Sensorimotor History Questionnaire for Parents of Preschool

SENSORIMOTOR HISTORY QUESTIONNAIRE FOR PARENTS OF PRESCHOOL CHILDREN 1.

Is your child particularly sensitive to touch? Yes…….No…….

2.

Does your child particularly enjoy fast moving or spinning activities at the playground or at home, perhaps with little or no dizziness? Yes…….No…….

3.

Does your child show particular caution in approaching activities involving fast movement or movement of the body through space? Yes…….No…….

4.

Does your child have unusual sensitivities to smell? Yes…….No…….

5.

6.

Is your child particularly sensitive to noise, e.g., putting hands over ears when others are not bothered by sounds? Yes…….No……. Have you ever had concerns about your child‘s hearing either in general or conjunction with ear infections? Yes…….No…….

7.

Have you ever had concerns about your child‘s speech and/or language skills? Yes…….No…….

8.

Have you ever child concerns about your child‘s vision? Yes…….No…….

9.

Does your child have a more ―loose‖ or ―floppy‖ body builds than others? Yes…….No…….

10.

Does your child have difficulty orienting his/her body effectively for dressing activities, such as putting arms in sleeves, putting fingers in mittens, or putting toes in socks? Yes…….No…….

11.

12.

Do you feel that your child has not yet established a definite hand preference when using a spoon, crayon, maker, pencil, etc? Yes…….No……. Does your child avoid active physical games involving running jumping and use of large play equipment? Yes…….No…….

13.

Does your child avoid manipulation of small objects? Yes…….No…….

14.

Does your child avoid activities involving the use of ―tools‖ such as crayons, pencils, markers, and scissors? Yes…….No…….

15.

Do you feel that your child has a short attention span, even for things that she/he enjoys? Yes…….No…….

16.

Do you feel that your child tends to be restless or ―fidgety‖ during times when quiet concentration is required? Yes…….No…….

17.

Has your child had difficulty regulating his her sleep patterns Yes…….No…….

SENSIMOTOR HISTORY QUESTIONNAIRE FOR TEACHERS OF ELEMENTARY-SCHOOL-AGE CHILDREN I.

Touch(Tactile) 1. Overreacts to physically painful experiences. Yes…….No……. 2. Underacts to physically painful experiences. Yes…….No……. 3. Avoids messy activities. Yes…….No……. 4. Craves messy activities. Yes…….No……. 5. Dislikes being touched, especially unexpectedly becomes irritated when crowded and isolates self from others. Yes…….No……. 6. Craves being touched. Yes…….No……. 7. Seeks out physically aggressive contact(roughhousing, Crashing into walls or people) Yes…….No……. 8. Is excessively ticklish Yes…….No……. 9. Avoids using hands for prolonged periods of time or for examining objects thoroughly Yes…….No…….

II.

Balance and Movement (Vestibular/Proprioceptive)

1. Has a poor balance Yes…….No…….

2. Has difficulty going up and down stairs or hills Yes…….No……. 3. Often rocks in chair or assumes an upside-down position Yes…….No……. 4. Often props head in hands while reading or writing Yes…….No……. 5. Seems fearful in space (e.g., swing, seesaw, heights). Yes…….No……. 6. Is afraid of or avoids, vigorous, fast-moving activities at the playground (bouncing, swinging, balancing or spinning). Yes…….No……. 7. Seems sensitive to movement, getting dizzy or seasick. Yes…….No……. 8. Prefers fast moving or spinning activities. Perhaps not getting dizzy or seeming less sensitive than most children to effects. Yes…….No…….

III.

IV.

Coordination 1. Has difficulty with manual skills (scissors, crayons, pencils, buttons ) and/or with handwriting. Yes…….No……. 2. Seems clumsy and accident-prone ,perhaps not catching self easily Yes…….No……. 3. Was slow to show a clear hand preference or is not vet clearly right- or left-handed Yes…….No……. 4. Must be reminded to hold paper while writing Yes…….No……. 5. Uses extraneous movements during physical activity (e.g., sticks out tongue, moves jaw, clenches fists). Yes…….No……. Muscle Tone

1. Appears stiff and rigid. Yes…….No……. 2. Appears loose and floppy Yes…….No……. 3. Has poor standing and/or sitting posture Yes…….No……. 4. Grasps objects too tightly Yes…….No……. 5. Grasps objects too loosely Yes…….No……. 6. Tires easily Yes…….No…….

