity to
Stimuli
Sensation
Avoiding
High
(habituation)
Low
(sensitization)
“There is no such thing as
a baby, there is a baby &
someone…” (Winnacott, 1987)
Emotions, Learning & Memory

LEARNING
change in
response over
time to a single
stimulus
forming
associations
between events
Tips for Enhancing Self Regulation
• Work on YOUR OWN capacity for self-regulation
• Be attuned to child & child’s needs
– ANS signs –check to ensure accurate behavior
interpretation
• Start with proximal strategies for regulation &
move to distal ones
• Provide structure & predictability (helps child
develop internal “structure."
– Too flexible -likely to see uncontrolled behaviors to seek
structure.
• Anticipate transitions & prepare child for them in
advance
– Timers-one more minute-songs…
Strategies for Teaching
•
•
Get caregivers to regulate
selves!!!
Focus!!!
–
•
Motivation matters!
–
–
•
Target specific areas for
growth & specific strategies
to address them
Use materials & activities of
interest
Work to broaden interests
Keep it light!
–
–
Be positive & have FUN
Encourage flexibility.
•
Context
–
•
Start with what is needed
& desired (social routines)
Practice
–
–
•
Reinforce learning
Generalize to different
people, settings, &
materials
Structure & routine add
predictability & comfort
–
Visual environment is
important
•
•
–
Placement of objects
Visual schedule
Social scripts can be a
building block
Coping
• “Things people do to
avoid being harmed by
life strain” (Pearlin & Schooler,
• Problem focused coping
– Attempts to
• Deal with reality &
consequences of crisis
• Create a better situation
1982, p. 109)
• Patterns of coping
responses
– Change the stressful
experience
– Control the meaning
– Manage stress
• Appraisal-focused coping
– Efforts to understand &
find meaning in a crisis
• Emotion-focused coping
– Handling feelings provoked
by the crisis
•
Moos & Billings (1982)
Attacking the Problem
• Change situations -that
cause stressful experiences
– To do this
• Situation must be amenable to
change
• Person must
1. Recognize the situation
which is causing stress
– Difficult to do
2.
Know to change the
situation directly
–
Often changing one
situation leads to different
additional stressors
• Making careful
observations of the
sensory environment can
help avoid un-needed
stressful situations
Think about the Sensory Contributions
to the Environment
• What type of sensory
information is present?
–
–
–
–
–
–
–
Visually
Auditory
Vestibular
Proprioceptive
Tactile
Olfactory
Gustatory
• Consider the following
for each
– Intensity-strength or
power
– Duration – of the
stimulation
– Location
– Predictability
Emotion, learning & memory

NONASSOCIATIVE LEARNING
HABITUATION: repeated presentation of the
same stimulus produces a
progressively smaller response
SENSITIZATION: a strong stimulus results in an
exaggerated response to all
subsequent stimuli
• Calming
– Predictability
– Rhythm
– Neutrality –middle
• Alerting
– Irregularity
– Novelty
– Intensity
• Extremes
Managing the Stress
• Control stress after it
emerges (Pearlin & Schooler, 1982, p. 115)
• Focus on managing stress
resulting from stressors
Attunement
Mutual Eye Contact
Baby smiles
Mother respondsusually by smiling
Right Brain Attunement
Joint Attention
– Process of sharing one’s experience of
observing an object or event, by following
gaze or pointing gestures.
– Critical for social development, language
acquisition, cognitive development
– Pre-linguistic communication skills that are
used to initiate or maintain turn-taking
routines & used to request or obtain help in
obtaining objects or events.
– Joint attention is used to direct attention in
order to share the experience of an object or
event with another person
Strategies to Build Joint Attention
• Observe child
– Watch for alternating his/her eye gaze between an object & person.
• Playfully try to get child to make eye contact
– Go to child’s level to make gaze shifts from object to face easier
– Play with toys that draw the child’s attention to your face. (bubbles,
pinwheels, balloons)
– Hold onto objects you are giving child until he looks at you & bring it to
eye level.
• Follow child imitate his actions with an identical toy/object
• Play with toys
– Draw attention to adult’s actions. (that make noise /need to be activated,
musical toys)
– Facilitate reciprocal interaction (balls, blocks in a form box, a train,
puppets, telephone)
– Facilitate requests for help (a jar that is too hard to open, an favorite
object out of reach, wind-up toys that are too hard to turn)
Evidence for SMD is Growing
 Davies & Gavin (2007)
 Ability to habituate typically develops over time
 Children identified as having SMD demonstrate difficulties
habituating to neurological stimuli compared with controls
 Difficulties increase with time & exposure to stimuli
 Schaaf, Miller, Seawall, & O’Keefe (2003)
 Children with SMD demonstrate vagal tone (PNS)
 Children with SMD do not habituate to repeated stimuli
 Do not shut off SNS
 McIntosh, Miller, Shyu, & Hagerman, (1999).
 Electrodermal responses high amplitude orienting is
associated with poorer performance on the SSP
Early Brain Development Concepts
• Children learn best through hands-on
experiences which require problem solving