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Keeping It Together at School Sensory_ Emotional and Behavioral

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					  Keeping It Together at School:
Sensory, Emotional and Behavioral
         Self-Regulation

                  Karen R. Gouze, Ph.D.
               Children’s Memorial Hospital
    Northwestern University Feinberg School of Medicine
                    February 25, 2011
          Self-Regulation
Definition:
– The individual’s ability to actively control
  arousal and one’s responses to it
– Self-regulation occurs in the context of
  goal attainment
– Mental health is the ability to love well,
  play well, work well, and expect well
– Ability to self-regulate is critical to all
  areas
Developmental Progression of Self-
      Regulatory Processes
Infants have basic self-regulatory
mechanisms—perhaps best captured in
notions of temperament
Sensory reactivity has long been
subsumed under the construct of
temperament.
CFA of Rothbart temperament, sensory
regulation yielded three distinct factors—
negative affectivity, effortful control,
sensory regulation (Gouze et al., 2010)
     Regulation Milestones
At 6 months- Babies should be able to
tolerate and enjoy being moved and
touched. They can sustain interest in an
object or person for more than a minute.
Can usually self console.
A 9 month old – should be able to play
with one toy for two to three minutes, and
attend to a speaking person or look at
pictures in a book.
     Regulation Milestones
At 12 months- an infant should be moving
to musical rhythm and sleeping twelve to
fourteen hours at night with naps once or
twice daily.
At 18 months- A toddler should enjoy
messy play and be demonstrating
preferences for toys. They should be
sleeping ten to twelve hours and napping
one time for three hours.
     Regulation Milestones
At 24 months- a toddler should be playing
by self for a few minutes, as well as freely
playing with playdoh, paint or other such
substances. They should enjoy rough
house play, most playground equipment.
Three year olds- Should show strong
independent drives. May not nap anymore.
They should be able to participate in circle
time and interactive games.
   Areas of Self-Regulation
Behavior Regulation
Emotion Regulation
Attention Regulation
Sensory Regulation
      Behavior Regulation
The ability to inhibit inappropriate
behavioral responses
The ability to choose appropriate
behavioral responses
Inhibiting or choosing behaviors in
response to internal emotional states
(Eisenberg, et. al., 2000)
Early social information processing models
of externalizing disorders focused on this
approach
       Emotion Regulation
Definitional disagreements
Garber & Dodge (1991)-
– ―Emotion is like pornography: The
  experts have great difficulty defining it
  but we all know it when we see it‖
       Emotion Regulation
Cole et. al. (2004)
– Changes associated with activated emotions
– Valence of emotion is irrelevant
– Can include changes in the emotion itself
  (intensity, frequency)
– Also includes changes in other psychological
  processes-e.g. memory
Emotion as regulating and emotion as
regulated
      Attention Regulation


Ability to focus and sustain attention
Ability to shift attention when appropriate
      Sensory Regulation
―The ability to regulate and organize
reactions to sensations in a graded and
adaptive manner‖ (McIntosh et al., 1999)
Includes sensory modulation primarily but,
more broadly speaking, sensory
processing disorder includes:
– Sensory modulation
– Sensory discrimination
– Sensory-based motor disorder
Sensory Processing is an important aspect of
normal brain function, enabling us to take in
and make sense of many different kinds of
sensation coming into the brain along different
sensory channels at the same time. The ability
to make adaptive responses is dependent upon
adequate sensory processing. (Hanschu, p.6)
  “We live on the leash
of our senses”
       Diane Ackerman
       A Natural History of the Senses, 1990
Relationships Between Self-Regulation
  and Adaptive School Functioning
 Behavior Regulation
 – The ability to suppress an inappropriate
   behavioral response.
 – The ability to sit still, follow directions, inhibit
   impulsive responses (including hitting,
   shouting out answers, etc.).
 – The ability to stand in line, walk down the
   halls quietly, take out the appropriate work,
   follow teacher directions.
Relationships Between Self-Regulation
  and Adaptive School Functioning
 Emotion Regulation
 – The ability to tolerate frustration (e.g. a
   difficult assignment)
 – The ability to delay gratification—to wait for
   something you want (e.g. wait your turn to
   speak).
 – The ability to modulate your emotional
   responses to others—manage feelings of
   anger, sadness, happiness.
Relationships Between Self-Regulation
  and Adaptive School Functioning
 Attention Regulation
 – Ability to maintain and focus attention is
   critical to school success- (e.g. to attend to
   lessons, complete assignments, etc.)
 – Ability to shift attention as needed is critical to
   school success (e.g. to transition from one
   subject to another or one task to another)
 – Many believe that the ability to regulate
   attention is also critical to the regulation of
   emotion (Posner & Rothbart, 2000)
Relationships Between Self-Regulation
  and Adaptive School Functioning
 Sensory Regulation:

