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TRANSCRIPT
3/26/2009
1
Winnie Dunn, PhD, OTR, FAOTA
Professor and Chair
Department of Occupational Therapy Education
University of Kansas
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
LEARNING OBJECTIVES Delineate the core concepts of sensory
processing to others
Recognize how sensory processing concepts can be applied in everyday life situations
Recognize the occupational therapist’s role as information broker in the therapeutic process
Select appropriate evidence to support practice decisions
Recognize how to integrate sensory processing insights into school and home environments
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Lessons in This Program
Core Concepts of Sensory Processing
Explaining Sensory Processing Concepts to
Others
Assessment and Interpretation of Sensory
Processing Patterns
Evidence-Based Intervention Planning
Applications to School Practice
Directions for the Future
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I am the author or coauthor of the Sensory Profile measures
discussed in this lesson; they are published by Pearson, Inc.
I am the author of the book Living Sensationally: Understanding Your
Senses, which is referenced in this lesson; it is published by Jessica
Kingsley Publishers.
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
• Dunn’s (1997) Model of Sensory Processing guides our thinking.
• Sensory processing reflects nervous system activity.
• Sensory processing patterns apply to everyone.
• Sensory processing concepts can be situated with other approaches.
5
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Dunn’s (1997) Model of Sensory
Processing
Responsiveness/
Self-Regulation Strategies
Thresholds/
Reactivity
Passive Active
High
Registration Seeking
Low
Sensitivity Avoiding6
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Dunn’s Model of Sensory
Processing
Responsiveness/
Self-Regulation Strategies
Thresholds/
Reactivity
Passive Active
High
Registration Seeking
Low
Sensitivity Avoiding7
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Dunn’s Model of Sensory
Processing
Responsiveness/
Self-Regulation Strategies
Thresholds/
Reactivity
Passive Active
High
Registration Seeking
Low
Sensitivity Avoiding8
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Sensory processing reflects
nervous system activity.(Brown, Tollefson, Dunn, Cromwell, & Filion, 2001)
Responsivity/ habituation
Sensitivity: high/high
Avoiding: high/low
Registration: low/low
Seeking: low/high
0
5
10
15
20
25
Sen
sit
ivit
y
Avo
id
Reg
iste
r
Seek
Respond
Habituate
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Sensory processing reflects
nervous system activity. McIntosh, Miller, Shyu, & Dunn, 1999)
00.5
11.5
22.5
33.5
44.5
5
Tac s
ens
Taste
/sm
Mvm
t sen
s
Under
/see
k
Aud fi
lt
Low e
nergy
Vis
/aud s
ens
SHORT SENSORY PROFILE
Normal EDR
Abnormal EDR
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
MEG Brain Imaging Data18-year-old with
Asperger syndrome
Definite difference:
Sensory sensitivity
Sensation avoiding
Dunn, Popescu, & Gustafson, Study currently underway at University
of Kansas Hoglund Brain Imaging Center
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Seeking High ability to
generate ideas and responses
Notices and enjoys all the activity in the environment
May be fidgety, excitable, continuously engaging
Responsiveness/
Self-Regulation Strategies
Thresholds/
Reactivity
Passive Active
High
Registration Seeking
Low
Sensitivity Avoiding
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Avoiding
High ability to
design and
implement structure
Enjoys routines
May be reliant on
rituals, rigid
Responsiveness/
Self-Regulation Strategies
Thresholds/
Reactivity
Passive Active
High
Registration Seeking
Low
Sensitivity Avoiding
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
SensitivityHigh ability to
notice, vigilant
Particular about task completion
May seem like a “complainer,” distractible
Responsiveness/
Self-Regulation Strategies
Thresholds/
ReactivityPassive Active
High
Registration Seeking
Low
Sensitivity Avoiding
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Registration High ability to focus
on something
Easygoing
Unaffected by varying environments
May seem uninterested, apathetic, self-absorbed
Responsiveness/
Self-Regulation Strategies
Thresholds/
ReactivityPassive Active
High
Registration Seeking
Low
Sensitivity Avoiding
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Sensory processing patterns
are not unitary constructs.
Sensory processing patterns apply to
everyone, not just people with
disabilities.
Everyone has some amount of each
sensory pattern.
Contexts and activities provide unique
sensory experiences.
