Sensory Regulatory Processing –

Bodies That Tell Stories

DIR® Regional Institute

Session 3
Milagros J. Cordero, EdD, OTR/L
What Do We Want
for Our Children?
Axis III –
Regulatory-Sensory Processing
Capacities
Type I - Sensory Modulation (challenges)
Type II - Sensory Discrimination
(challenges)
Type III - Sensory Based Motor
(challenges) Abilities, including postural
control and motor planning
Regulatory Sensory Processing
Capacities - Definition
isa term that refers to the way the
nervous system receives messages from
our senses and turns them into appropriate
motor and behavioral responses
Sensory Processing Development –
A Continuum
The behaviors observed in a child will
exist in a continuum
◦ from within typical guidelines and its
variations to
From newborn until toddler – In alertness / Diffuse
From toddler to pre-school – Transitional Period
By kindergarten – Discriminatory/Manual dexterity
established

◦ disorders
Master Observer: A.J. Ayres
“The child’s innate ability drives and
neural capacities lead him to an
abundance of responses, many of them
involving maximal effort, that enable him
to master those demands and result in
experiences that foster his development.”
Master Observer: J. Piaget
J. Piaget - stressed that the early
sensorimotor (including reflex) stages of
infant development extends into reflective
intelligence through process of
accommodation and assimilation
Master Observer: M. Levine
Multiple forces (genetic factors,
environmental influences, family factors,
cultural values, educational experience,
physical health, influence of peers,
temperament/emotional factors) determine
a child’s neurodevelopmental profile.
Master Observer: S. Greenspan
 S. Greenspan – In discussing areas that influence the
child’s 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 the
child’s capacity for relative mastery
Sensory Processing Development

According to Ayres, sensory integration (the term) is the

organization of sensation for use. We need to have this
skill so as to:
◦ Play
◦ Engage and maintain social interaction
◦ Have the ability to stay modulated
◦ Completion of activities of daily living
◦ Development of new skills – including academics
Development of Sensory Integration
Sensory Integration is a normal process that
supports all our behavior and actions.
(Influenced by the developmental level)
 S. Szklut, 1999
It involves not only the 5 senses we learn at
school, but also the vestibular and the
proprioceptive systems
It is also influenced by the environment
It is influenced by the individual presenting
the stimuli
D.I.R.®/Floortime & Sensory Processing Models
MC, EdD, OTR/L 2009

Logical & Cognitive Emotions

Abstract
Thinking
Symbolic and Language
Creative Use
of Ideas
Complex Ideation, Motor & Execution
Presymbolic, Planning
shared social
communicati
on
Two Way Proprioceptiv Vestibular
Communicati e
on
Engagement Tactile Taste Vision Smell Auditory

Shared Muscle Tone Range of Primitive Protective Balance

Attention & & Muscle Motion Reflexes Reactions &
Regulation Strength

Equilibrium
Modulation
Development of modulation
 “When inhibition and facilitation are balanced, we can
make smooth transitions from one state to another.”
“Modulation determines how efficiently we self-
regulate, in every aspect of our lives.”
 C. Kranowitz
How is Regulation Accomplished?

Itis the “capacity to regulate and organize

the degree, intensity, and nature of
responses to sensory input in a graded and
adaptive manner. …to achieve and
maintain an optimal range of performance
and to adapt to challenges in daily life.”
 Miller & Lane, 2000
What is meant by Regulation/Modulation?
Co-regulation? How Does it Look?

