socal jan 2011 mili cordero sensory regulation ca

8/7/2019 Socal Jan 2011 Mili Cordero Sensory Regulation CA

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Sensory Regulatory ProcessingSensory Regulatory Processing Bodies That Tell StoriesBodies That Tell Stories

DIR Regional Institute

Session 3

Milagros J . Cordero, EdD, OTR/L

What Do We WantWhat Do We Wantfor Our Children?for Our Children?

Axis IIIAxis III

RegulatoryRegulatory--Sensory ProcessingSensory ProcessingCapacitiesCapacities

y Type I - Sensory Modulation (challenges)

y Type II - Sensory Discrimination(challenges)

y Type III - Sensory Based Motor(challenges) Abilities, including posturalcontrol and motor planning


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Regulatory Sensory ProcessingRegulatory Sensory ProcessingCapacitiesCapacities -- DefinitionDefinition

y is a term that refers to the way thenervous system receives messages fromour senses and turns them into

appropriate motor and behavioralresponses

Sensory Processing DevelopmentSensory Processing Development A ContinuumA Continuum

y The behaviors observed in a child willexist in a continuum

from within typical guidelines and itsvariations to

disorders

From newborn until toddler In alertness / Diffuse

From toddler to pre-school Transitional PeriodBy kindergarten Discriminatory/Manual dexterityestablished

Master Observer: A.J. AyresMaster Observer: A.J. Ayres

y The childs innate ability drives andneural capacities lead him to anabundance of responses, many of them

involving maximal effort, that enable himto master those demands and result inexperiences that foster his development.


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Master Observer: J. PiagetMaster Observer: J. Piaget

y J. Piaget - stressed that the earlysensorimotor (including reflex) stages ofinfant development extends into reflective

intelligence through process ofaccommodation and assimilation

Master Observer: M. LevineMaster Observer: M. Levine

y Multiple forces (genetic factors,environmental influences, family factors,cultural values, educational experience,

physical health, influence of peers,temperament/emotional factors)

determine a childs neurodevelopmentalprofile.

Master Observer: S. GreenspanMaster Observer: S. Greenspan

y S. Greenspan In di scussing areas that i nfluence thechilds development, he identifies them as:

Biological and genetic factors

Cultural, environmental, and family factors

Child/caregiver interaction patterns

It is this interaction patterns that then determines thechilds capacity for relative mastery


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Sensory Processing DevelopmentSensory Processing Development

According to Ayres, sensory integration (the term) is theorganization of sensation for use. We need to have thisskill so as to:

Play

Engage and maintain social in teraction

Have the ability to stay modulated

Completion of activities of daily living

Development of new skills including academics

Development of Sensory IntegrationDevelopment of Sensory Integration

y Sensory Integration is a normal process thatsupports all our behavior and actions.(Influenced by the developmental level)

x S. Szklut, 1999

y It involves not only the 5 senses we learn atschool, but also the vestibular and the

proprioceptive systemsy It is also in fluenced by the environment

y It is influenced by the individual presentingthe stimuli

D.I.R./Floortime & Sensory Processing ModelsD.I.R./Floortime & Sensory Processing ModelsMC, EdD, OTR/L 2009MC, EdD, OTR/L 2009

Logical &Logical &AbstractAbstract

ThinkingThinking

CognitiveCognitive EmotionsEmotions

SymbolicSymbolicand Creativeand Creative

Use of IdeasUse of Ideas

LanguageLanguage

ComplexComplexPresymbolicPresymbolic

, shared, shared

socialsocial

communicaticommunicationon

Ideation,Ideation, MotorMotor

PlanningPlanning

& Execution& Execution

Two WayTwo WayCommunicatCommunicat

ionion

ProprioceptivProprioceptiv

ee

VestibularVestibular

EngagementEngagement TactileTac tile TasteTaste VisiVisionon SmellS me ll A ud it or yAuditory

SharedShared

Attention &Attention &

RegulationRegulation

Muscle ToneMuscle Tone

& Muscle& Muscle

StrengthStrength

Range ofRange of

MotionMotion

PrimitivePrimitive

ReflexesReflexes

ProtectiveProtective

ReactionsReactions

BalanceBalance

&&

EquilibriumEquilibrium

ModulationModulation


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Body Centered vs.Body Centered vs.Far Centered SensesFar Centered Senses

y Interoceptive (body centered) senses - tactile,vestibular, and proprioceptive senses - operatewithout conscious thought - includes state ofarousal

y Far senses - responds to external stimuli - sight,sound, taste, smell, and touch - respond toexternal stimuli from the environment

x C. Kranowitz

Mechanisms to Self RegulateMechanisms to Self Regulate

y Modulation - brain will turn switches on or off toregulate its activity and our activity level

y Inhibition - brain will reduce connections betweensensory intake and behavioral output wheninformation is not needed

y Habituation - when we become accustomed tofamiliar sensory messages our brain automatically

tunes them outy Facilitation - brain will promote connections

between sensory intake and behavioral output bysending messages - it lets us known when we needto stop or continue activities

