Return to Home Page
Topics for Therapists |
Topics for Parents |
Q. The wording on some of the items of the Infant/ Toddler Sensory Profile is confusing. It is hard to figure out whether it is good or bad to do some of the behaviors, e.g.,: ‘my child stays quiet and calm in an active environment’. we were not sure what the meaning is. Is it good or not so good to stay quiet and calm? These sound like such positive words to us.
A. We learned
from previous work with children to make the items more 'neutral' so that we
could get the range of performance, rather than extreme scores in one direction.
This also encourages the caregivers to give us the frequency of the behavior
without thinking there is a RIGHT answer. With our national sample of scoring,
we can see what is the most likely answer, and then children with many more
or many less responses fall outside that range... and we can hypothesize that
either extreme might interfere with participation. if you look at the scoring
system for the infants, you will see that the scores go 'both ways', that is,
you can have more than others and less than others, indicating that both ends
of the behavior are out of range when compared to peers.... the 'typical' scores
in the middle represent the fat part of the bell curve [approximately 68%]
Also, remember there are more than one item to reflect each way of responding,
so although the individual items do matter, it is the pattern that they produce
as a group that you are interested in.... does the child respond overall more
or less than others...in an active or passive way?
Q. Can we have the teachers complete the Sensory Profile on the children? When I have the teachers fill out the form, to get a good sense of how the child is functioning at school, they are unable to answer many of the items that are more often seen in other environments. When I send the form home for the caregiver to fill out, I get a good sense of the issues at home, but not always a good sense of the performance at school. Since I am supposed to be focusing on the impact on a student's educational program, I find it difficult to make accurate interpretations of the data. What are your recommendations for school therapists?
A. It is important to remember that the Sensory Profile was designed for parents and not teachers. I designed the Sensory Profile for parents for several reasons.
I believe that although behaviors may be somewhat different because of the contextual variables and task demands at school vs home, vs community settings, the person's overall patterns are likely to be similar [just as the temperament literature shows].... We need to discriminate between the child's overall patterns of sensory processing and the participation issues the child might face in various settings....
the focus of our therapy is on participation in desired and necessary tasks in the persons' life... skillled observations and tests like the SP provide validation and evidence about the nature of the characteristics that may be interfering with desired performance.....
look at how the test scores from the parents impressions inform the challenges the child may be having at school.....
you can also talk to the teacher about the concepts of sensory
processing, particularly the 4 types of sensory processing [seeking, avoiding,
sensitivity and low registration] as a way to frame your collaborative efforts
to design good strategies for school...
At school, to validate other evidence, you can conduct skilled observations,
interview the teacher regarding what is challenging for the child, administer
the School Function Assessment, all which focus on the PARTICIPATION issues
at school.
Q. I have a question on the profile for Adolescent/Adults. I have high school students who are unable to verbally answer the questions on the profile. Do I use the younger age profile or have a close school or family member fill out the form based on their observations?
A. this is a
hard decision....
i think that you have to use your judgment...are the items on the Adolescent/
Adult version reflective of the students' lives?... will it be possible to answer
the questions even if a care provider completes them?... for example, if children
have severe disabilities, there may be a number of items that cannot be answered...
in that case, you could use the sensory profile to get an IDEA of the student's
sensory processing patterns WITHOUT using the cut scores....perhaps to generate
discussion with parents about the students' ways of responding...
if the AASP items are good for the family to answer, then i think that would
be a reasonable alternative.... paired with interveiws and skilled observations,
you will have all the info you need to make useful plans.
Q. I am trying to score
some sensory profiles for a data comparison, however
some scores are missing. Is it okay to put in a score by extrapolation? I can
make some assumptions based on the other scores, however this is obviously not
the correct way. Can you please help me? Thanks!
A. i typically
say that if you have a blank, you cannot score that section.... there are plenty
of other scores to consider.
There is another alternative to get an impression of the child’s performance.
When 1 score is missing:
1. add the items the family completed
2. then add 1 to the total,
3. then add 5 to the total
.... this will give you the range of where the score WOULD be with the lowest
and highest possible response to the omitted item. Look at the cut scores and
see where the range would fall, because you know the responses would be within
this range..... it may be that the person is in 'definite' difference no matter
what.....
...you cannot report this, just use it to THINK about the situation and what
might be interfering...