 – Related to most aspects of adaptive
   functioning.
 – The ability to respond in behaviorally
   appropriate ways.
 – The ability to manage one’s emotional
   responses.
 – The ability to regulate one’s attention.
Sensory Regulation and the School
          Environment
 Sensory Regulation:

 – Difficulty managing the noise, smells,
   movement, textures of everyday life.
 – Difficulty standing in line, staying seated,
   managing lunch room noise and jostling.
 – Difficulties in the classroom, the gym, the
   lunchroom, the hallways
The Relationship Between SPD and
 Emotional and Behavior Disorders
Increasing evidence for a relationship
between poor sensory processing and:

– ADHD (Dunn & Bennett, 2002; Mangeot et
  al., 2001; Parush et al., 1997).
– Externalizing disorders (Ben-Sasson et al.
  2009; Gouze et al., 2009; Gunn, 2008).
– Internalizing disorders (Goldsmith et al., 2006;
  Gouze et al. 2009).
– Later fearfulness (Calkins et al., 1996).
Relationships between Self-Regulation and
           Adaptive Functioning


 Parents of children with SPD report impaired
 daily functioning across a range of daily activities
 (Dunn, 1997, 2001).
 Parents of children with sensory over-
 responsiveness report more early and
 concurrent socio-emotional problems and lower
 levels of adaptive skills than parents without
 these problems (Ben-Sassoon et al. 2009)
Relationships Between Self-Regulation and
       Adaptive School Functioning


 Sadhwani and colleagues (2006) found a strong
 positive relationship between good sensory
 processing and the development of effortful
 control.
 Effortful control is critical in school to the ability
 to apply oneself persistently to a difficult task
 and manage one’s emotions.
Relationships between Self-Regulation and
           Adaptive Functioning