V.

Haring (Auditory) 1. Is frightened or irritated loud noises Yes…….No……. 2. Is very sensitive to background sounds. 3. 4. 5. 6. 7. 8. 9.

Yes…….No……. Has the difficulty paying attention amid surrounding noise. Yes…….No……. Often shouts or speaks in loud voice. Yes…….No……. Frequently makes repetitive noises or sounds. Yes…….No……. Fails to follow through on verbal requests. Yes…….No……. Needs directions repeated Yes…….No……. Confuses spoken words. Yes…….No……. Misses same sounds. Yes…….No…….

VI.

Sight (Visual)

1. Appears sensitive to light, preferring dark or dim lighting Yes…….No……. 2. Have difficulty discriminating shapes or colors. Yes…….No……. 3. Has difficulty keeping eyes on objects. Yes…….No……. 4. Cannot follow a moving object or line of print smoothly with eyes; loses place. Yes…….No……. 5. Often squints, rubs eyes, and gets headaches or watery eyes after reading. Yes…….No……. 6. Becomes excited with a lot of visual stimuli. Yes…….No……. 7. Resists having vision blocked. Yes…….No……. 8. Reverses confuses numbers, letters, or whole words. Yes…….No……. 9. Has difficulty with written instructions Yes…….No……. 10.Has difficulty copying from blackboard or books. Yes…….No…….

VII.

Smell (Olfactory) 1. Is factory sensitive to certain smells Yes…….No……. 2. Ignores noxious odors. Yes…….No……. 3. Has difficulty discriminating odors. Yes…….No…….

VIII.

Attention And Behaviour

1. Is restless or fidgety Yes…….No……. 2. Is impulsive, often jumping up before instructions are given. Yes…….No……. 3. Has difficulty organizing or structuring activities. Yes…….No…….

From books…………………

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

13. 14.

Likes an activity, food or other? ………………………………………………………………………………... Does not like any activity, food or other? ……………………………………………………………………………... Feels good or happy? ……………………………………………………………………………... Feel ill or in pain? ………………………………………………………………………………... Is hungry? ………………………………………………………………………………... Is uncomfortable? ………………………………………………………………………………... Is anxious or afraid? ………………………………………………………………………………... Wants attention? ………………………………………………………………………………... Wants more of something? ………………………………………………………………………………... Wants you to continue an activity (e.g., playing a game)? ………………………………………………………………………………... Wants you to stop an activity? ………………………………………………………………………………... Wants you start a familiar routing (e.g., fixing a snack)? ………………………………………………………………………………... Wants help? ………………………………………………………………………………... Wants something to eat?

………………………………………………………………………………... 15. 16. 17. 18. 19. 20.

21. 22.

23.

24.

25. 26.

Wants something to drink? ………………………………………………………………………………... Wants certain object? ………………………………………………………………………………... Wants to do something? ………………………………………………………………………………... Wants to use bathroom? ………………………………………………………………………………... Wants affection? ………………………………………………………………………………... Does your child make a choice between several objects when the objects are presented or in view? ------ Describe. ………………………………………………………………………………... Does your child make choice among several activities? _______Describe. ………………………………………………………………………………... Does your childe make a choice of an object or activity when the possible selections are not presented or in view? _____ Describe? ………………………………………………………………………………... How do you know when your child does not understand something that someone has said? __________ Does your child ask for clarification by saying, ‖what‖ or ―I don‘t understand‖ or by doing something like self biting? __________Describe. ………………………………………………………………………………... Does your child ask for information (e.g., where someone is, where someone lives, or when a birthday or holiday will occur)? __________Describe. ………………………………………………………………………………... Does your child ask the same questions repeatedly? ………………………………………………………………………………... Does your child ask for anything but appear to want something different? __________Describe. ………………………………………………………………………………...

How do you know when your child 27.

28.

Does not want to do something or wants to stop doing something? __________Describe. ………………………………………………………………………………... Does not want a specific object of food? Describe ………………………………………………………………………………...

When does you child do when 29. 30. 31.