ALSO remember, that NA might itself be informative...why haven’t they
been able to observe this behavior?...is the child too sensitive?, too oblivious?......
Q. many of the children we see/evaluate are young (3 to 6 yrs) and non verbal. They are unsure what criteria/characteristics they should be looking at for the following items so that a raw score could be computed for sections such as Behavior and emotional responses
A. in our standardization, it was up to the families to decide how to interpret these items.... which they seem to do in their own context... since this is a family centered measure, let the parents decide, or just leave these sections blank if necessary... it is more important to have good scores on areas that the parents can report than questionable scores on everything...
Q. A total raw score for Section M and Factor 9 can not be computed for most (essentially all) of the children (3 to 6 yrs) as they are unable to write legibly (118) (this is pretty normal for 3 to 6 yr olds) or color (119) (3 4 yr olds generally tend not to stay between the lines when coloring), so how do you rate this?
A. it is ok to leave these sections blank for younger children...many families do leave them blank...they are not critical to your decisions about sensory processing. These scores are more reflective of functions that are the outcomes of sensory processing.
Q. Another question therapists have is concerning items 9 and 11 (prefers to be in the dark vs hapy to be in the dark) would it be possible for you to clarify this (e.g., provide therapists with a concrete example).
A. remember, these items are geared toward caregivers, so whatever they decide these mean for their chhildren is what matters.... the items on the sensory profile represent a constellation of behaviors and responses of children... in our studies, families made their own determination about the exact meaning of items for themselves [and likely there is variability in their decisions and variability is GOOD]... and even with all this variability, we still got significant differences amongh groups of children.... so you dont need to worry so much about one or two items in a section...
Q. The quadrant scores are very helpful on the Infant Toddler Sensory Profile and the Adolescent/ Adult Sensory Profile. How do we get that information on the Sensory Profile?
A. The website, www.sensoryprofile.com contains information about calculating the quadrant scores on the Sensory Profile. This breakdown has been helpful for other studies we have done because it discriminates high and low threshold responses, and passive and active self regulation... see what you think
Q. the scores for the children’s
versions of the Sensory Profiles go in the opposite direction from the Adolescent/
Adult version of the Sensory Profile…HELP!!!
A. for the infant/
toddler and child versions of the sensory profiles, 'always' gets a 1 and 'never'
gets a 5 so that higher numeric scores = less of the behavior
therefore higher scores on the scales are representing LESS THAN OTHERS of the
behaviors described...
lower scores on the scales are representing MORE THAN OTHERS of the behaviors
described...
For the Adolescent/ Adult version, ‘more than others’ has higher
numeric scores and ‘less than others’ has lower numeric scores
Q. I completed adult sensory profiles with normal functioning adults with no diagnosis and found only a portion had all 4 quadrant scores in the typical range. How can this be?
A. it is important
to remember that sensory processing is about ALL people, not just people who
have disabilities..... and additionally, we each have an amount of all types
of sensory processing.... although we discuss each pattern as if it is discreet,
in truth, we all have some amount of seeking, avoiding, registration and sensitivity....
for example, i have very high [++]seeking, very little low registration [ ],
a little less avoiding [ ] and a little more [+] sensitivity when compared to
the norm group.... my sensitivity is related to movement and sound, my seeking
is related more to touch and visual input..... my low registration score suggests
that i dont miss things... and my avoiding scores suggests i am less likely
to withdraw than others...
the patterns are a profile of a person's individual way of responding to the
sensory events of everyday life.... the high and low scores merely point out
tendencies... the critical issue is not the score
the critical issue IS the person's life.... given their pattern, are they aware
of their own sensory processing needs?... have they constructed life events
to be a good match for these needs?... are there areas of life that are particularly
challenging, that could be easier if they reconstructed things to be more reflective
of sensory processing needs?... for people who have good awareness, they are
likely to have satisfying life activities, because these people have constructed
life to match their needs.....
for example, a person with a lot of sensation avoiding tendencies will have
maladaptive behavior if the person has to live in a chaotic dormitory...and
will likely do better in a more reclusive location...
we are not diagnosing disability with sensory profiles... we are characterizing
that person's way of responding, and then we must look into their lives to see
if this pattern is likely to support their life or create more barriers...as
OT"s we can suggest ways to reduce the barriers AND increase the adaptive
ways of participating WITH whatever pattern of sensory processing the person
has....
so, most people WILL have variable scores across the quadrants.... it can help
them with planning....
look in the section about hi and low scores and in appendix A of the manual
for some more info on this.....