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission. 16
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Example of Sensory PatternAVOIDER for
sounds in
hallway
SEEKER for food
tastes, spices,
variety
BYSTANDER who doesn’t notice
disarray in home
SENSOR for clothing textures
and weight of items
DECORATING
YOUR HOME
WORKING
SELECTING
YOUR
WARDROBE
DINING
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What sensory processing pattern for dressing do these people have?
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
How do sensory approaches
compare with each other?
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Emphasis
for Sensory
Integration
Activity Demands
Context and Environment
Performance Patterns
Performance Skills
Client Factors
Areas of Occupation
Emphasis
for Sensory
Processing
Occupational
Therapy Practice
Framework
(American
Occupational
Therapy Association
[AOTA], 2008)
20
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Occupational Therapy Practice Framework (AOTA,
2008)
Occupational Therapy Intervention Approaches
Create/ Promote
Establish/ Restore
Maintain Modify Prevent
Emphasis for
Sensory Integration
Emphasis for
Sensory Processing
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
• Using common ―sense‖
• Using clear language
• Linking to everyday life
• Coaching: Talking to family, teachers, friends, and
individuals
• Creating friendly documentation: Useful written
communication
22
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Common “Sense” Key Points
Use regular words, no jargon.
Use clients’ own words to link everyday life
to sensory processing knowledge.
Listen—really listen—to what they need.
Learn how to coach them toward finding
solutions.
23
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Use clear, understandable,
and precise language.
Unclear/jargon filled:
Your child has
difficulty with
somatosensory
processing.
Clear/jargon free:
You said your child
hits and screams;
it may happen
when people and
objects touch his
skin.JARGON
ALERT!
Being
unclear
Regular
words
Being
precise
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Linking to Everyday Life
The general way:
―He would have trouble in crowds, like at a concert or sporting event.‖
(The child does not encounter these experiences.)
The everyday life way: ―…that’s why he has
trouble standing in line with the other children; they will bump into him.‖
(The teacher has told you that line behavior is a challenge.)
Shows you are really listening to
what concerns them.
25
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Coaching invites involvement.
“Yes” “Well, it seems to be when we
get home from school. . . .”
Traditional way:
Are there times
when he has
outbursts for no
apparent reason?
Coaching way:
What do you know
about the times
that he has
outbursts for no
apparent reason?
Keeps you in
charge
Invites
participation26
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
COACHING: Reflective QuestioningAWARENESS
What do you know about. . . ?
What have you tried?
What happened when you. . . ?
What supports were most helpful?
ANALYSIS
How does that compare with what you
did before?
What do you think will happen if you. . .
?
How is that consistent with your goals?
ALTERNATIVES
What else could you have done?
What would it take for you to be able
to. . . ?
What might make it work better next
time?
ACTION
What do you plan to do?
What supports do you need to take that
step?
Where will you get the resources you
need?(Rush & Shelden, 2005a, 2005b)
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Creating Friendly Documentation
Summary Report for Daniel
Daniel is an 8-year-old third
grader. His parents and
teacher are concerned that he
picks fights with other children
for no apparent reason. . . .
Our testing included
completing questionnaires
(School Companion: teacher
and Sensory Profile: parents);
interviewing the teacher and
parents; and observing Daniel
in several environments,
including. . . .
Summary Report for Daniel
. . . our results show that Daniel is just like
other children in his responses to what he
sees and hears. These are great
advantages for Daniel, because school
emphasizes using information from eyes and
ears to follow directions, complete work
sheets. . . .
. . . our results show he reacts differently
from his peers when he is touched; in the
normal course of lining up, getting on the
bus, and playing, children bump into each
other. Daniel may be picking fights with other
children because his nervous system is
overreacting to these experiences. . . .
Use many
sources.
Say what is
great!
Link to
participation.
State
concern in
life.
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Creating Friendly Reports
Keep participation in the FOREFRONT.
Link sensory patterns with participation.
Do NOT write about every score!!!Report on patterns.
Emphasize links to participation:○ Findings that support participation
○ Findings that seem to interfere with participation.
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Ongoing Assessment and Setting
GoalsDO Focus on the priorities
of the child, family,
and teacher regarding
participation.
Measure progress on
the basis of the child’s
effectiveness in life.