C. Kranowitz

Importance of ArousalImportance of Arousal

y Arousal is our level of alertness

y The ability to maintain appropriate statesof arousal develops from our ability tobalance the sensory input from ourenvironment

y With adequate arousal, we can thenattend and learn


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How is a Disorder Identified?How is a Disorder Identified?

y A disorder is identified when a behaviorinterferes with the age expectedperformance of the individual

y A disorder can appear in one or more ofthe developmental areas of: physical,emotional, social, cognitive, learning

The Range of ChallengesThe Range of Challenges

y None

y Challenges but with normal range ofvariation

y Mild to Moderate Impairments

y Severe Impairments

Sensory Modulation PatternsSensory Modulation Patternsy 201 Over-Responsive, Fearful, Anxious

y 202 Over-Responsive, Negative, andStubborn

y 203 Under-responsive, Self-Absorbed

203.1 Self Absorbed and Difficult to EngageType

203.2 Self-Absorbed and Creative Type

y 204 Active, Sensory Seeking Pattern


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Using the Functional DevelopmentalUsing the Functional DevelopmentalGrowth Chart QuestionnaireGrowth Chart Questionnaire

y By 3 Months Focusing and Attention/Shared Attention and Regulation Does your infant usually show an interest in

things around him/her by looking at sights,turning towards sounds?

y By 5-6 Months Engaging in Relationships Does your baby seem happy or pleased to see

you and / or other favorite people: lookingand smiling, making sounds or some othergesture, such as moving arms, that indicatespleasure or delight?

Early Identification of RegulatoryEarly Identification of Regulatoryand Sensory Processing Problemsand Sensory Processing Problems

y Sleep Disturbances

y Eating Problems

y Sensory Reactivity

y Attentional Problems

y

High Irritability

Levels 1 & 2Levels 1 & 2

Attention and EngagementAttention and Engagement

y These first two crucial thinking levels,attention and engagement, are exactlywhere the trouble shows up first.x S. Greenspan. The Learning Tree, 2010

y Experience shows us that even as chi ldrencontinue to grow and develop, we oftenneed to revisit these areas since they are

the first ones to be affected when theindividual faces other challenges.


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Questions to keep in Mind WhenQuestions to keep in Mind WhenPlaying with an Infant/ChildPlaying with an Infant/Child

y How does the infant/child respond tomovement?

y How does the child deal with transitions?

y What is the quality of their motor planningat the gross and at the fine motor level?

y Is the intensity and frequency of thebehaviors demonstrated at par with thechilds age?

y What strategies does the child use to calmherself?

InteractionInteraction

With Mom and Dad at 8 WeeksWith Mom and Dad at 8 Weeks


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Sensory ProfileSensory Profile

y A profile is not always obvious because it

can vary according to Circumstances

Who is with the child

y Therefore, good observations are veryimportant

y According to S. Greenspan,As you play, talk,or interact with your child, no matter howold, always remember to check whether heis calmly engaged and in control of hisemotions and behavior. The Learning Tree, pp.160

Identifying a Childs Sensory ProfileIdentifying a Childs Sensory Profile

y How would you describe the sensoryprofile for Child #1, for Child #2?

y Areas that Support Development

y Areas that Hinder Development

Sensory Modulation PatternSensory Modulation Pattern

.201.201 OverOver--Responsive, Fearful, AnxiousResponsive, Fearful, Anxiousy Characterized by responses that are

larger than the ones expected

y Individuals are often seen to over-react tostimuli or to the possibility there will be astimuli coming their way


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Sensory Modulation PatternSensory Modulation Pattern.201.201 OverOver--Responsive, Fearful, AnxiousResponsive, Fearful, Anxious

Sensory Modulation PatternSensory Modulation Pattern .202.202 OverOver--Responsive, Negative, andResponsive, Negative, andStubborn (Sensory Avoiding)Stubborn (Sensory Avoiding)

y Respond to touch with aggression orwithdrawal

y Afraid of or becomes sick withmovements and heights

y Cautious or unwilling to take risks

y Uncomfortable in loud or busyenvironments

y Very picky eater and/or overly sensitiveto food smells

Negative and StubbornNegative and Stubborn


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Overly SensitiveOverly Sensitive

Sensory Modulation PatternSensory Modulation Pattern.203.203 UnderUnder--responsive, Self Absorbedresponsive, Self Absorbed