Q. I am concerned about the Sensory Profile for Infants and Toddlers. I have a young boy of 10 months with obvious oral sensory hypersensitivity. I used the Sensory Profile to hopefully give objective feedback to his Physician. I found that because of the wording in the oral sensory area, his scores were on both sides of the extreme spectrum, but balanced out to a typical midrange score. I am quite concerned about this and would like some feedback. An example would be that he scored a 1-always on noticing changes and refusing food, and a 5-never on mouthing objects and licking food.
A. you are correct
that sometimes an overall score will fail to reflect the extremes within a section...
remember, nationally standardized scores can only reflect an overall pattern...
and the overall quadrant scores include items from many sections, not just one...
what is the child's overall pattern of sensory processing?... perhaps it is
a low threshold pattern, and you can discuss this issue in a more general way
with the pediatrician....it is ALWAYS critical to temper this with the daily
life information and concerns in individual cases....
i als suggest in this case that you take advantage of the categories of the
individual items [those icons next to each item reflect which quadrant they
represent]...
plot the number of extreme scores for the low threshold items in oral, and show
the consistency of these items with the observations during eating times/ interviews
with parents.... i hope this helps.
remember, it is OUR PROBLEM SOLVING that parents and others need....any tool
merely guides and informs that process....
thanks for letting me know about this so i can include it in my comments in
the future with other therapists and parents.
Q. I'm considering using the Infant/Toddler Sensory Profile in a research project. The construct I'm wanting to measure is "tendency to ignore speech". I noticed that this instrument derives a low threshold score but not a high threshold score. I'm wondering why.
GREAT question...
when we conducted the factor analyses, the two quadrants that represent the
high thresholds, i.e., seeking and registration, always load independently of
each other as separate constructs...
the low threshold quadrants, i.e. sensitivity and avoiding, however, have some
sharing of variance [e.g., mostly avoiding items with a few sensitivity items
in a factor and vice versa]....
and in clinical practice, there are children and adults who have a range of
responses from 'sensitivity' to withdrawing [avoiding] for things that they
notice a lot...
related to your research question, i have several thoughts...
1. 'ignore' suggests an active behavior...if so in your ideas, then Avoiding
would match....
2. if you think the reporter [?parent, ?teacher] will think of ignoring as volitional,
but actually the child is more likely to be oblivious, i would hypothesize Low
Registration....
3. you could report both high threshold scores
fyi...if you ever need the child version, i have calculated the quadrant scores
for this version too...[not in the original protocol, since i didnt think of
the ideas until after that one was published...]
Q. Is the Sensory Profile a measure of occupational performance?
A. i posed your
question to some of my grad students, and here are their responses for you:
I think the Sensory Profile is a measure of a person's range, tolerance, and
needs for sensory information that gives insight into their ability to participate
in occupational performance activities. I have not thought of the Sensory Profile
as a specific measure of occupational performance. I am not familiar with too
many occupational performance measures, but I think they probably look at life
skills and a person's ability to carry them out.
I think back to my school based days and giving the SFA in combination with
the Sensory Profile. The SFA looks at "what" the child is doing or
not doing and the Sensory Profile looks at "why" they might be struggling
with certain activities from a sensory perspective.
and...
The Sensory Profile does provide an emphasis on viewing sensory processing in
the context of daily occupation. Furthermore, it is my understanding that sensory
processing differences alone do not warrant intervention, but when sensory processing
interferes with daily occupation, intervention would be a useful consideration.
Without knowing the age of this student's participants, it is difficult to recommend
a measure of occupational performance. I have used the School Function Assessment,
and The Canadian Occupational Performance Measure.
Q. I am writing to ask a question regarding the Short Sensory Profile. I often use the SSP with the children and families I work with, as it is very time efficient for families to complete. After reviewing the manual, I could not locate any information on it's use with 4 and 5 year olds. I wondered if there are similar cut scores for 4 and 5 year olds when using the SSP.
A. since the items on the Short Sensory Profile are very discriminating, there is only one set of cut scores...this version does not contain the items that were more developmentally driven [eg, stays inthe lines when writing...] so you should be all right with the cut scores you have.