―Abe will get on the
bus independently.‖
DON’T Retest underlying factors
that contribute to or
interfere with participation.
Measure progress on the
basis of changes in
underlying factors.
―Abe will demonstrate
better one-foot balance.‖
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Comprehensive assessment (every 3 years) can include a wider range of
areas for testing.
3/26/2009
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
• Identifying participation challenges
• Gathering data from standardized measures
• Designing strategic interpretation strategies
• Applying strategies to children’s everyday experiences
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Identifying Participation
ChallengesReview the referral concern and record.
Interview the client, family, and teacher.
Conduct skilled observations:
Participation is successful.
Participation is challenging.
Complete formal assessments:
Performance-based testing
Informant questionnaires.
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission. 33
(Brown & Dunn, 2002; Dunn, 1999, 2002,
2006a, 2006b)
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
CollaboratorsDebby Daniels, PhD, CCC
Pat Pohl, PhD, PT
Donna Bennett, MS, OTR
Tana Brown, PhD, OTR, FAOTA
Jessica Clark, MS, OTRSunday Dove, PhD, OTR
Julie Ermer, MS, OTRMary Kientz, MS, OTR
Lucy Miller, PhD, OTR, FAOTA
Kay Westman , MS, OTR
Brenda Myles, PhD
PT
Teacher
Speech
OTOTOT34
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Bell CurveTypical
Performance
Much More
Than Others
Much Less
Than Others
More Than
Others
Less Than
Others
68% of
Population
14%14%
2%2%
For more info: http://classes.kumc.edu/sah/resources/sensoryprocessing/35
Comparison across groups
Infant Toddler Sensory Profile
0.00
10.00
20.00
30.00
40.00
50.00
60.00
typical autism DD
Avoid
0.00
10.00
20.00
30.00
40.00
50.00
60.00
typical autism DD
Registration
mean
-1SD
+1SD
Typical
range
Dunn, 2002
Bell Curve
on its side
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Comparisons With the Sensory
Profile
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
Registration
0.00
20.00
40.00
60.00
80.00
100.00
120.00
140.00
Seek
0.00
20.00
40.00
60.00
80.00
100.00
120.00
Sensitivity
0.00
20.00
40.00
60.00
80.00
100.00
120.00
140.00
160.00
Avoiding
(Dunn, 1999, 2006a,
2006b)
Note. ADHD = attention
deficit–hyperactivity
disorder.
37
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Sensory Processing Across Groups (Rogers, Hepburn, & Wehner, 2003)
Short Sensory
Profile (McIntosh, Miller, Sh
yu, & Dunn, 1999)
Autism
(n = 26)
Fragile X
(n = 20)
DD
(n = 32)
Typical
(n = 24)
Tactile
sensitivity
Signif. more
than others
Signif. more
than others
Same as others Same as others
Taste–smell
sensitivity
Signif. more
than others
Same as others Same as others Same as others
Low energy/
weak
Same as others Signif. more
than others
Same as others Same as others
Auditory
filtering
Signif. more
than others
Signif. more
than others
Same as others Same as others
Under/seek Same as others Signif. more
than others
Same as others Same as others
Differences NOT accounted for by DEVELOPMENTAL LEVEL or IQ
38
Note. DD = developmentally delayed.
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Interpretation Strategies
Keep participation in the FOREFRONT.
Link sensory patterns with participation.
Report about supports to participation.
Look for patterns in data. Concepts from Dunn’s Model of Sensory Processing.
Consider which sensory systems support or interfere.
How do interviews and observations link with test data?
Prioritize findings within the person’s life.
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Look for patterns in data.
REGISTRATION SEEKING Both high thresholds: may
miss cues when tired or
stressed
[Reg + Seek]
SENSITIVITY AVOIDING Both low thresholds: may
be rigid in situations
[Sens + Avoid]
Both passive self-
regulation: May find
themselves
overwhelmed in
situations [Reg + Sens]
Both active self-
regulation: Need and
want some control over
situations [Seek + Avoid]
For example, when two patterns are both “different from others”:
Expect these
behavior
patterns.