 Children with SPD show a range of problems
 with other aspects of self-regulation including
 attention and emotion regulation, differential
 physiological reactivity and emotional and
 behavior problems.
  The Relationship Between SPD and
   Emotional and Behavior Disorders
PACT (NIMH RO1- MH063665, PI- John
Lavigne, Ph.D. )
Findings:
– 33%- 63% of 4 year old children with SPD
  (based on a short sensory profile) have
  another psychiatric disorder—ODD, ADHD,
  depression, or anxiety.
– 37%-67% have only SPD
     Aims of PACT Study
– To examine the constitutional
  (temperament, sensory regulation) and
  psychosocial (attachment, parenting)
  factors contributing to externalizing and
  internalizing disorders in 4-year-olds.
– To determine whether psychosocial
  variables mediate the relationships
  between constitutional vulnerability and
  disorder.
             Participants
N = 796 children and their parents
Age 4-5 years (mean = 4.6)
Gender
– 389 (48.8%)boys
– 401 (50.3%) girls
Ethnicity
– 451 (56.6%) Non-Hispanic White children
– 136 (17.1%), African American children
– 158 (19.8%), Hispanic children
                     Measures
Temperament: Child Behavior Questionnaire (CBQ;
Rothbart, Ahadi, Hershey & Fisher, 2001 )
Sensory Regulation: Short Sensory Profile (McIntosh
et. al. 1999)
Attachment: Attachment Q-Sort (AQS; Vaughn & Waters,
1990)
Parenting
 – Parenting Behavior Inventory (Lovejoy et al., 1999)
 – Three Boxes Task (NICHD Early Child Care Research
   Network, 1999)
Symptoms of disorders : Child Symptom Inventory
(Gadow &Sprafkin, 2002)
 Reducing Measure Contamination
Expert ratings were used to reduce item
 overlap on temperament, sensory
 regulation and symptom measures.
 Items on each measure were rated on
 Likert scales.
 Mean ratings were used to eliminate
 overlapping items from each scale.
 Sensory Items Retained After
       Expert Ratings
13 Pure Sensory Items were retained from
the following scales:
– Tactile
– Movement
– Low energy
– Visual-auditory
– Taste
  Sensory Items Eliminated by
            Experts
Two scales were eliminated as containing
items that were more closely related to
temperament or emotional/behavior
disorder:
– Seeks sensation
– Auditory sensitivity
Predictors of ODD Symptoms
Overall model contributed 33% of the
variance
– (F= 54.45 (7,788), p<.0001)
Significant predictors
– Sensory Regulation (β =-.34)
– Effortful Control (β = -.19)
– PBI Hostile/Coercive Parenting (β =.23)
– AQS (β =-.10)
   Mediators of Constitutional
           Variables
Mediators of relationship between SR and
ODD
– PBI Hostile/coercive parenting
– Attachment
Mediators of relationship between EC and
ODD
– PBI Hostile/coercive parenting
– Attachment
Predictors of ADHD Symptoms
Overall model contributed 42% of the
variance
– (F= 83.15 (7,788), p<.0001)
Significant predictors
– Sensory Regulation (β =-.35)
– Effortful Control (-.33)
– PBI Supportive/Engaged Parenting (β = .07)
– Positive Parenting (β = -.07)
– PBI Hostile/Coercive Parenting (β =.16)
– AQS (β =-.12)
   Mediators of Constitutional
           Variables
Mediators of relationship between SR &
ADHD
– Positive parenting,
– PBI Hostile/Coercive Parenting
– AQS
Mediators of relationship between EC &
ADHD
– Positive parenting,
– PBI Hostile/Coercive Parenting
– AQS
Predictors of GAD Symptoms
Overall model contributed 38% of the
variance
– (F= 68.59 (7,788), p<.0001)
Significant predictors
– Sensory Regulation (β = -.46)
– Effortful Control (β = -.19)
– PBI Hostile/Coercive Parenting (β = .13)
– AQS (β = -.09)
   Mediators of Constitutional
           Variables
Mediators of relationship between SR &
GAD
– PBI Hostile/coercive parenting
– Attachment
Mediators of relationship between EC &
GAD
– PBI Hostile/coercive parenting
– Attachment
Predictors of MDD Symptoms
Overall model contributed 29% of the
variance
– (F= 45.51 (7,788), p<.0001)
Significant predictors
– Sensory Regulation (β = -.38)
– PBI Supportive/Engaged Parenting (β = -.08)
– PBI Hostile/Coercive Parenting (β =.14)
– Positive Parenting (β = -.07)
– AQS (β = -.09)
   Mediators of Constitutional
           Variables
Mediators of relationship between SR & MDD
– PBI Supportive/Engaged Parenting; Positive
  parenting
– PBI Hostile/Coercive Parenting
– Attachment
Mediators of relationship between EC & MDD
– PBI Supportive/Engaged Parenting; Positive
  Parenting
– PBI Hostile/Coercive Parenting
– Attachment
               Discussion
Both constitutional and psychosocial variables
are related to concurrent measures of
internalizing and externalizing disorders but
different patterns emerge.
Sensory regulation was the only variable related
to every disorder.
Negative affect was not related to any of the
disorders.
Effortful control was related to both externalizing
disorders and GAD, but not to MDD
       Acknowledgments

This research was supported by NIMH grant
#RO1MH063665, PI: John Lavigne, Ph.D.
Research assistants
– Kyla Aimone, Hyo Bae, Karyn Brasky, Elisabeth
  Carrigg, Helen Chee, Vanessa Christian, Maria
  D’Aniello, Carly Demopoulos, Ilana Gonik, Bryce
  Hella, Jamie Howard, Jen Keller, Lindsay Pate,
  Ginger Robinson, Edna Romero, Joshua Shulruff,
  Jen Strickland, Roberto Uribe
Thanks to the parents and children who
graciously allowed us into their homes.
  The Relationship Between SPD and
   Emotional and Behavior Disorders
Are SPD and emotional and behavior
disorders separate?
– Yes, remember 37%-67% of SPD children in
  this sample did not have any emotional or
  behavior problems BUT:
– SPD is clearly a significant risk factor for the
  development of emotional and behavior
  problems AND:
– SPD and emotional and behavior problems
  often occur co-morbidly.
 So, how do we understand and clinically
address these relationships?
Sensory regulation is critical for healthy
child development—for the development
of self-efficacy, feelings of mastery,
identity and understanding one’s place in
the world.
Self-regulation is critical for adaptive
functioning.
        Meet Jorge, age 6
Problems at home

– Uncooperative
– Unresponsive
– Hard to move through the day
– Moody and anxious
– Disorganized
Problems at school:

– Incomplete work
– Disorganized
– Difficulty ―getting started‖
– Uneven academic skills
– Clumsy
Problems with peers:

– Difficulty making friends
– Perceived as aggressive
– Left behind in group settings
– Withdrawn on playground
School Observation
   Thinking About Jorge Through a
            Sensory Lens