Q. I have a question concerning the use of the sensory profile in research. I am interested in using it as a screening tool to identify children with sensory processing difficulties. Am I better to use the long form of the Sensory Profile or the Short Sensory Profile? I am tempted to use the SSP since it is quicker to complete and you obtain a Total Score. I am thinking of using the Total score of the SSP and include all children who perform in the Probably Difference and the Definite Difference range as the inclusion criteria. However, if I am unable to get a Total Score due to items that could not be scored (see above) how am I best to get around this for research screening purposes?
A. we actually designed the Short Sensory Profile for research and screening protocols because the items are VERY discriminating. If you cannot get a total score,,, then consider setting a criteria for how many 'probable' or 'definite' differences will matter to you on the subsections.
Q. I have been working
with children who are blind or have severe vision impairments, and feel that
SI principles are appropriate for these clients. The challenge is determining
if the difficulties are as a result of being blind (impact of lack of vision
on development, or impact of the actual diagnosis causing blindness) or because
of a sensory processing dysfunction. I see tactile defensiveness, poor tactile
discrimination, poor motor planning, poor fine and gross motor coordination,
poor body awareness and poor spatial awareness (particularly projecting spatial
concepts from their bodies onto the environment around them). These difficulties
have a significant impact on their ability to learn braille, independence and
mobility skills.
We have administered the Sensory Profile to a few of our children, whom we suspect
have sensory modulation problems. The difficulty we have, however, is with the
questions the parents cannot complete because their child is blind, eg the visual
processing questions or those questions which could have a visual component
(eg child gets lost easily).
how would you recommend I guide the parents in answering these questions?
A. you are raising
good issues related to special populations... i am glad that your comments are
grounded in what the children need to do in their lives, because that is ultimately
what matters the most.
re: the Sensory Profile... instruct the parents to answer all that they can,
and write NA [not applicable] on any items that they dont feel they can answer....
you cannot score any sections that have empty items, but you can get a sense
about where in the range the child's responses might fall with a partial score....
e.g., if one item is blank, you can add up the other items, and then add 1 to
see the loweste possible score, and then add 5 to see the highest possible score
the child could have received...then look at the cut scores and see where the
score might have been... you cannot report this, but can use it to consider
possibilities as yu devevelop your intervetnions.....
you are right that children with blindness will likely have some scores that
are different from typical children.... that would be great to know, wouldn't
it?... to see a pattern for them that we could use to predict general issues
with sensory processing.... e.g. they might as a group respond more intently
to one area... that would be useful for planning interventions, or anticipating
needs of other children as we intersect sensory processing patterns with participation...
Q. My client has some vision although he is legally blind. This child is struggling to learn Braille. He has scored in the average range for cognitive ability. The psychologist and I are trying to determine if there are other reasons he is finding it difficult to learn braille. He scored in definite difference for low registration; probable difference (more than others) for sensation seeking; typical performance for sensation sensitivity; and probable or definite difference for sensation avoiding.
A. it is important
to remember that each of the 4 quadrants represent a discreet pattern of sensory
processing, such that each person has 'an amount' of each kind [i learned this
idea from the temperament literature]... so it is possible, in fact, likely
that a child with a disability will have multiple scores outside the typical
range...
consider these issues as you and the psychologist problem solve...
1. i was delighted to see that you are focusing on the participation issue,
in this case, braille reading... participation is what matters the most...
2. this child has low registration and sensation seeking...they are alike in
their HIGH THRESHOLDS... i.e., that the child needs moore input than other children
to notice and respond... this may be consistent with the child's inability to
pick up braille, which requires high detection skills... [kids with sensitivity
have high detection]... i am thinking that you can use the childs good cognition
to support braille learning, by providing talking cues [ a strength if you use
it to his advantage... otherwise talking through things can be irritating and
distracting], you may want to 'name' some of the configurations, or make the
dots bigger for a while [to fit into his palm], or add texture to the dots to
make them more salient for him...
3. he has some indications of sensation avoiding as well... remember, a person
has an amount of each one of the patterns... so imagine this scenario... the
child needs more input to meet high thresholds [as indicated by regis/seek pattern]
AND some inputs create a withdrawal response [avoiding]... this leaves very
little room for exploration and learning... so your challenge is to find out
what sets this child's avoiding patterns off [?is it texture, is it distractions,
..... ] and work to reduce these inputs while you are enhancing sensation for
noticing....