40
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
THOMAS: Elementary School
Student
Struggles with changes in routines and with transitions
Uses emotional outbursts when things don’t go his way
Withdraws or gets angry when in trouble
Shoves and pushes peers
Doesn’t understand “personal space”
Poor sense of his body
Never recognizes dirt on his face
Mouths objects, loves to chew
Poor articulation: When others don’t understand him, he gets angry
When getting dressed, doesn’t know what to do next
Hates tags on his clothing
Hates socks
Loves being naked
Loves the shower, but doesn’t use soap or cloth
Ok academically
Handwriting poor
41
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
THOMAS: Elementary school
student
Struggles with changes in routines and with transitions
Uses emotional outbursts when things don’t go his way
Withdraws or gets angry when in trouble
Shoves and pushes peers
Doesn’t understand “personal space”
Poor sense of his body
Never recognizes dirt on his face
Mouths objects, loves to chew
Poor articulation: When others don’t understand him, he gets angry
When getting dressed, doesn’t know what to do next
Hates tags on his clothing
Hates socks
Loves being naked
Loves the shower, but doesn’t use soap or cloth
Ok academically
Handwriting poor
1. Thomas is a good student
who might be at risk because of
difficulty with self-management.
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
THOMAS: Elementary school
student Struggles with changes in
routines and with transitions
Uses emotional outbursts when things don’t go his way
Withdraws or gets angry when in trouble
Shoves and pushes peers
Doesn’t understand “personal space”
Poor sense of his body
Never recognizes dirt on his face
Mouths objects, loves to chew
Poor articulation: When others don’t understand him, he gets angry
When getting dressed, doesn’t know what to do next
Hates tags on his clothing
Hates socks
Loves being naked
Loves the shower, but doesn’t use soap or cloth
Ok academically
Handwriting poor
2. Thomas may have oral–sensory difficulties.
43
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
THOMAS: Elementary school
student Struggles with changes in
routines and with transitions
Uses emotional outbursts when things don’t go his way
Withdraws or gets angry when in trouble
Shoves and pushes peers
Doesn’t understand “personal space”
Poor sense of his body
Never recognizes dirt on his face
Mouths objects, loves to chew
Poor articulation: When others don’t understand him, he gets angry
When getting dressed, doesn’t know what to do next
Hates tags on his clothing
Hates socks
Loves being naked
Loves the shower, but doesn’t use soap or cloth
Ok academically
Handwriting poor
3. Thomas may have poor body
awareness due to difficulty
interpreting touch input.
44
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
THOMAS: Elementary school
student
Struggles with changes in routines
and with transitions
Uses emotional outbursts when
things don’t go his way
Withdraws or gets angry when in
trouble
Shoves and pushes peers
Doesn’t understand “personal
space”
Poor sense of his body
Never recognizes dirt on his face
Mouths objects, loves to chew
Poor articulation: when others don’t
understand him, he gets angry
When getting
dressed, doesn’t know what
to do next
Hates tags on his clothing
Hates socks
Loves being naked
Loves the shower, but
doesn’t use soap or cloth
Ok academically
Handwriting poor
4. Thomas may have poor body awareness
due to difficulty interpreting movement
[Vestib] and body position [Proprio] input
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Thomas Case Study: SP
DataMuch
Less Less
Same as
Others More
Much
More
SEEK X
AVOID X
SENS X
REG X
AUD X
VIS X
VEST X
TAC X
MULTI X
ORAL X
What do you see?
Notices just like
others [Reg]
Seek + Avoid =
need for control
Vestib and Oral
same as others!
Tactile much more
than others [2%]
Aud and Vis: some
concerns
46
Note. SP = Sensory Profile.
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Thomas Case Study: SP Data
(cont.)Much
Less Less
Same as
Others More
Much
More
TONE X
POS/MVMT X
ACTIVE X
SENSORY/
EMOT
X
MULTI X
EMOT/
SOC
X
BEH X
THRESH X
What do you see?
Proprioception/tone
is ok.
It may be harder for
Thomas when
stimuli are combined
(modulation sections
are “more”).
Difficulty with
managing self is
verified [Emot/soc and
Beh scores].
Mo
du
lati
on
Secti
on
47
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Decision Hypotheses Findings
Hypothesis
supported1. Thomas is a good student
who might be at risk
because of difficulty with
self-management.
+ Skilled observations
+ Parent and teacher report
+ Emot/soc score; Beh score SP
+ Seek, Avoid, and Sens scores SP
+ Tactile score SP
+ Modulation scores SP
+ Aud and Vis scores SP
Hypothesis
rejected2. Thomas may have oral–
sensory difficulties.
