An Introduction

      My name is Jessica Barker and I am a third year occupational therapy student, as part of our course we are doing a project on aspect upcoming in the profession which we are interested in. I have decided to my presentation in the form of a blog on the topic of sensory modulation in schools with children, I am particularly interested in this topic because of a placement I have had. On my placement I was in a school pediatric occupational therapy unit, in the unit I did not work with students that had sensory disorders but this is where my interest formed.

The aims of this blog are; to educate people on what sensory modulation is, what kind of deficits a person with sensory modulation dysfunction could have and the interventions that occupational therapists can do with a person that has sensory modulation problems. After each entry I will update the contents below.

1. Introduction
2. Sensory Modulation
3. Sensory Modulation Disorders
4. Sensory Over-Responsive
5. Sensory Under-Responsive
6. Sensory Seeking
7. Therapy Rooms
8. Interventions
9. Reflection

Please feel free to comment. 

Sensory Modulation

  Sensory is a system in the body that uses a process of sensory receptors which can detect the senses; olfactory (smell), tactile (touch), gustatory (taste), auditory (hearing) and vision (sight). With sensory modulation there are two more senses that they are; proprioception (track where you are in space), vestibular (position in relation to the rest of the body).  Modulation is a process by which a person is able to adjust him or herself to the environment to match a social or contextual situation (Lane, 2010).

 Sensory modulation is a part of sensory processing; this begins with sensory input from receptors this information is then transcribed to the central nervous system (CNS).  From here the sensory information can be strengthened, weakened or inhibited (Lane, 2010). Sensory modulation is when the CNS is able to normalize excitatory and inhibitory sensory signals from external and internal senses.

 Sensory modulation can be seen through a persons behaviors and can be observed by; “responses that match the demands and expectations of the environment” (Lane, 2002).  Behavior can be a reproduction of processing sensory input and the ability of the person’s central nervous system to process and modulate this sensory information.  An example of this from Shelley Lane’s article is a “child sucking his or her thumb to settle down before going to sleep, “ (Lane 2010), this is an example of behavioral modulation. Habituation in sensory modulation is when you may initially attend to something such as a sound but as you get used to it, you no longer pay attention to it. Habituation allows people to ignore irrelevant information and be able to focus on what is more important at that time, (Lane 2010).

           

  The foundation of knowledge for sensory modulation and associated disorders has come from the work of Jean Aryes. Jean had worked extensively with children that have had sensory modulation difficulties, on theory and treatment this was started in the 1950’s.  The terminology used in relation with sensory modulation disorders are; sensory integration, tactile defensiveness, sensory defensiveness, sensory over-responsive, sensory under-responsive, sensory seeking. Classification of sensory modulation disorders can come under an umbrella term of sensory processing disorders, (Lane, 2010)

Lane, S., Lynn, J., & Reynolds, S. (2010). Sensory Modulation: A Neuroscience and Behavioral Overview. OT Practice, 15(21). 

Sensory Modulation Disorders

      There are several assessments that you can do to assess people’s sensory dysfunctions there is a caregiver report measure for sensory processing behaviours this is called the sensory profile and is for use with children between the ages of 3 and 10 years old, (Dunn, 1999).  There is also the sensory processing measure is measured on the Likert scale and the aspects contain three areas (sensory processing, praxis and social participation) these are assessed in seven different school environments, (classroom, recess, cafeteria, music, art, physical education, and bus), (Miller et. al. 2007).

     

            Sensory modulation disorders can be associated with other disorders such as; autism spectrum disorders, attention deficit hyperactivity disorder and in adults is associated with mental health disorders.  In children with autism it is more often seen in the tactile senses, and can have aspects of under responsivity, over responsivity and sensory seeking (Williams et. al. 2006). Attention deficit hyperactivity disorder (ADHD), can often be diagnosed instead of a sensory integration dysfunction, some of the behaviours leading to a diagnosis of ADHD are closely related to sensory modulation such as; a child not seating on a seat in class due to bad proprioception where as the same child given bumpy cushion to sit on may sit still for the class

      This is a Video where children of different ages give their opinion's on sensory processing disorders from their experiment they were in. 