Who He Is                      What
                              Happens
            What He Must Do    Success
                                or
Where He Is                    Failure
          Looking at Jorge
      Through the Sensory Lens
Who He Is:

  – Auditory defensiveness
  – Poor proprioceptive discrimination
  – Proprioceptive insensitivity
  – Poor tactile discrimination
            Other Lenses
Attentional Lens
    Inattentive ADHD

Learning Lens
    Visual-spatial deficits
    Slow processing speed
Where He Is:

  – Loud classroom
  – Restricted desktop space
  – Crowded classroom
  – Cluttered visual environment
What He is Expected to Do:

  – Work independently
  – Cut, paste, assemble project parts in
    sequence
  – Look up/down and back/forth from board
    to desktop to copy model of project
  – Stay seated
  – Screen out irrelevant noise and
    movement
  – Keep materials organized on desktop
   Jorge: It’s Not That Simple
Multiple lenses are required to understand
Jorge:
– Sensory challenges
    At home
    At school
    With peers
– Attentional challenges
– Family issues
   Helping the Dysregulated Child

The role of the occupational therapist
– Experts in the treatment of sensory regulation
The role of the educator
– Experts in learning and the technology of
  instruction
The role of the psychologist
– Experts in the treatment of behavioral and
  emotional regulation
Quick Review of the Basics of SPD
 Three areas of sensory processing disorder:

 – Sensory modulation
 – Sensory discrimination
 – Sensory-based motor planning
      Dysfunctional Modulation:
          Hypersensitivity

Sensory Experience   Observable Behavior
  too loud            hyper-responsive
  too rough           overwhelmed
  too bright          anxious
  too spicy           holds back, withdraws
  too ―scratchy‖      resistant
  too fast            overstimulated
       Dysfunctional Modulation:
         Sensory Insensitivity
Sensory Experience   Observable Behavior
  too soft            tuned out
  too low             sensory-seeking
  too slow            hypo-responsive
  too bland           clumsy
  too loose           messy
                      overactive
                      risk-taking
              Remember:

Dysfunctional modulation can be either
over- or under-sensitivity.
It can also be a problem of dysregulation,
a shifting between the two extremes.
Like poor radio reception, the signal does
not come in clearly or consistently.
Some Daily Challenges for the Child
  with Poor Sensory Modulation

Tolerating noise, making noise.
Personal space.
Seeking stimulation in inappropriate ways or at
inappropriate times.
Staying seated, postural control.
Interpreting the emotions and reactions of others
accurately.
    Dysfunctional Discrimination

Difficulties telling whether sensory input is
near/far, hard/soft, coming from the
left/right or front/back, threatening/benign,
relevant/irrelevant.
These mis-interpretations can interfere
with fine-motor skills, early learning, social
functioning and appropriate behavior.
Some Daily Challenges for the Child
 with Poor Sensory Discrimination

Finding things in a cluttered desk.
Tying shoes.
Recognizing ABCs.
Picking out an object in a large array, e.g.
on a bulletin board or worksheet.
Handwriting
Interpreting social cues
    Dysfunctional Motor Planning

When sensory modulation or
discrimination are compromised, a child
cannot efficiently conceptualize, plan, or
carry out (and remember) motor
movements.
Her behavior may appear disorganized,
erratic, clumsy, off-task or uncoordinated.
Ideational dyspraxia: difficulty ―knowing
what to do‖ or getting started on unfamiliar
or complicated motor tasks.This leads to
trouble with self-directed and self-initiated
activities.
      Some Daily Difficulties for
  the Child With Poor Motor Planning
Learning to talk
Riding a bicycle
Cutting and pasting
Team sports
Getting dressed
Getting started on a school project
Learning a line dance
  School: A Continuous Sensory
             Assault


School is a potential nightmare for the child
    with sensory processing problems.
Poor Sensory Regulation at School
A student with inefficient sensory processing
  is likely to have trouble:
  Learning new information
  Demonstrating what she knows
  Behaving appropriately in the classroom
  Moving herself through the daily routines.
Sensory Processing and Learning

The relationship between sensory processing
and academic achievement has not been well
studied but large numbers of sensory
dysregulated children have learning disabilities.
It is reasonable to assume that sensory
processing problems will affect learning in both
direct and indirect ways.
The more ―mismatches‖ between a child and her
school environment, the greater the potential for
interference in learning.
             Types of Help
This child will need help from teachers and
 other school personnel in these areas:
 Decreasing sensory arousal
 Organizing herself/focusing on work
 Following directions
 Managing her emotions
 Getting along with peers
       Using the Sensory Lens
Use the sensory lens to look for
 ―mismatches‖ between:
  the child’s sensory capacities
  the sensory characteristics of the
 classroom
  the sensory demands of the activity she
 has been assigned.
Remember……….
    Looking Through a Sensory Lens