+ Parent and teacher report
ok Oral score SP is typical.
Hypothesis
supported3. Thomas may have poor
body awareness due to
difficulty interpreting touch
input.
+ Parent and teacher report
+ Skilled observations
+ Tactile score SP
Hypothesis
rejected4. Thomas may have poor
body awareness due to
difficulty interpreting
movement [Vestib] and body
position [Proprio] input.
+ Parent and teacher report
+ Skilled observations
ok Vestibular score SP is typical.
ok ―Tone‖ score SP is typical.
48
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17
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
• Reviewing evidence on traditional interventions
• Framing decision making with interdisciplinary evidence
• Using evidence to create a participation focus
• Implementing an evidence-based sensory processing approach within daily life
49
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Summary Review of Sensory–Motor Interventions in Autism
Design educational programs that accommodate unique sensory
processing patterns.
Make task and environmental modifications.
Use systematic data collection to chart progress.
Consider that traditional sensory integrative (SI) therapy is
beneficial ANECTODALLY, but evidence does not substantiate
effects.
Increase generalization with functional activities in daily routines
within natural contexts.
(as reported in Baranek, 2002)50
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Evidence Brief on
Sensory Integration
Refer to Evidence Brief: Keeping Current in Sensory
Integration (Pollock, 2006; www.canchild.ca/Default.aspx?tabid=1237).
Some studies report positive changes in behavior; treatment efficacy is still unknown because of limitations in designs.
Better designed studies do not show a difference in SI therapy.
SI therapy (classical) should be considered a trial.
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
So . . . Now What?
There is a difference between knowledge
and the application of knowledge.
Neuroscientists and others have provided
evidence about how the brain works.
Applied scientists make use of knowledge in
particular ways.
52
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Evidence About the
Structure of Services
Teachers are 4 times more likely to
implement practices learned through
partnerships than to implement practices
learned in traditional in-service training.
Implementation of strategies rates:
From traditional in-services: 10%
From partnership approach: 85%
53
(Knight, 2004, 2008; Showers & Joyce, 1996)
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Evidence About Using
Children’s Routines as Context
for Intervention Using children’s routines provides more varied
opportunities for practice.
Using everyday activities has a positive impact on
children’s development.
Parent-facilitated child learning is equally or more
effective than therapist-implemented interventions.
Must be active, intentional, purposeful, and contextual
Must be interest-based, responsive interactions.
54
(Dunst, 2001; 2006; Dunst, Bruder, et al., 2001; Dunst, Trivette, & Hamby, 2006;
Gibbard, Coglan, & MacDonald, 2004; Kellegrew, 1998; Law et al., 1998;
Law, Garret, & Nye, 2004; McLean & Cripe, 1997; Roper & Dunst, 2003;
Trivette, Dunst, & Hamby, 2004)
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Evidence About Capacity
Building Family-, person-, and school-centered care has a
capacity-building effect.
Build capacity by teaching care providers how to
interact with children within natural learning
opportunities.
Capacity building:
Therapists support strengths and abilities.
Care providers recognize, learn, and use their abilities.
Therapists and care providers assume responsibility for
working toward desired outcomes.
55
(Davies, 1995; Dempsey & Dunst, 2004; Dunst, Trivette, & Snyder, 2005; Law et
al., 1998, 2004; Shelton & Stepanek, 1994; Trivette et al., 2004)
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Evidence Related to
Natural Environment Interventions
Providing theoretically sound interventions during daily life routines improves PARTICIPATION.
Skill development develops isolated skills.
(Dunst, Bruder, Trivette, & Hamby, 2006; Dunst, Bruder, et al., 2001; Dunst, Hamby, Trivette, & Raab, 2002; Dunst, Hamby, et al., 2000; Dunst, Herter, & Shields, 2000; Dunst, Humphries, & Trivette, 2002;
Dunst, Trivette, & Cross, 2002; Dunst, Trivette, Humphries, Raab, & Roper, 2001)
Sensory processing interventions need to be part of the natural context to support generalization.
(Baranek 2002; Hanft & Pilkington, 2000)
@ winnie dunn 2009 56
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Summary: Key Tips for Practice
Here’s What to Do Here’s Why
Create partnerships with
care providers.
