Understanding Sensory Processing in The Early Years

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					                                                                             Workshop Objectives
                                                                    • Describe sensory processing and how the senses
     Understanding Sensory                                            develop in infants and young children
                                                                    • Define sensory processing dysfunction in the
  Processing in The Early Years                                       various systems
                                                                    • Learn how to recognize when behaviours may be
                      Liv Elliott and Katrina Millen                  based on sensory issues
                        Occupational Therapists
      Infant and Child Development Services Peel, Mississauga, ON
                                                                    • Provide examples of environmental
                                                                      accommodations and sensory activities using case
               Presented at: The Early Years Conference               studies and hands on activities.
                          February 6th, 2010

   What is Sensory Processing?                                        Terminology can be confusing
• Our senses give us information about each event                   • Sensory Processing (neural level response)
  and activity that we do during the day.
                                                                    • Sensory Integration (organization of
• Our bodies respond to the sensory information                       sensations)
  after our brain has processed it.
• Sometimes the sensory information is noticeably
                                                                    • Sensory Integrative Dysfunction
  pleasant or unpleasant but the vast majority is not               • Sensory Processing Disorder
  consciously registered by us.

   How Do the Senses Develop?                                          How Do the Senses Develop?
• Most activity in the first 5 to 7 years of life                   • Adaptive responses are crucial to the
  contributes to learning how to organize the senses                  development of properly functioning
  from our nervous system.                                            sensory motor systems.
• A newborn hears, sees and feels touch but cannot
  organize what they mean. Most reactions are
                                                                    • They are a result of our reactions to sensory
  reflexes based on survival.                                         information and create the “neural
• As children grow they learn to organize sensations                  pathways”
                                                                      pathways” that later become our automatic
  through adaptive responses (what is important vs.                   responses to events or stimuli.
  what isn’t important).
                              Ayres (1979)

       Pyramid of Sensory Systems and
                Development                                 Development of the Senses
                                                       • Infant - Reflex based reactions; basic emotions
                            Cognition                    associated with the senses; motor learning based
                                                         on sensory input.
                        Perceptual Motor               • Toddler - Exploring the environment through the
                                                         senses and learning adaptive responses through
                  Sensory Motor Development
                                                       • Preschooler - Fine tuning of the perceptual motor
               Sensory Systems (Visual, auditory,        skills and increased attention span/focus.
               tactile, vestibular, proprioceptive)
                                                       • School aged child - Cognitive and social responses
                                                         become more complex.

             Sensory Systems                                       Sensory Systems
The five basic senses are:                             Internal movement senses (hidden
• Vision (focus, tracking)                               senses):
• Hearing (alerting to sound, localizing source)
                                                       • Proprioception – the position and
• Taste (sweet, salty, sour, bitter)
                                                         movement of our muscles and joints
• Smell (important for taste, detect noxious odours)
• Touch (temperature, light touch, pressure,           • Vestibular sense – our head position,
  vibration, pain, discriminative touch)                 body movement in relation to gravity

                         Vision                                           Hearing
• Visual processing - Works in close                   • Auditory processing - Sound waves work in
  conjunction with the vestibular and                    conjunction with the proprioceptive and
  proprioceptive systems. Forms our basic                vestibular systems to make sense of what
  awareness of our environment and the                   we hear. Visual and auditory centres in the
  location of things in it.                              brain work closely together.
• It is necessary for visual processing to             • Integration with the other sensory
  integrate properly with the other senses in            information in the brain is crucial in giving
  order to see meaning in the environment.               meaning to sounds and language.
                            Ayers (1979)

              Taste and Smell                                                           Touch
• Gustatory and olfactory processing - Well               • Tactile processing - One of the senses that
  developed senses in the newborn since they                develops before birth. Touch receptors can
  are important for survival.                               give information about a variety of different
• Creates a variety of behavioural and motor                stimuli. There are touch receptors in our
  (reflex) responses in infants. Responses                  skin as well as in the muscles, ligaments,
  becomes more fine tuned with experience                   joints and in the mouth.
  (i.e. feeding).                                         • Tactile information is an important factor in
                                                            basic neural organization.

               Proprioception                                           Vestibular Sensation
• Deep touch pressure.                                    • Vestibular system develops before we are born
• One of the “hidden” senses.
              hidden”                                     • Receptors located within structures of inner ear
                                                          • Provides information about:
• Sensors are in our muscles, joints, ligaments and            – Movement
  bones.                                                       – Gravity (e.g., changing head positions)
• Keeps us aware of posture and movement.                 • Important for development of control of posture and eye
• Gives us the sense of our body position in space.         movements
                                                          • Acts as “volume control” for all other sensory systems
• Affects how we integrate our other senses
                                                          • Helps with self-regulation, arousal and attention
  including visual, tactile and vestibular.