Who He Is                      What
                              Happens
            What He Must Do    Success
                                or
Where He Is                    Failure
Distinguishing SPD, Emotional and
        Behavior Problems
 Evan’s story
Distinguishing Sensory, Emotional and
         Behavioral Problems

 Not always possible.
 Think of a key and its many notches.
 Try using a good functional behavior
 analysis.
      Using the Behavioral Lens
Use the behavioral lens to look for
 ―mismatches‖ between:
  the child’s behavioral capacities (e.g. self-
 control, ability to inhibit)
  the behavioral characteristics of the
 classroom (e.g. clear vs. unclear rules)
  the behavioral demands of the activity she
 has been assigned (requires quiet, sitting
 still, etc.).
       Using the Emotional Lens
Use the emotional lens to look for ―mismatches‖
 between:
  the child’s emotional capacities (e.g. frustration
 tolerance, tolerance of disappointment)
  the emotional characteristics of the classroom
 (e.g. affectively charged vs. affectively neutral)
  the emotional demands of the activity she has
 been assigned (task that causes strong arousal).
        Using the Attentional Lens

Use the attentional lens to look for ―mismatches‖
 between:
  the child’s attentional capacities (e.g.persistent
 focus, attentional shifting))
  the attentional characteristics of the classroom
 (e.g. lots of distractions)
  the attentional demands of the activity she has
 been assigned (e.g. amount of focused attention
 required for task completion).
      Individual Solutions
How to analyze a situation to determine
sensory, behavioral, emotional
contributions to the problem.
  Functional Behavior Analysis


Looks beyond the behavior itself.
Identifies child specific cognitive,
emotional, social and\or environmental
factors associated with the occurrence or
non-occurrence of a behavior.
       Functional Analysis

Day and time
Problem incident
Behavioral, emotional, sensory
characteristics of the environment
Behavioral, emotional, sensory
characteristics of the task
Already identified behavioral, emotional,
sensory characteristics of the child.
        The Sensory Diary
Child’s response
Teacher’s response
Recovery--how long it took and how it was
accomplished
Think about using different lenses--who
the child is, where he is, what he is being
asked to do. What fits best?
       Program for Jorge
Must take into account:
          Looking at Jorge
      Through the Sensory Lens
Who He Is:

  – Auditory defensiveness
  – Poor proprioceptive discrimination
  – Proprioceptive insensitivity
  – Poor tactile discrimination
   Looking at Jorge Through a
        Behavioral Lens
After sensory issues not too many
behavioral issues left—aggression (the
major behavioral issue) appears to be
related to sensory issues.
Looking at Jorge Through an Emotional
                 Lens
 Gets flooded emotionally when he cannot
 be successful.
 Feels inadequate leading to emotional
 ―shut-down‖
    Looking at Jorge Through an
          Attentional Lens
Inattentive ADHD—difficulty sustaining
focus even in quiet situations.
Where He Is:

  – Loud classroom
  – Restricted desktop space
  – Crowded classroom
  – Cluttered visual environment
What He is Expected to Do:

  – Work independently with sustained
    focus.
  – Cut, paste, assemble parts in sequence.
  – Look up/down and back/forth from board
    to desktop to copy model of project.
  – Stay seated.
  – Screen out irrelevant noise and
    movement.
  – Keep materials organized on desktop.
    Proposed Interventions
Desk organizer
Come in earlier than the crowd of
classmates.
Organize area for entire class for
backpacks and coats.
Give Jorge work packet at his desk to
minimize looking up and down.
Sensory shelter area for work/noise
blocking headphones.
    Proposed Interventions
Additional time for writing/ability to take
unfinished assignments home without penalty.
Lots of praise for progress.
Medication for inattentive ADD.
Family therapy with behavioral/emotional
emphasis to manage tasks of daily living and
provide a sense of positive self worth.
Occupational therapy in and out of school for
sensory and fine motor issues.
     School Based Interventions

Be preventive
Use a collaborative problem solving approach
(see Ross Greene: ―The Explosive Child‖, ―Lost
at School‖)
Use a functional analysis to determine when and
how to intervene.
Think ―multi-determined‖.
        The Sensory Diet