Sensory Modulation PatternSensory Modulation Pattern

.204 Sensory Seeking Behaviors.204 Sensory Seeking Behaviors

y Hyperactivity as they seek more input

y Unawareness of touch or pain ortouching others too often or too hard

y Engaging in unsafe behaviors

y Being too loud/too soft spoken orenjoying the extremes in volume


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CoCo-- RegulationRegulation

Accompanying Emotional StatesAccompanying Emotional States

y Anxiety

y Depression

y Anger hostility

y Functional performance

y Attentional concomitants Distractibility

Disorganization

Impulsivity

HyperactivityMiller, 2000


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Other IdentifiedOther IdentifiedBehaviors ExpressionsBehaviors Expressions

y Parents have reported concerns relatedto:

Poor social participation

Insufficient self regulation

Inadequate perceived competence

Inadequate self esteemx Cohn & Miller, 2000

Strategies to Support Levels 1 & 2Strategies to Support Levels 1 & 2fromPfeifferfromPfeiffer, Koenig,, Koenig, KinnealeyKinnealey, Sheppard, Henderson, Sheppard, Henderson Effectiveness of Sensory Integration Intervention in ChildrenEffectiveness of Sensory Integration Intervention in Children

with Autism Spectrum Disorders: A Pilot Study. AJOT January/February 20 11,with Autism Spectrum Disorders: A Pilot Study. AJOT January/February 20 11, VolVol 65, Number 165, Number 1

y Arrange the room to entice engagementy Ensure physical safetyy Present sensory opportunitiesy Attain and maintain optimal arousal levely Taylor activity to present just right challengey Ensure that activities are successfuly

Guide the self-regulation of behaviory Create a playful contexty Collaborate in activity choicey Foster therapeutic alliances

Supporting Each Other quietlySupporting Each Other quietly

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And in a more active EnvironmentAnd in a more active Environment

Type IIType II Sensory DiscriminationSensory Discrimination

y Defined as inability to distinguish onetype of input from another.

y Discriminatory skills include: differentweights, different temperatures, different

How Sensory and Regulatory IssuesHow Sensory and Regulatory Issues

Affect InteractionAffect Interaction

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Need to express versus control theNeed to express versus control theSensory InputSensory Input How it affects engagementHow it affects engagement

y Many individuals engage in self stimulatory

behaviors to either calm or arousethemselves

y These behaviors are looked at as negativeor inappropriate by other neurotypicalindividuals

y The relationship between those that needthis input and those that observe it butdo not need it do not supportengagement

All I can Do is ConcentrateAll I can Do is Concentrate

Peers may be Interested,Peers may be Interested,

but not Understandbut not Understand

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TeaserTeaserMoving into Motor PlanningMoving into Motor Planning

y that neurological process by whichcognition defines motor action

x Ayres 1985

Maintaining High Self EsteemMaintaining High Self Esteem

y Difficulties in understanding theenvironment will affect higher levels ofmotor planning

y The child has the choice of showingfrustration, or withdrawing

y

Other children may express activities aretoo babyish, stupid and refuse tocomplete them

y Child may keep from participating ingroup/team activities

Remember it is a Family AffairRemember it is a Family Affair

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Suggested ReadingsSuggested Readings

y Delaney, T. The Sensory Processing

Disorder Answer Boook. Naperville, Ill:Sourcebooks, Inc, 2008

y Greenspan, S., Greenspan, N. The LearningTree. Cambridge, MA: Da Capo Press,2010

y Miller, L.J. with Doris A. Fuller. SensationalKids. New York, NY: Perigee Book, 2006

y ICDL Diagnostic Manual

y ICDL Clinical Practice Guidelines

Goals for the PresentationGoals for the Presentation

y On viewing video, identify strengths and constrictionswithin FEDM 1 and 2

y Describe strategies to support FEDM 1 and 2y Describe regulatory-sensory processing capacities

(DMIC Axis III)y Identify and describe a childs sensory profile and how

it supports or hinders a childs developmenty Describe the role of affect in understanding and

working with a child with regulatory and sensoryprocessing concerns.

y *Provide in-depth discussion of Regulatory-Sensory

Outline of the PresentationOutline of the Presentation

y Review of Axis III Regulatory Sensory ProcessingCapacities

y Sensory Processing Development as a Continuum

y Importance of Sensory Processing/ Integration Capacities

y Development of Modulation

y Identifying a Childs Sensory Profile Supports development

Hinders development

y Identifying early markers of sensory processing development

y Identifying difficulties/ patterns of difficulty in sensoryprocessing capacities

y Discussion of how these difficulties affect development ofFunctional Developmental Levels

y Role of affect in our work with children with SPD

socal jan 2011 mili cordero sensory regulation ca

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