Why Assess Sensory Processing?                                Sensory Processing Dysfunction
• If it’s impacting on a child’s daily participation in
     it’                  child’                          •   Fussy, irritable babies.
  play and routines.                                      •   Delayed motor and language milestones.
• Interpreting behaviour in infants and children is       •   Avoidance of activities.
  often difficult, particularly when they are not able    •   Lack of interest in exploring environment.
  to communicate verbally.                                •   Clumsy, accident prone children.
• Knowledge of sensory processing helps caregivers        •                            visual-
                                                              Difficulty learning new visual-motor skills.
  to interpret behaviour and helps children be            •   Social-
                                                              Social-emotional challenges.
  successful in everyday activities.                      •   Regulation of attention.

  Visual Processing Dysfunction                                  Auditory Processing Dysfunction
• Under-responsive to input:                                       Under-
                                                                 • Under-responsive to input:
   – Seek visual sensations (e.g., shiny, spinning, fast paced      – Seek auditory sensations (e.g., make noises/sounds with
     objects)                                                         mouth; noisy play)
   – May miss some visual information                               – May not notice some auditory/verbal information
   – Stare at people or actions                                     – Normal hearing test

• Over responsive (sensitive) to input:                          • Over responsive (sensitive) to input:
   – Avoid eye contact; use peripheral vision                       – Cover ears with loud or unexpected noise
   – Easily distracted                                              – Distracted or irritated by noise in surroundings
   – Irritated by or sensitive to light                             – Become distressed in some environments
                                                                    – Normal hearing test

 Gustatory and Olfactory Processing
                                                                   Tactile Processing Dysfunction
• Under-responsive to input:                                       Under-
                                                                 • Under-responsive to input:
   – Seek sensations (e.g., stronger tastes; mouths inedible        – Seek sensations (e.g., deep pressure on body; chew inedible
     objects; smell objects)                                          materials)
                                                                    – Decreased body awareness, “clumsy”
   – May not detect some typical taste/smell sensations             – Slower to respond to touch sensation (e.g., stuffs mouth)
                                                                    – Higher pain threshold
• Over responsive (sensitive) to input:
   – Avoid sensations (e.g., typical diet)                       • Over responsive (sensitive) to input:
   – May react to typical tastes/smells as aversive                 –   Physical/emotional reaction when touched
   – Distracted or irritated by scent in surroundings,              –   Avoid or become distressed in some situations
     comment on odours                                              –   Difficulty tolerating food textures, clothing
                                                                    –                            self-
                                                                        Decreased tolerance to self-care routines

     Proprioceptive Dysfunction                                         Proprioceptive Dysfunction
• Under-responsive to input:                                     • Gravitational Insecurity:
   – breaks toys easily
                                                                    – becomes anxious when moved too quickly or when feet
   – exhibits low muscle tone                                         leave the ground
             under-                         fix”
   – may be under-responsive to touch; may “fix” joints.
                                                                    – moves slowly and carefully
                                                                    – anxious when objects approach
• Seeks proprioceptive input:
   – exhibits deficits in tactile or vestibular systems
   – bites, pushes, hits, scratches or bangs                     • Proprioceptive sensitivity:
   – may appear clumsy                                              – cries in weight bearing positions
   – can exhibit hyperactive or unsafe behaviours (hand             – cries when joints are moved
     biting, head banging)                                          – chooses not to move

               Vestibular Dysfunction                                               Vestibular Dysfunction
• Under-responsive to input:                                             • Gravitational Insecurity:
     – Need more intensity to register movement                             –   Over-
                                                                                Over-react or become fearful with changes in gravity, position
     – Add movement to everything they do                                   –   Avoid stairs, bicycles, playground equipment
     – Difficulty with balance reactions, planning actions and grading      –   Tolerate passive movement of limbs; often able to move actively
       movements → “clumsy”
     – Often need close supervision during play due to decreased            –   May prefer fine motor activities
       awareness of risks                                                • Vestibular sensitivity:
• Seeks vestibular input:                                                   – Feel discomfort or threatened with certain types of movement
     – Crave movement                                                       – Become anxious/insecure, avoid typical childhood activities
     – May not register movement or may need excessive movement to          –                                                             resist
                                                                              Try to prevent movement, become controlling, inflexible or resist
       stay alert and organized                                               participating
     – Screen out uncomfortable sensations from other sensory systems
                                                                            – Problems with self-regulation
     – Difficult to maintain their attention

     Model of Sensory Processing                                             Model of Sensory Processing
Threshold       Passive response           Active response               • Definitions (Dunn, 2006):
High                                                                       Threshold      Passive response           Active response
                                                                           High           Low Registration: The      Seeking: The degree to
                                                                                          degree to which a child    which a child obtains
                                                                                          misses sensory input.      information.
                                                                           Low            Sensitivity: The degree    Avoiding: The degree to
                                                                                          to which a child detects   which a child is bothered by
                                                                                          sensory input.             sensory input.

     Model of Sensory Processing                                             Model of Sensory Processing
• Each person experiences these patterns on a                            • A child with Autism Spectrum Disorder may have
  continuum                                                                the following profile:
• Each sensory system may have a different pattern                          – Low registration in the area of auditory and
  (threshold and type of self-regulation)                                     visual processing.
• Children with autism, ADHD, Asperger’s, Fragile
  X syndrome, developmental and learning                                    – Sensitivity in the area of tactile and oral motor
  disabilities have more intense patterns of sensory                          processing.
  processing; some have distinct patterns                                   – Seeking in the area of visual and vestibular.
• Example →                                                                 – Avoiding in the area of auditory and tactile.