Be preventive—use a sensory diet
          The Sensory Diet

A sensory diet is the assortment of
sensory experiences a child (or grown up)
is exposed to on a regular basis. The type,
timing, intensity and duration of these
experiences determine their influence on
the child’s mind, body, behavior and
emotions.
    A Healthy Sensory Diet
Movement and Balance
– Jumping
– Swinging
– Pushing/Pulling
– Rocking
– Sitting assists
     A Healthy Sensory Diet
Touch
– Swaddling
– Weighted Blankets/Vests
– Bear Hugs
– Massage
– Textured Play
     A Healthy Sensory Diet


Volume Control
– Hideaways
– Lighting, Colors, Smells, Sounds
– Relaxation
By raising a child’s awareness of her
sensory diet, you are teaching her to
tune in to her body and to recognize
and respect her sensory needs.
   Helping a Child to Help Himself

Talking honestly about sensory sensitivities and
behavioral and emotional difficulties helps a
child become aware of his own needs.
Problem-solving difficult situations from all
perspectives allows him to accept his
vulnerabilities and teaches him how to recognize
and accommodate them.
Emphasizing his strengths encourages him to
persevere.
Examples of Sensory Modifications
 Challenge                    Modification
 – Lockers/proximity,         – Locate locker at end of
   spacing, fine motor          row, key or additional
                                time
 – Lunch/noise level,         – Lunch alternative,
   crowds, seating,             perimeter seating,
   carrying tray                beginning or end of
                                lunch line
 – Music class/noise          – Sensory shelter or ear
   level, pitch sensitivity     plugs
Examples of Sensory Modifications
 Challenge                Modification
 – Classroom noise        – Place in quiet
                            classroom, earplugs,
                            sensory breaks
 – Anxiety/stress with    – Early warning for
   changes in routine       changes


 – Writing difficulties   – Word processing,
                            dictation, notetaker
Examples of Sensory Modifications
 Challenge                  Modification
 – Seating/furniture        – Seat at perimeter,
   height, traditional        cushion, leave room
   posture, movement,         for minor movement,
   space                      bands on chair legs

 – Physical                 – Consult with
   education/uniform,         PE/PT/modification to
   changing time, locker,     classes, alternate
   echo                       uniform (or
                              undergarment), key
Behavioral Intervention at School
Good behavioral control requires:

– Building a positive relationship.
– Lots of praise.
– Clear and reasonable expectations.
– Predictable consequences for misbehavior.
Behavioral Interventions at School
Behavior management programs:

 – Select a few target behaviors.
 – Make sure the child understands the
   behavioral goals.
 – Select short time periods—the goal is for the
   child to be successful.
 – Be consistent with earned rewards.
 – Communicate with home.
Behavioral Interventions at School
Stay away from power assertive
approaches.
Plan ahead—avoid situations that create
sensory or emotional discomfort.
Discriminate between ―must do‖ and
optional tasks.
Behavioral Interventions at School
Effective consequences are:

 – Immediate
 – Logical
 – Fair (smaller works better than larger)
 – Universally applied
 – Enforceable
 Common Behavioral Pitfalls
Too many target behaviors.
Target behaviors are vague or subject to
interpretation.
Too long a time period until feedback.
Poor reward structure.
Rewards are not given or are withheld.
No connection between school and home.
Child does not understand the program.
 Sample Behavioral Program
Jorge:
 – Reward task completion.
 – Set goal to complete ―morning work‖ in
   packet.
 – Start with completion of smaller amount of
   work.
 – Immediate reinforcement—a sticker on an
   index card that goes home to mom.
 – Possible reward in school—special job/help
   teacher (requires 80% success in week).
 – Gradually increase demands.
Emotional Interventions at School
Modeling- a calm teacher is the best
model.
Emotional reactivity causes adults to be
more emotionally reactive.
Down-regulate the emotions in the
classroom.
Allow for emotional ―chill-outs‖
Emotional Interventions in School
Cognitive-behavioral techniques