To increase implementation fidelity and
achieve better child outcomes
Provide person-centered
care.
To increase capacity of care providers
and achieve children’s developmental
outcomes
Embed your expertise
within children’s daily
routines and natural
contexts.
To provide more practice and foster
generalization
Provide theoretically sound
interventions.
To provide a structure for data collection
and decision making
57
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Impact of
Caregiver-Implemented Routines Multiple-baseline
design with 4 toddlers
with developmental
delays
Train parents during
indoor play
Test for generalization
in outdoor play and
caregiving routines
Positive parent and
child outcomes
Multiple-baseline
design with 5
children with autism
Train parents during
certain daily routines
Test for
generalization in
other daily routines
Positive parent and
child outcomes(Kashinath, Woods, & Goldstein, 2006;
Woods, Kashinath, & Goldstein, 2004)
58
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Comparison of Traditional and
Functional Physical Therapy (Ketelaar, Vermeer, Hart, Beek, & Helders, 2001)
55 children with cerebral palsy
Compared functional physical therapy (PT) to
normalization of movement
Measured quality of movement, skill
development, and movement in daily routines
BOTH groups improved gross and fine motor
skills.
Functional PT group did better in daily
routines (Pediatric Evaluation of Disability Inventory;
Haley, Coster, Ludlow, Haltiwanger, & Andrellos, 1992).
59
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Use of Touch Pressure and
Proprioception to Support Participation
VandenBerg (2001)
4 students with ADHD
Wore vests for 15 min (put on
5 min before observation)
5% of the child’s weight
Outcome
On-task behavior improved
18% to 25%.
Students asked to use the
vest again.
One student noticed
difference in weight.
60
Fertel-Daly, Bedell, & Hinojosa (2001) 5 preschoolers with
pervasive developmental disorder
Wore vests for 2 hr (data collected at 1.5-hr mark)
1 lb of weight
Outcome Improvements in behavioral
repertoire included– < Self-stimulation,– < Distractibility, and– > Focused attention.
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Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Use of Postural and Vestibular
Activation to Support Participation
Schilling, Washington, Billing
sley, & Deitz (2003)
Used ball chairs in fourth-grade
classrooms to study in-seat
behavior and legible word
productivity
ABAB design (3-wk alternating
chair and ball)
Significant increase in in-seat
behavior and legible writing
61
Schilling & Schwartz (2004)
4 preschool boys with autism
Used ball chairs with molded
feet in preschool classrooms to
study in-seat behavior and
engagement
Teacher chose time of day
ABAB design (2-wk alternating
chair and bench seat)
Significant increase in in-seat
behavior and engagement
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Sensory Processing Patterns of
Teachers Related to Their
Students
seeker
avoider
Pers
on
al–
So
cia
l
(Teachable Pupil Inventory
[Kornblau, 1982]; this study by Johnson-
Coffelt, 2001)
PERSONAL–SOCIAL
• Happy
• Cheerful
• Honest
• Sense of humor
• Sincere
• Confident
62
High Seeking
High Avoiding
(Mische-Lawson & Dunn, 2008)
Miniature pretend toys
vehicles
Creative art
Building materials
no toy preference
No body position changes
Varied body positions
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission. 63
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22
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
• Gaining insights about the teachers’ points of view
• Understanding the special context of school
• Learning about the data available from school context
• Practicing how to meet the demands of learning and
interacting at school
64
Providing insights about the teacher’s point of view
(Dunn, 2006a)
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Understanding the special context of school…
What are the benefits and risks?
What are the benefits?
Sensory Profile (SP) is
not appropriate for
teachers.
We need context-specific
data.
School is a major life
context for children.
What are the risks?
We might compare
teachers and parents to
see who is RIGHT.
We might abandon parent
information because
teachers are more
convenient.
We might get
overwhelmed with
complexity of data.