   Model of Sensory Processing                                            Model of Sensory Processing
• Behaviour characteristics:                                          • Accommodations or strategies:
 Neurological                                                           Neurological
 Threshold      Passive response          Active response               Threshold      Passive response         Active response
 High             Misses cues in env.      Adds sensory experiences     High             Provide enriched         Provide structured,
                  Easy going               Constantly moving                           sensory environment to   enriched sensory environment
                  May not be responding    Easily distracted                           improve participation    to improve focus.
                or interacting                                                           Consider all senses.

 Low              Notice sensation more     Bothered by sensations      Low              Reduce sensory input     Reduce sensory input to
                  Easily upset/cry          Overwhelmed/hide/run                       in environment.          improve task completion.
                  Aware of any changes      May become anxious or                        Have a structured,       Offer predictability and
                in environment.           aggressive.                                  predictable routine.     choices to routine.

                  Case Study #1                                                          Case Study #1
• Child in a preschool setting:                                       • Strategies tried:
  – Referred due to poor attention at preschool and                      –   Inflatable seat cushion for table and circle activities
    frequent sensory seeking behaviour.                                  –   Weighted toy at rest time
  – Behaviours noted were: lots of fidgeting;                            –   Chewy tube on end of pencil
    enjoyed erasing his work; chewed on his                           • Recommendations:
    clothes; preference for textured foods. Seemed                       – Increase sensory input throughout day (resistive
    to calm and sit longer when given pressure on                          materials, movement activities)
    arms/shoulders, weighted lap animal.
                                                                         – Sit facing teacher during circle time
                                                                         – Movement break after circle time

                  Case Study #2                                                          Case Study #2
• Child in a home setting:                                            • Strategies tried:
                                                                         –   Remove reinforcer
  – Referred due to safety issues related to
                                                                         –   Use visuals to redirect behaviour, provide choices
    behaviour.                                                           –   Therapy ball activities
  – Behaviours noted were: climbing and falling                          –   Pressure vest
    with no regard for safety; hitting head; jumping                  • Recommendations:
    from furniture to furniture; climbing onto                           – Sensory diet throughout day (scooter board, mini
    counters, fridge; jumping off swing set.                               trampoline, slide, weighted blanket, rough and tumble
                                                                         – Change bath time to evening routine on weekend

                       Case Study #3                                                                 Case Study #3
• Child in a home and preschool setting:                                            • Strategies tried:
                                                                                       –   Therapressure program
     – Referred due to lack of ability to stay in group
                                                                                       –   Weighted lap pad
       activities and choosing to only play on his own.
                                                                                       –   Vibrating massager around jaw
     – Behaviours noted were: Tantrums; constantly                                     –   Pressure vest
       running; climbing onto high surfaces; hitting                                • Recommendations:
       others; biting himself. He also hid under a sheet                               – Sensory diet throughout day (weighted knapsack,
       or under tables at times and squeezed into tight                                                                          work”
                                                                                         therapy ball activities, lots of “heavy work” activities)
       spaces.                                                                         – Providing a place for retreat
                                                                                       – Soft material as a comfort toy

                             Summary                                                                      Resources
• When a child’s behaviour interferes with
           child’                                                                   • www.connectability.ca
  participation in daily activities an OT/sensory                                      – Sensory Workshop → Sensory Areas → Sensory List
  assessment should be considered.                                                     – Activity and material ideas for children who seek or
                                                                                         limit different types of sensory input
• “Hidden” sensory systems often have the greatest
  impact on behaviour.
                                                                                    • http://www.hceip.org
• Understanding how a child processes sensory                                          – Sensory Observation Guide
  information can help with increasing a child’s                                       – Lists concerns that may indicate sensory processing
  success during play and participation in                                               difficulties
  meaningful everyday activities.                                                                      12-
                                                                                       – 0-12 months; 12-18 months; 18 months – 3 years

•                                                               Angeles:
    Ayres, A. J. (1979). Sensory Integration and the Child. Los Angeles: Western
    Psychological Services.
•   Dunn, W. (2007). Supporting children to participate successfully in everyday
    life by using sensory processing knowledge. Infants & Young Children. 20(2):
•                                                               CanChild
    Pollock, N. (2006). Keeping current in sensory integration. CanChild Centre
    for Childhood Disability Research, McMaster University.
    http://www.canchild.ca/Default.aspx?tabid=1237. June 24, 2008.
•                                                                 Nature
    Roley, S., Blanche, E., Schaaf, R. (2001). Understanding the Nature of
    Sensory Integration with Diverse Populations. U.S.A.: Therapy Skill Builders.
•                                                                     Run?”
    Williams, M., Shellenberger, S. (1996). “How Does Your Engine Run?”.
    U.S.A.: TherapyWorks Inc.
•                                                              Through
    Yack, E., Sutton, S., Aquilla, P. (1998). Building Bridges Through Sensory
    Integration. Weston, ON.