– Teach children to recognize physical cues.
– Teach children the language of emotion.
– Teach children relaxation techniques.
– Thought stopping.
– Changing channels.
– Cool tools.
             Relaxation
Breathing exercises
Visual imagery—e.g. ―turtle‖, a ―web‖, a
calming place
Deep muscle relaxation
Sensory shelters
Other sensory input
       Thought Stopping
Teach children the relationship between
thoughts, feelings, and actions
Teach them control over their thoughts
Externalizing the problem—‖what can you
do to keep anger out when he comes
knocking on your door?‖
      Changing Channels
Thought switching—shifting from negative
to positive thoughts
Use cartoon imagery and thought
bubbles—have children practice, practice,
practice
             Cool Tools
Have children make a ―tool box‖ with their
favorite techniques
Reward them for using their ―cool tools‖
Use story telling to reinforce the use of
―cool tools‖
Identify ―Islands of Competence‖
Identify children’s strengths.
Provide opportunities for these strengths
to flourish and be publicly celebrated.
Allow child to ―shine‖ in these areas.
Find adult supports-critical for these
children. (De-escalation requires a trusting
relationship).
Children are much less likely to be
reactive if they feel appreciated!
  Social Challenges in School
For a child with sensory modulation
difficulties:
    Noise may seem louder
    Scrapes may be more painful
    Tumbling and jostling may be threatening
    High fives may be too hard
    May always be ―in your face‖
   Social Challenges in School
For a child with sensory discrimination
difficulties:
    Difficulty with group projects involving
    planning and assembly.
    Difficulty telling when a peer’s touch is
    friendly or fearsome.
    Difficulty discriminating emotional
    expressions.
  Social Challenges in School
A child with poor motor planning might
have difficulty with:

    Baseball
    Basketball
    Hopscotch
    Four Square
    Other recess activities
 Social Challenges at School
For a child with behavioral regulation
difficulties:
    Waiting his turn might be difficult
    Not grabbing things that are appealing is
    harder
    Not saying the first thing that comes to his
    mind is a challenge
 Social Challenges at School
For a child with emotional regulation
difficulties:
    Tolerating others’ negative emotions.
    Delaying gratification.
    Tolerating frustration.
    Managing uncomfortable feelings.
    Modulating anger.
 Social Challenges at School
A child with attention regulation issues
might have difficulty:
    Shifting attention to new games or
    activities.
    Maintaining interest in a given social
    exchange or activity.
    Following quickly paced social interactions.
          Being in Control

Children with self regulation
difficulties often feel assaulted or out
of control. Their response is to be
rigid and controlling—a sure fire way
to alienate their teachers and their
peers.
     Difficulties with Recess

Difficulty organizing themselves or
others.
Difficulty managing more than one
child at a time.
Difficulty translating their ideas into
action.
 Difficulties with Structured Group
               Activities

Motor demands may be too difficult.
May take them longer than others to
manage the task so they lag behind
their peers.
For many sensory kids, ―two is
company, three is a crowd‖.
 Social Interventions at School


Alternatives to lunch/recess.
Social skills groups.
Classroom based bullying interventions.
Help the child select activities at which she
can be successful.
          The Helping Team
Children with sensory, behavioral, emotional
 and social problems often have multiple
 needs:
 They may require extra instructional support.
 They may be eligible for special education
 services.
 They may be on medication.
 They may benefit from counseling or social work
 services.
              The Helping Team
Their team of helpers may include:
  –   Classroom teachers
  –   Parents
  –   Occupational therapist
  –   LD specialist
  –   Speech/language therapist
  –   School psychologist
  –   Behavior specialist
  –   Private therapist
  –   Other people at school important to the child
           The Helping Team
The purpose of the team is to recommend
  strategies to help the child succeed.
  Focus on child’s strengths as well as her
  weaknesses.
  Improve sensory climate and reduce/alter
  sensory demands placed on child.
  Implement appropriate behavioral and emotional
  interventions.
  Work toward the ―just-right challenge.‖
            Conclusions

There are no magic bullets.
The sensory lens can be a helpful guide.
Sensory sensitive solutions require
stepping back, analyzing the situation,
generating solutions, and trying them out.
Behavioral, emotional and social
interventions are necessary adjuncts to
sensory interventions!
                       References

Ackerman, D. (1990). A natural history of the senses. New York: Random
House.
Ben-Sasson, A.; Carter, A.S.; & Briggs-Gowan (2009) Sensory over-
responsivity in elementary school:Prevalence and social-emotional
correlates. Journal of Abnormal Child Psychology, 37 (5), 705-716.
Calkins, S.D., Fox, N.A. & Marshall, T. (1996). Behavioral and physiological
antecedents of inhibited and disinhibited behavior. Child Development, 67,
523-540.
Cole, P.M.; Martin, S.E.; & Dennis, T.A. (2004). Emotion regulation as a
scientific construct: Methodological challenges and directions for child
development research. Child Development, 75, 377-394.
Dunn, W. (1997). The impact of sensory processing abilities on the daily
lives of young children and their families: A conceptual model. Young
Children, 9(4), 23-35
                        References
Dunn, W. (2001). The Sensations of Everyday Life: Empirical, Theoretical
and Pragmatic Considerations. The American journal of Occupational
Therapy, 55(6), 608- 620.
Dunn, W., & Bennett, D. (2002). Patterns of sensory processing in children
with attention deficit hyperactivity disorder. Occupational Therapy Journal of
Research, 22, 4-15.
Eisenberg, N., Guthrie, I. K., Fabes, R. A., Shepard, S. A., Losoya, S. H.,
Murphy, B. C., et al. (2000). Prediction of elementary school children's
externalizing problem behaviors from attentional behavioral regulation and
negative emotionality. Child Development, 71(5), 1367-1382
Gadow, K. D., & Sprafkin, J. (2000). Early Childhood Inventory 4 Screening
Manual. Stonybrook, NY: Checkmate Plus.
Garber, J. & Dodge, K.A.(Eds.) (1991). The Development of Emotion
Regulation and Dysregulation. New York: Cambridge University Press.
                      References