Q. Is it possible for a person to have more than one pattern of sensory processing? My child got most of the Sensory Profile Scores in the ‘definite difference’ range. How can this occur, and where do I start?
A.
as with any complex system, you cannot have simple categories to explain their
operations...
the nervous system operates based on a balance of excitation and inhibition,
[modulation], and so when this system is operating poorly, there is a RELEASE
phenomenon.... when the nervous system is out of balance, then ANY responses
are possible---the system is attempting to create an adaptive response, and
so you can have over responsiveness and under resposiveness as a result...
when you add different sensory systems, the person’s experiences, different
environments and demands, of course you are going to see variability of responses,.....
your challenge in intervention is to identify the triggers and then create environments
and activities that keep the person 'inside' of those trigger points, so there
are more opportunities to create more appropriate adaptive responses.....
We always start with the person’s life: what do they
want or need to do that is unsuccessful right now?... that is what matters...scores
are secondary to support and validate our skilled interviews and observations....
never substitute your judgment about the person’s life for any isolated
scores on formal tests....... when a person has all scores out of range, we
might hypothesize two things....
1. the overall nervous system modulation is probably poorly organized to result
in extreme scores in all areas
2. each extreme score is likely to represent different sensory systems...e.g.,
hypersensitivity of auditory [hands over ears], etc....
match your observations and parent's comments with the extreme scores, and ask
yourself...how do the scores provide validation and support for the participation
issues this child is having.... and which things are INTERFERING the most with
participation.... THAT IS WHERE YOU BEGIN... because your goal is to get this
kid back into his life.... trust your instincts, and use the SP data to provide
evidence to support your hypotheses...
then create a strategy for collecting data about performance, so you can monitor
the success of your interventions and make adjustments accordingly.....
Q. I am struggling to understand how the ‘more than others’ and ‘less than others’ concepts work. E.g., if you have ‘less than others’ sensation avoiding, does this mean that you are sensation seeking?
A. Each quadrant
represents a discreet continuum of behavior. If you have low sensation seeking
it doesn't mean that you avoid activities it just means that you don't try to
find/create added sensation and that you engage with the environment less than
most people. If you have low avoiding it doesn't necessarily mean you are a
seeker but that you don't ever do things to control or limit the sensation in
your environment.
Every sensory processing pattern has potential positive and negative impacts
on a person's day. If a person has a "more than" issue, the negative
component may become dominating in daily life. If the person has a "less
than" issue, the positive component may be impoverished. For example, sensory
seeking has the positive of seeking out new sensations for enjoyment and the
negative of it interfering with other activities. So a person with "more
than others" could have more interference due to their seeking behaviors
and a person with "less than others" may have lower enjoyment of new
sensations. This would be an impoverished habit of not looking for high threshold
sensations rather than a dominating habit of not looking for high threshold
sensation (Sensation Avoiding). These distinct scenarios would effect different
interventions.
Q. Some of the kids we
are working with are all over the place with extreme scores on different ends
in different sections. Do you often see this?
A. a child with an out of range
score is PROCESSING DIFFERENTLY than peers, putting that child's participation
at risk... the OT's job is to sort out the interaction between the child's sensory
processing patterns and the participation challenges....it is better to start
with the participation issue, then look at the quadrant scores, and then see
how the sensory processing patterns inform you related to the first two things...
so, if a child has out of range 'Sensitivity' score, then we would consider
this in relation to the participation challenge, and then look to the sensory
processing scores to see which sensory systems might be contributing to the
challenge, or that might be recruited to support performance... if it is a strength.
Q. What do you say and do with a family whose child has 4 quadrant scores out of the typical range?
A. This child’s
processing shifts from day to day, so some days
The thresholds will be low and other days the thresholds will be high. This
makes intervention tricky because things that are encouraged / needed by
the child when thresholds are high are exactly the opposite of what is needed
by
the child when thresholds are low! The therapist’s role will be
helping parents identify ways of telling what type of processing their child
is
"in" that day / hour etc and educate them on ways to present sensory
info to
them that is consistent with their current pattern.
truthfully, this is what each of us does every day.... we all have days when
we are more or less sensitive to certian stimuli in the environment... the difference
is, we usually know how to make those adjustments for ourselves.... when things
get bad, we withdraw or explode..... our children just have less of a range,
and do not know GOOD strategies for managing.... they use strategies, but they
are sometimes maladaptive [e.g., biting, tantruming, shutting down].... these
behaviors are messages to us, and the nervous systems' attempts to cope with
being poorly organized or modulated.....
keep up your thinking and document what you do as a model for others.