Self regulation is the nervous system’s

ability to attain, maintain, and change
levels of arousal or alertness
◦ (William & Shellenberger, 1994)
Body Centered vs.
Far Centered Senses
Interoceptive (body centered) senses - tactile,
vestibular, and proprioceptive senses - operate
without conscious thought - includes state of
arousal
Far senses - responds to external stimuli - sight,
sound, taste, smell, and touch - respond to
external stimuli from the environment
 C. Kranowitz
Mechanisms to Self Regulate
 Modulation - brain will turn switches on or off to
regulate its activity and our activity level
 Inhibition - brain will reduce connections between
sensory intake and behavioral output when
information is not needed
 Habituation - when we become accustomed to
familiar sensory messages our brain automatically
tunes them out
 Facilitation - brain will promote connections
between sensory intake and behavioral output by
sending messages - it lets us known when we need
to stop or continue activities
C. Kranowitz
Importance of Arousal
Arousal is our level of alertness
The ability to maintain appropriate states
of arousal develops from our ability to
balance the sensory input from our
environment
With adequate arousal, we can then attend
and learn
How is a Disorder Identified?

A disorder is identified when a behavior

interferes with the age expected
performance of the individual
A disorder can appear in one or more of
the developmental areas of: physical,
emotional, social, cognitive, learning
The Range of Challenges
None
Challenges but with normal range of
variation
Mild to Moderate Impairments
Severe Impairments
Sensory Modulation Patterns
201 – Over-Responsive, Fearful, Anxious
202 – Over-Responsive, Negative, and
Stubborn
203 – Under-responsive, Self-Absorbed
◦ 203.1 – Self Absorbed and Difficult to Engage
Type
◦ 203.2 – Self-Absorbed and Creative Type
204 – Active, Sensory Seeking Pattern
Using the Functional Developmental
Growth Chart Questionnaire
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?
By 5-6 Months – Engaging in Relationships
◦ Does your baby seem happy or pleased to see
you and / or other favorite people: looking and
smiling, making sounds or some other gesture,
such as moving arms, that indicates pleasure or
delight?
Early Identification of Regulatory
and Sensory Processing Problems
Sleep Disturbances
Eating Problems
Sensory Reactivity
Attentional Problems
High Irritability
Levels 1 & 2
Attention and Engagement
“These first two crucial thinking levels,
attention and engagement, are exactly
where the trouble shows up first.”
 S. Greenspan. The Learning Tree, 2010
Experience shows us that even as children
continue to grow and develop, we often
need to revisit these areas since they are
the first ones to be affected when the
individual faces other challenges.
Questions to keep in Mind When
Playing with an Infant/Child
How does the infant/child respond to
movement?
How does the child deal with transitions?
What is the quality of their motor planning at
the gross and at the fine motor level?
Is the intensity and frequency of the
behaviors demonstrated at par with the
child’s age?
What strategies does the child use to calm
herself?
Interaction with dad at 10 weeks
Interaction
With Mom and Dad at 8 Weeks
Sensory Profile
A profile is not always obvious because it
can vary according to
◦ Circumstances
◦ Who is with the child
Therefore, good observations are very
important
According to S. Greenspan, “As you play,
talk, or interact with your child, no matter
how old, always remember to check whether
he is calmly engaged and in control of his
emotions and behavior.” The Learning Tree, pp.160
Identifying a Child’s Sensory Profile
How would you describe the sensory
profile for Child #1, for Child #2?
Areas that Support Development
Areas that Hinder Development
Sensory Modulation Pattern
.201 – Over-Responsive, Fearful, Anxious
Characterized by responses that are larger
than the ones expected
Individuals are often seen to over-react to
stimuli or to the possibility there will be a
stimuli coming their way
Sensory Modulation Pattern
.201 – Over-Responsive, Fearful, Anxious
Sensory Modulation Pattern –
.202 – Over-Responsive, Negative, and
Stubborn (Sensory Avoiding)
Respond to touch with aggression or
withdrawal
Afraid of or becomes sick with
movements and heights
Cautious or unwilling to take risks
Uncomfortable in loud or busy
environments
Very picky eater and/or overly sensitive
to food smells
Negative and Stubborn
Overly Sensitive
Sensory Modulation Pattern
.203 – Under-responsive, Self Absorbed
Sensory Modulation Pattern –
.204 Sensory Seeking Behaviors