Goldsmith, H.H., Van Hulle, C.A., Arneson,C.L., Schreiber, J.E., &
Gernsbacher, M.A. (2006). A population- based twin study of parentally
reported tactile and auditory defensiveness in young children. Journal of
Abnormal Child Psychology, 34(3), 393-407.
Gouze, K.R., Hopkins, J., LeBailly, S.E., & Lavigne, J.V. (2009). Re-
examining the epidemiology of sensory regulation dysfunction and comorbid
psychopathology. Journal of Abnormal Child Psychology, 37 (8), 1077-
1087.
Gouze, K.R.; Lavigne, J.V., Hopkins, J.; Bryant, F., & LeBailly, S.A. The
relationship between temperamental negative affectivity, effortful control
and sensory regulation, Unpublished manuscript.
Greene, R. W. (1998). The explosive child: A new approach for
understanding and parenting easily frustrated ―chronically inflexible‖
children. New York: Harper Collins.
                        References

Greene, R.W. (2008). Lost at school: why our kids with behavioral
challenges are falling through the cracks at school and how we can help
them. New York: Scribner.
Gunn, T.E. (2008) Relationship between sensory deficits, oppositional
defiant disorder, and externalizing behaviors in an urban preschool
population. Dissertation Abstracts International: Section B: The Sciences
and Engineering, 68(11-B),
Hopkins, J., Gouze, K.R., Sadhwami, A., Radtke, L. LeBailly, S. A. &
Lavigne, J.V. (2008) Temperament, sensory regulation, parenting, and
attachment differentially lead to internalizing and externalizing behaviors in
4-year olds. Paper presented at the 20th Annual Association for
Psychological Science Convention, Chicago, IL.
                        References
Lovejoy, C. M., Weis, R., O’Hare, E., & Rubin, E. C. (1999). Development
and initial validation of the Parent Behavior Inventory. Psychological
Assessment, 4, 1-12.
Mangeot, S.D., Miller, S.J., McIntosh, D.N., McGrath-clarke, J., Simon, J.,
Hagerman, R.J., & Goldson, E. (2001). Sensory modulation in children with
attention deficit hyperactivity disorder. Developmental Medicine & Child
Neurology, 43, 399-406.
McIntosh, D.M., Miller, L.J., Shyu, V., & Hagerman, R.J. (1999). Sensory-
modulation disruption, electrodermal responses, and functional behaviors.
Developmental Medicine and Child Neurology, 41, 608-615
NICHD Early Childhood Research Network (1999). Child care and mother-
child interaction in the first three years of life. Developmental Psychology,
35, 1399-1413.
                        References
Parush, S., Sohmer, H., Steinberg, A. & Kaitz, M. (1997). Somatosensory
functioning in children with attention deficit hyperactivity disorder.
Developmental Medicine & Child Neurology, 39, 464-468.
Posner, M. I. & Rothbart, M. K. (2000).Developing mechanisms of self-
regulation. Development and Psychopathology, 12, 427-441.
Rothbart, M. K., Ahadi, S. A., Hershy, K. L., & Fisher, P. (2001).
Investigations of temperament at three to seven years: The Children's
Behavior Questionnaire. Child Development, 72(5), 1394-1408.
Sadhwani, A.; Bae, H.; Strickland, J.; Gouze, K.; Hopkins, J.; & Lavigne, L.
(2006) Do parenting behaviors moderate the relationship between negative
affect, sensory processing, and effortful control? Poster presentation at the
Biennial Meeting of the Society for Research in Child Development, Boston,
MA.
Vaughn, B. E., & Waters, E. (1990). Attachment behavior at home and in
the laboratory: Q-Sort observations and Strange Situation classifications of
one-year-olds. Child Development, 61, 1965-1973.

				
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