Q. can a person have a significant different in all 4 quadrants?
A. it is quite common for children with pervasive disabilities to have many scores outside the typical range..... this illustrates the difficulty the children are having with sensory processing overall.... and with modulating input for use of any kind to create adaptive responses.
Q. I have been trying
to find information about something I am experiencing. I hope
that you can help. I am having an aversion to touching certain materials, such
as newspaper or toilet paper or the carpet (with bare feet). I have experienced
this over the years, but during the last year I have had more days with this
feeling.
A. i can tell
that these sensations are making you feel uncomfortable.
what you are describing is an increased sensitivity to certain textures on the
surface of your skin... your nervous system is noticing particular characteristics
of these materials and reacting to them----
when considering the 3 things you mention, it seems that they all have i kind
of layered texture within them [eg, the pulp pressed into the newspaper and
the ink on the surface, the fibers pressed together in the toilet paper...]
with this awareness, you might pay attention to other textures in objects that
do not create discomfort, perhaps smoother surfaces, ... sometimes understanding
the nature of what triggers the uncomfortable response is helpful... then consider
alternatives for yourself...
for example, you might lay the newspaper down on the table to read it, so you
dont have to touch it continuously with your hands, and lay a cloth or other
acceptable surface on the bottom part of the newspaper while reading it so you
dont have to prop your forearms on it either...
wearing tight socks can mediate the effect of the carpet by providing your skin
with a continuous surface of input, rather than the variable input of the carpet
fibers...
some people with sensitivity like you are describing also find it helpful to
use lotion [you may have to experiment with what texture is right for you],
pressing firmly on your skin when you apply it... this firm pressure activates
calming parts of the nervous system and can reduce the effect of the sensitivity
you are describing...
we have studied people of all ages, and found this sensitivity to be one of
the categories of sensory processing in the general population.... as with many
things, there is a continuum of how much the sensitivity interferes with everyday
life...
Q. How do I interpret
a Low Threshold ‘more than others’ score?
A. the LOW THRESHOLD scores are
merely a combined score of the sensitivity and avoiding...the manual talks about
the fact that you ONLY report the low threshold score when BOTH are outside
of the typical range...
sometimes it is easier to explain to parents and teachers that the child is
more sensitive to stimuli, and because of this the child has a range of responses,
from being 'crabby' to withdrawing from stimuli...
You need to explore the sensory features of the challenging daily life tasks
that the parents/ teachers have identified, and see how you can make these aspects
of the tasks more palatable for this child.
Q. My team consistently challenges me to the term "sensory seeking" feeling that all children are normally sensory seekers. They also feel that the sensory profile leans to label anyone and everyone as having sensory processing issues.
A. although you
are frustrated, it is important to remember that all professionals have a responsibility
to question the basis for decision making for children.
your colleagues are correct that all children are 'sensation seekers'. i agree
that this is likely the pattern for all people to acquire information and learn.
it is also important to remember that the cut scores on the sensory profile
are based on the bellcurve, so that if any child gets a 'definite difference
score' that this indicates that the child engages in the behaviors more than
about 98% of other children....so even if it is the way children gather info,
this child is doing the behaviors a lot more than everyone else...AND
you must remember that 'sensation seeking' is not the relevant issue.... YOUR
JOB is to determine whether this higher rate of sensory seeking is INTERFERING
with participation in every day life.... THAT is what matters.... intervention
planning needs to focus on taking advantage of knowing that this child seeks
a lot, and find ways to build that 'seeking' tendency into daily routines so
that learning, skill development and participation can all increase even with
high seeking patterns.
Q. My child has been receiving Early Intervention and OT services and now that he is going to school, they say he doesn’t need services. How can this be?
