ASSESSMENT Evidence that SPD is a causative factor in a child’s performance or behavior

problems can be extracted from a detailed history and parent interview. Referral to an
occupational therapist for standardized testing can confirm the diagnosis.

History The parent’s history of the child’s birth and developmental milestones may reveal an
unremarkable birth and typical achievement of motor milestones in the first years of life. The
parents of children with SMD often describe them as difficult, irritable, and anxious infants.
They describe an infant with persistent sleeping and eating problems. As toddlers and
preschoolers, the parents frequently describe a defiant, irritable, stubborn or rigid child who
does not tolerate certain activities or environments and resists transitions. Sleeping and eating
problems may continue into the preschool years. By asking about antecedent factors to
specific instances of sleeping or eating problems, patterns emerge suggesting that the child’s
behaviors are associated with specific sensory experiences. Parents of children with SMD often
describe a passive child who seems reluctant to try new activities and who struggles to learn
new skills. The interview also may reveal an association between sensory experiences and
reluctance to participate, avoidance, or noncompliance. Infants who originally were resistive to
touch or refused certain food textures often become less sensitive as they mature; however,
they may maintain the negative and defiant behaviors when these are reinforced by adult
attention or parents’ emotional responses. The interview may reveal that sensory processing
problems in infants become behavioral problems in preschoolers that are self-sustaining
because they create multiple layers of reactions from others.
A detailed history can identify problems in sensory processing.
Table 73-3 lists potential interview questions.

Examination
An in-depth examination and extensive observations
are required to analyze sensory processing problems.
Referral to an occupational therapist, particularly one
trained in administering the Sensory Integration and
Praxis Tests (Ayres, 1989), is optimal for comprehensive
evaluation and intervention. Table 73-4 lists standardized
assessments administered by therapists that are
helpful in confirming this diagnosis and developing an
intervention plan. The examination can include assessment
of neurologic soft signs to screen for possible SPD.
Table 73-4 also lists clinical observations and neurologic
soft signs associated with each SPD.

INTERVENTION
Occupational therapists are the primary professionals to
provide services to children with SPD; referral to speech
pathology or physical therapy services may be appropriate.
Services are directed to the child, the family, and
other adults who teach or care for the child. A priority
goal of intervention is to promote the child’s integration
of sensation and ability to show adaptive and organized
responses to sensory input (Ayres, 2005). Equally important
goals are to help the child learn to compensate
for SPD, to help parents understand and reframe the
problem, and to modify the child’s environments and
routines to improve goodness-of-fit. The intervention
plan should consider the child’s multiple environments
(e.g., home and school), and should emphasize caregivers’
understanding of the problem such that they learn
to accommodate the child’s sensory needs. Optimal timing
for sensory integration intervention is 2 through
7 years of age (generally SPD is not identified before age
2 years). Children may receive services beyond 7 years if
more involved, identified at an older age, or according
to the family’s preference.
Children with significant SPD may receive occupational
therapy services at school and in a clinic.
Generally, these services complement each other; the
school-based occupational therapist helps the teachers
and aides accommodate to the child’s sensory needs
and recommends modifications to the classroom environment
and routines. The clinic-based occupational
therapist has opportunities to work directly with the
child and family to improve performance and behaviors
through one-on-one sensory integration treatment.
Services
should emphasize the family’s education about
the disorder and should teach parents strategies that
help the child improve arousal, alertness, attentiveness,
and performance (Bundy and Koomar, 2001).
One typical recommendation to family members is
to provide a “sensory diet” to the child. This diet helps
the child’s arousal and organization throughout the day
and generally includes activities that provide deep pressure,
heavy work, linear vestibular input, and sometimes
rhythmic movement such as bouncing. The goals of
these activities are to increase arousal, calm, help organize,
increase attentiveness, improve alertness, and decrease
activity level (Koomar and Bundy, 2002). Sources
of sensory stimulation believed to help children better
modulate sensory input include filtered (modulated) music
through head phones, weighted vests, therapy balls,
deep pressure, and massage. Sensory diets should be
closely monitored and modified over time; they should
fit easily into the family’s daily routine.
Table 73-5 lists the principles of sensory integration
intervention. Sensory integration intervention includes
activities that directly promote skill building (e.g.,
practice of balance, visuomotor skills, handwriting, or
activities of daily living). Parents have defined the outcomes
that they value for sensory integration intervention.
Cohn (2001a) found that parents valued most
(1) reframing of their children’s behavioral and performance
problems as SPD; (2) learning to accommodate
to their children’s sensory needs; (3) learning strategies,
tools, and language for advocating for their children;
and (4) observing improvements in their children’s selfesteem,
confidence and social skills. Resources for parents
are provided at the end of this chapter.
OUTCOMES OF SENSORY INTEGRATION
INTERVENTION
Two meta-analyses (Ottenbacher, 1982; Vargas and
Camilli, 1999) and one systematic review (Polatajko
et al, 1992) of sensory integration intervention have been
published. These reviews have shown that the effects of
sensory integration are positive but modest. Gains were
primarily in motor skills; however, behavioral organization
and self-esteem measures have rarely been used in
clinical trials. Vargas and Camilli (1999) found that average
effect sizes for motor performance and cognition
measures (0.39 to 0.40) were higher than average effect
sizes for language and perceptual skills (0.13 to 0.14).
Because a primary outcome of sensory integration intervention
is goodness-of-fit among parent, child, and
environment, interactional variables should be assessed,
but rarely have been.
Although behavior and performance improvements
are modest, parents have indicated that they are important
and relate to significant changes in their children’s
self-esteem, peer relations, and confidence. In two qualitative
studies that involved interviewing parents whose
children received sensory integration intervention
(Cohn, 2001a, 2001b), parents expressed that their
children’s participation in a range of activities had increased,
and their perception of self-worth seemed to
improve. Equally important outcomes for parents were
(1) increased understanding of their children, (2) ability
to establish expectations for their children, (3) validation
of their parenting experiences, and (4) learning strategies
for supporting and advocating for their children.
SUMMARY
Children with SPDs present with a range of behavioral
and performance consequences. Identification requires
history and examination, and when suspected,
SPD should be confirmed by standardized sensorymotor-
perceptual scales administered by an occupational
therapist. Essential elements of intervention include educating
the family members about SPD and how it affects
the child’s behaviors; recommending modifications to
the child’s environment and routines; helping all caregivers
accommodate to the child’s sensory processing
needs; and giving the child methods to maintain optimal
levels of arousal, attentiveness, organized behavior, and
skillful performance.