66
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23
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Data Available From the
Sensory Profile School Companion
Comparable Info to SP
Quadrant Scores
SEEK
AVOID
SENSITIVITY
REGISTRATION
System Scores
Auditory
Visual
Touch
Movement
Behavior
New Info Available
School Factor Scores
School Factor 1
School Factor 2
School Factor 3
School Factor 4
67
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
School Factor 1
School
Factor 1
Registration Seeking
Degree to which a child
needs someone else to
manage or influence the
actions
Teacher interacts to change
the course of events with the
child
External influences affect
behavior
Combination of SEEK and
REG [Registration]High
Thresholds
68
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
School Factor 1 Examples
REGISTRATION
Misses oral directions
in class more than
other students
Has trouble keeping
materials and
supplies organized for
use during the day
SEEKING
Hums, whistles, sings, or
makes other noises
throughout the day
Gets up and moves
around more than other
students
69
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24
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
School Factor 2
School
Factor 2
Seeking Sensitivity
Level of child’s attention and
awareness of self and
environment
Busy, engaged, alert, resp
onsive, detail oriented
Combination of SEEK and
SENS
70
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
School Factor 2 Examples
SEEKING
Adds more details to
drawing and coloring
than other students
Seems more curious
than other students
SENSITIVITY
Comments on small
details in objects or
pictures that others
haven’t noticed
Is bossy with
classmates and
peers
71
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
School Factor 3
School
Factor 3
Sensitivity Avoiding
Range of tolerance for
what is going on in the
environment
Hyperawareness, rigidit
y, bothered, defiant
Combination of SENS
and AVOID
Low
Thresholds
72
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25
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
School Factor 3 Examples
SENSITIVITY
Is easily upset by minor injuries (e.g., bumps, scrapes, cuts)
Becomes distressed during assemblies, lunch, or other large gatherings
AVOIDING
Withdraws when changes in the environment or routine occur
Flinches when people get in close proximity to or touch his or her body
73
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
School Factor 4
School
Factor 4
Registration Avoiding
Level of availability for
learning
Removed, stoic, distant, disengaged, inactive
Combination of AVOID and REG
74
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
School Factor 4 Examples
REGISTRATION
Shows little emotion regardless of the situation
Seems oblivious within an active environment (i.e., is unaware of activity)
AVOIDING
Stands or sits at the side of the playground during recess
Withdraws from active environments or situations (e.g., retreats to a quiet area in the classroom)
75
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26
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Zachary’s Participation
Zachary is a 6-year-old first grader.
SCHOOL
Zachary is doing fine at
school.
He has more challenges in
group situations
(e.g., lunch, hall, group
projects).
Zachary fiddles with small
toys at his desk but won’t use
glue during art.
HOME
Zachary doesn’t respond to his
parents’ calls.
He is particular about
situations, including getting
dressed.
Zachary’s parents want him to
be successful at school.
76
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Zachary’s Sensory Profile and School
Companion Quadrant ScoresMuch
Less Less Same More
Much
More
SP home
SEEK Seek
SENS Sens
AVOID Avoid
REG Reg
SP school
SEEK Seek
SENS Sens
AVOID Avoid
REG Reg
What do you see?
Seeking scores are
Same.
Both parents and
teacher see Zach as
having low thresholds
[Sens and Avoid scores
More Than others on
both].
Parents see Zach as
failing to
notice, whereas teacher
sees Zach as noticing
just like everyone else
[Reg scores].77
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Hypotheses About Registration for
Zachary
He has enough models at school to see
what to do if he misses directions; if he
misses directions at home, he is lost.
The teacher has seen many more 6-
year-olds and thus has a different idea
about ―missing cues.‖
The family and teacher see Zach in
different situations that might bring out
his noticing or missing information.
78
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27
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Zachary’s Sensory Profile
School Companion ScoresMuch
Less Less Same More
Much
More
SP school
Visual X
Auditory X
Touch X
Movement X
Behavior X
School Factor 1 X
School Factor 2 X
School Factor 3 X
School Factor 4 X
What do you see?
Zach is just like
other students in
the amount of
guidance he needs
from the teacher
[Factor 1],
and
he is just as available
for learning as
other students
[Factor 4].
He is more sensitive
to touch and sound.
He is more busy and
less tolerant
[Factors 2 and 3].
79
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Victoria’s Participation Victoria is an 11-year-old middle
school student.
Teachers agree that she is bright;
grades are lower because she doesn’t
turn in homework.
Parents report that she does homework
every night.
Some teachers are resistant to ―taking
over Victoria’s responsibilities for her.‖
80
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Victoria’s Scores
Much
Less Less Same More
Much
More
AASP*
SEEK Seek
SENS Sens
AVOID Avoid
REG Reg
SP school
SEEK Seek
SENS Sens
AVOID Avoid
REG Reg
*Victoria completed the Adolescent/Adult Sensory Profile because she is 11 years old.