A. you have
been very active in supporting your child during these early years. you have
provided focused support during a critical period for development.
it is important to remember that young children are quite adaptable and nervous
systems are quite adaptable as well. this adaptability creates immense possibilities,
so that we cannot predict how well [or poorly] someone will do with any amount
of nervous system involvement.
your vigilance in providing an enriched environment for your child's early learning
undoubtedly has made a difference in your child's current ability to participate.
because the brain is so adaptable in early years, it is likely that your efforts
have made it possible for your child's nervous system to create alternative
ways to know and understand what is going on, and how to respond.
your focus must remain on what enables your child to participate successfully...your
agency is telling you that your child IS PARTICIPATING successfully right now...this
is excellent news, it means that early intervention efforts have been successful---that
is why we provide early intervention services, and in your case, why you provided
the myriad of supports in your home and family life....they worked.
this does not mean that you child will not need supports as time passes, and
i would imagine that your team [you are part of this team] will want to create
a schedule of checking in so that things stay on course.
for example, think of what will make you comfortable to know that your child
continues to participate successfully,,,, will this be true if your child can
answer questions in a group learning situation? will this be true if your child
can line up with others and get to lunch or recess? will it be true if your
child can complete seatwork in a timely manner?..... suggest that the team check
in on whatever these performance criteria are, and report back quarterly...this
will give you and the team continued peace of mind about your child's continued
success...remember, it is GOOD when children can be included with peers...that
is what we WANT.
our goal in services through IDEA is to make it possible for children to work
successfully WITHOUT US...so they can go on to an independent life... it sounds
like you are all on the right track.
Q. I have a 9 year old son who has some processing problems based on the Sensory Profile. The Private Practice OT recommended treatment to address handwriting and sensory processing. The school feels OT is not indicated due to the processing problems not affecting him in his educational environment. My argument is that his attention problems, disorganization and very poor handwriting indicate that OT which would focus on his sensory dysfunction is indicated. What do I do?
A. you know that
the focus of our professional practice is on the child's ability to participate
successfully in desired and necessary daily life activities...
therefore, any specific test score is not helpful alone, but rather only as
this data informs us about why a child may be having challenges in everyday
life [which for a 9 year old includes school performance, playing, completing
chores, personal hygiene, socializing with family....].
in situations like yours, i always recommend that professionals meet with each
other [or even have the private therapist visit your son's school] to get clearer
about the goals of different settings and your child's participation... it is
likely that the varied perspectives that are causing you anxiety right now also
contain unique ideas for crafting a successful overall plan for you, your son
and the teacher....
you are correct.... it is hard to imagine that an OT perspective could not be
helpful to his educational experience.... OT's can reconstruct seatwork, sequence
of work during the day, and offer both your son and the teacher ideas for minimizing
the impact of his attentional challenges...
remember: OT is a GREAT resource in schools.... it may not be necessary or appropriate
for the OT to remove your child from the classroom to provide 'therapy' in the
traditional sense....therapy includes consultation with your son and his teacher
[and you] to offer ideas --- this actually may be MORE in service to your son,
who needs to be in the room for as much instruction as possible...with the OT"s
input about that process, the teacher and your son will be more successful together
every day.
invite your service providers to collaborate and negotiate on your behalf, and
expect them to HELP you make your son's life more successful...
Q. Are we working on changing a person’s sensory processing scores in therapy?
A. the most
important issue is ALWAYS participation....there is some data about the thresholds
changing in particular research situations….. i think within some parameters
there are adjustments, but i hypothesize that sensitive people continue to have
sensitivities.... we can manage and satiate, and set ourselves to a mind set
to handle things, but i think the basic way we respond has limits based on our
nervous system.... people who seem to have less issues have usually learned
strategies to manage their own capacities, such that they dont overload themselves
on the irritating stuff and so are available for the important issues....
We must not get so caught up in the idea of FIXING the thresholds that the participation
issues get lost.... LIVING is what matters...and when people engage more successfully,
there adaptive behaviors likely change and organize the nervous system too.
Q. I am an Occupational therapist working on developing a research study looking at children with SMD, and the effectiveness of our interventions. We had planned on using the Sensory Profile Caregivers Questionaire at the beginning of the study as part of our inclusion criteria, and at appropriate intervals throughout the study. Could you comment on the ability of the SSP to measure change, and at what time intervals you might readminister it?
A. We did not design the Sensory Profile as a retest measure. Although more studies will be needed to know for sure, it seems that the Sensory Profile is measuring a set of characteristics about the person. When retesting, look at improved participation and satisfaction rather than changes in characteristics of sensory processing patterns.