Hyperactivity – as they seek more input

Unawareness of touch or pain or touching
others too often or too hard
Engaging in unsafe behaviors
Being too loud/too soft spoken or
enjoying the extremes in volume
Sensory Seeking
Co- Regulation
Accompanying Emotional States
Anxiety
Depression
Anger hostility
Functional performance
Attentional concomitants
◦ Distractibility
◦ Disorganization
◦ Impulsivity
◦ Hyperactivity
Miller, 2000
Other Identified
Behaviors Expressions
Parents have reported concerns related to:
◦ Poor social participation
◦ Insufficient self regulation
◦ Inadequate perceived competence
◦ Inadequate self esteem
 Cohn & Miller, 2000
Strategies to Support Levels 1 & 2
fromPfeiffer, Koenig, Kinnealey, Sheppard, Henderson – Effectiveness of Sensory Integration Intervention in Children
with Autism Spectrum Disorders: A Pilot Study. AJOT January/February 2011, Vol 65, Number 1

Arrange the room to entice engagement

Ensure physical safety
Present sensory opportunities
Attain and maintain optimal arousal level
Taylor activity to present just right challenge
Ensure that activities are successful
Guide the self-regulation of behavior
Create a playful context
Collaborate in activity choice
Foster therapeutic alliances
Supporting Each Other… quietly
And in a more active Environment
Type II – Sensory
Discrimination
Defined as “inability to distinguish one
type of input from another.”
Discriminatory skills include: different
weights, different temperatures, different
How Sensory and Regulatory Issues
Affect Interaction
Need to ‘express’ versus ‘control’ the
Sensory Input – How it affects engagement
Many individuals engage in self
stimulatory behaviors to either calm or
arouse themselves
These behaviors are looked at as negative
or inappropriate by other neurotypical
individuals
The relationship between those that need
this input and those that observe it but do
not need it do not support engagement
All I can Do is “Concentrate”
Peers may be Interested,
but not Understand…
Teaser…
Moving into Motor Planning
“…that neurological process by which
cognition defines motor action…”
 Ayres 1985
Maintaining High Self Esteem
Difficulties in understanding the
environment will affect higher levels of
motor planning
The child has the choice of showing
frustration, or withdrawing
Other children may express activities are
too babyish, ‘stupid’ and refuse to
complete them
Child may keep from participating in
group/team activities
Remember… it is a Family Affair…
Suggested Readings
Delaney, T. The Sensory Processing
Disorder Answer Boook. Naperville, Ill:
Sourcebooks, Inc, 2008
Greenspan, S., Greenspan, N. The Learning
Tree. Cambridge, MA: Da Capo Press, 2010
Miller, L.J. with Doris A. Fuller. Sensational
Kids. New York, NY: Perigee Book, 2006
ICDL Diagnostic Manual
ICDL Clinical Practice Guidelines
Goals for the Presentation
 On viewing video, identify strengths and constrictions
within FEDM 1 and 2
 Describe strategies to support FEDM 1 and 2
 Describe regulatory-sensory processing capacities
(DMIC Axis III)
 Identify and describe a child’s sensory profile and
how it supports or hinders a child’s development
 Describe the role of affect in understanding and
working with a child with regulatory and sensory
processing concerns.
 *Provide in-depth discussion of Regulatory-Sensory
Processing Disorders (DMIC Axis I)   * For DIR C
Outline of the Presentation
 Review of Axis III – Regulatory Sensory Processing
Capacities
 Sensory Processing Development as a Continuum
 Importance of Sensory Processing/ Integration Capacities
 Development of Modulation
 Identifying a Child’s Sensory Profile
◦ Supports development
◦ Hinders development
 Identifying early markers of sensory processing development
 Identifying difficulties/ patterns of difficulty in sensory
processing capacities
 Discussion of how these difficulties affect development of
Functional Developmental Levels
 Role of affect in our work with children with SPD