What do you see?
Victoria completed
the AASP on herself.
The teacher and
Victoria agree about
her patterns of
sensory processing.
Victoria sees herself
as more avoiding
than does the
teacher.
81
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28
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Victoria’s Scores (cont.)
Much
Less Less Same More
Much
More
SP school
Visual X
Auditory X
Touch X
Movement X
Behavior X
School Factor 1 X
School Factor 2 X
School Factor 3 X
School Factor 4 X
What do you see?
Visual and Movement
sensation scores are
“More Than Others.”
School Factors 1 and
4 both involve
Registration.
82
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Maria’s Participation
Maria is a 4-year-old attending
the neighborhood preschool
program. Maria does great during free play at
preschool.
Maria does great during teacher
directed activities.
Maria is out of control during snack
time.
Mom and Dad say Maria is fine at
mealtime at home.
83
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Maria’s Sensory Profile and School
Companion Quadrant ScoresMuch
Less Less Same More
Much
More
SP home
SEEK Seek
SENS Sens
AVOID Avoid
REG Reg
SP school
SEEK Seek
SENS Sens
AVOID Avoid
REG Reg
What do you see?
Maria has some
sensitivity at home and
at school.
Maria is mostly like other
children at preschool
[Same scores on School
Companion].
Maria’s reactions at
home are mostly more
intense and frequent
than would be expected
of children her age
[scores More and Much
More than others on
Sensory Profile].84
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29
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Maria’s Sensory Profile School
Companion scores (cont.)
Much
Less Less Same More
Muc
h
More
SP school
Visual X
Auditory X
Touch X
Movement X
Behavior X
School Factor 1 X
School Factor 2 X
School Factor 3 X
School Factor 4 XNOTE: on the SP, scores more than others on
auditory, touch, multisensory and oral processing
What do you see?
Maria needs the
same amount of
support as others
[Factor 1].
Maria is just as
available for learning
as others [Factor 4].
Maria reacts more
than others to sound
and touch stimuli.
Maria is more active
and needs more
structure in the
school environment
than others [Factors
2 and 3]. 85
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
• What is on the horizon to invite us to higher ground?
86
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Consider Other Points of
View
Is normalcy . . .
Overrated?
Underrated?
An artificial parameter?
Are too many people being
labeled with illnesses?87
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30
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Consider Other Points of
View Is our perspective about disability . . .
Too negative?
Too narrow?
Does our perspective about intervention . . .
Need to be more universally focused?
Need to be reconsidered?
88
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Returning to Sensory Processing
Seeker:
Creates excitement and
change
Bystander:
Easygoing and can maintain
focus
Avoider:
Creates routines to manage day
Sensor:
Notices details and has precise
ideas
89
Dunn, W. (2008) Living sensationally:
Understanding your senses.
London: Jessica Kingsley Publishershttp://livingsensationally.blogspot.com/
Acknowledgments
Images of the Sensory Profile assessments are reproduced with the permission
of NCS Pearson, Inc., as follows:
Sensory Profile. Copyright © 1999 by NCS Pearson, Inc. Reproduced with
permission. All rights reserved.
Infant/Toddler Sensory Profile. Copyright © 2002 by NCS Pearson, Inc.
Reproduced with permission. All rights reserved.
Adolescent/Adult Sensory Profile. Copyright © 2002 by NCS Pearson, Inc.
Reproduced with permission. All rights reserved.
Sensory Profile School Companion. Copyright © 2006 by NCS Pearson, Inc.
Reproduced with permission. All rights reserved.
Sensory Profile Supplement. Copyright © 2006 by NCS Pearson, Inc.
Reproduced with permission. All rights reserved.
―Sensory Profile‖ is a trademark in the United States and other countries of
Pearson Education, Inc., or its affiliate(s).
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission. 90
3/26/2009
31
Acknowledgments (cont.)
The image on the cover of Living
Sensationally: Understanding Your
Senses, by W. Dunn, is reproduced with
the permission of Jessica Kingsley
Publishers.
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission. 91
References
For course references and bibliography, go
to the References tab on the main menu.
A course bibliography is included in the
course resources.
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission. 92