Dunn.W. (1999). Sensory Profiling. San Antonio: The Psychological Corporation.

Miller-Kuhaneck H, Henry DA, Glennon TJ, Mu K (2007). "Development of the Sensory Processing Measure-School: initial studies of reliability and validity". American Journal Occupational Therapy. 61 (2)

Williams DL, Goldstein G, Minshew NJ (2006). "Neuropsychologic functioning in children with autism: further evidence for disordered complex information-processing". Child Neuropsychology 12 (4–5)

Sensory Over- Responsiveness

A person experiencing sensory over responsiveness are sometimes called sensory defensive. People experiencing this sensory defensiveness have a hypersensitivity to  sensory input and can often find the senses they experiences awful and scary. The  different sensory defensiveness’s people can experience are;

1.     Tactile/ touch

2.     Gustatory/ oral

3.     Olfactory/ smell

4.     Visual/ sight

5.     Auditory/ hearing

6.     Vestibular

7.     Proprioceptive

This link will take you to a website which has descriptions of each defensiveness.  Children that have sensory over responsiveness or defensiveness in the areas or tactile and auditory senses, can impact in a children’s learning environment. (Ben-Sasson et. al., 2009).

When working with children that you think or know they have sensory defensiveness, I think it is essential to complete a sensory diet form, most of these are similar and there are many that are online that are free. This is a link to one which I have found online.  They are good for gaining understanding on what the children like to do for calming and energizing, this form may need to be completed with the assistance of the parents. This is a link to activities that can be carried out with children that have sensory defensiveness. This link is good for gaining ideas on what to do with your children. 

This is a video showing how to complete deep pressure for a child this is one of the examples that comes from the list of activities and this can be incorporated in a fun or innovated way such as a bear hug.

Ben-Sasson, A., Carter, A & Briggs-Gowan, (2009). Sensory Over-Responsivitiy in Elemantry School: Prevalence and Social-Emotional Correlates. Journal     of Abnormal Child Psychology, 37

Biel, 2013. http://sensorysmarts.com/about_book.html (accessed 01/07/13)

Sensory Under-Responsive

A person showing sensory under-responsiveness is when a child or person will not react to a stimuli, or stimulation, they may be seen as they do like interacting with people, they will come across as disinterested and are hard to get engagement in activities, they will be described as passive (Collins & Miller 2012).  Symptoms of sensory under-responsiveness can be described in the seven sensory fields below:

“Visual: loses place when reading, complains of eyes being tired


Auditory: does not respond to name being called, may hum while working on a task


Olfactory: does not notice a strong odor in the refrigerator that others instantly notice


Taste: does not notice or care if foods are spicy or bland


Vestibular: does not voluntarily choose to play on playground equipment, preferring sedentary tasks


Tactile: may not notice if they get hurt or bumped


Proprioception: slumps in chair or leans on walls, may have weak muscles”

                                                                                    (Collins & Miller, 2012)

Children that have sensory under responsiveness can have poor inner drive and have a lack of desire to play and will often bump into things and have a lower sense of pain when they do this. (Bialer & Miller, 2011). To get children that have sensory under responsiveness to be better at participating in activities they should be undertaking pre activities that will alert their senses such as; loud music, swinging fast, high movement and also changes in food might make some changes in the responses a child may have (Collins & Miller, 2012).

Some ideas for interventions is having a corner before therapy that is filled with things that will stimulate the senses. Things that could be included in this corner could be bean bags, touch books, blankets of differing materials and anything that will provide stimulation.

Bialer, D. S., and L. J. Miller. 2011. No Longer A SECRET: Unique Common Sense Strategies for Children with Sensory or Motor Challenges. Arlington, TX: Sensory World.

http://autismdigest.com/sensory-underresponsivity/ accessed on 02/07/13

by Britt Collins, MS, OTR and Lucy Jane Miller, PhD, OTR
Autism Asperger’s Digest | March/April 2012