Not allowed to do or have something desired? __________Describe. ………………………………………………………………………………... A desired object is taken away? __________Describe. ………………………………………………………………………………... The environment of routine is changed? __________Describe. ………………………………………………………………………………...

Does your child‟s Response to Each of the following: 32. 33. 34. 35. 36. 37.

Verbal Directions ………………………………………………………………………………... Questions that begin with, who, where, when, how or why ………………………………………………………………………………... Questions that call for yes or no answer? ………………………………………………………………………………... How does your child greet you or others without direction? ………………………………………………………………………………... How does your child respond when generated by others? ………………………………………………………………………………... Does your child use polite word (such as ―thank you‖ , ‖please‖, or ‖excuse me‖) appropriately?_________without prompting? __________Describe. ………………………………………………………………………………...

38.

If another child asks for a turn or a toy, will your child acknowledge the request? ………………………………………………………………………………...

Does your child 39. 40. 41.

42.

43.

44.

45.

46.

Comment about himself and his own activity? __________Describe. ………………………………………………………………………………... Comment about other people or their actions? __________Describe. ………………………………………………………………………………... Comment about object is present or the event is occurring? __________Describe. ………………………………………………………………………………... Comment about objects or events when the object is not present or the event is not currently occurring? __________Describe. ………………………………………………………………………………... Talk about events that happened in the past or will happen in future? __________Describe. ………………………………………………………………………………... Does your child say the names of objects or people for no apparent reason, without looking at you or relating to you? __________Describe. ………………………………………………………………………………... Does your child talk to himself about what he is doing is going to do (e.g., ―sit down‖ as he sits down) or is not supposed to do (e.g., ―don‘t touch‖ when beginning to touch something that is off limits) as if repeating a rule? __________Describe. ………………………………………………………………………………... Does your child talk to himself about things that don‘t appear to be related to the current situation? __________Describe. ………………………………………………………………………………...

47.

48.

If your child has a limited vocabulary (25 words or so) please list the words and describe any words that are used in specific or unusual ways or situations. ………………………………………………………………………………... What functions, concepts, vocabulary, or forms of communication do you feel are most important for your child to learn this year? ………………………………………………………………………………...

What is sensory integration? Sensory integration is the neurological process of organizing the information we get from our bodies and from the world around us for use in daily life. It occurs in central nervous system, which consists of countless neurons, a spinal cord, and – at the ―head‖- a brain. The main task of our central nervous system is to integrate the senses. According to Dr. Ayres, ―Over 80 percent of the nervous system is involved in processing or organizing sensory input. And thus the brain is primarily a sensory processing machine‖. When our brain efficiently process sensory information. We respond appropriately and automatically. We do this because our brain is equipped to modulate sensory messages. Modulation is the term used to describe the brain‘s regulation of its own activity-and, therefore, of our activity level. Activity level refers to mental, physical, and emotional behaviour. Activity level can be high, low, or somewhere in between. For instance, mental activity is high when a child concentrates on an interesting science lesson, or low when she thinks the history lecture is dull physical activity is high when she leaps and low when she sleeps. Emotional activity is high when she feels threatened or exhilarated, and low when she has no special investment in routine events of the day, like running errands with Mom. Modulation balances the flow of sensory information coming into the central nervous system. The brain turns on, or turn off, the neural switches of all the sensory systems, so that they work in random to keep us in sync. Every minute of every day, we receive millions of sensations. Most of these are irrelevant to our current situation. Therefore, our brains inhibit them. Inhibition is the neurological process that reduces connections between sensory intake and behavioural out-put. Inhabitation is a good and healthy thing; without it. We would be giving full attention to every sensation. Useful or not. For instance, it

is unnecessary to respond to the sensation of air on our skin or of a shift in balance when we take a step, so we learn to ignore the messages. Some messages are meaningless now, although they grabbed our attention at one time, such as the tautness of a seat belt. When we have become accustomed to familiar messages. Our brain automatically tunes them out because they are no longer extraordinary. This process is called habituation. But we must- and do- pay attention to meaningful sensory messages. Some of these are positive sensations, such as moving rhythmically in a rocking chair. Others are negative, such as spinning until we feel sick. These messages are facilitatory. Facilititation is the neurological process that promotes connections between sensory intake and behavioral output. If we are doing something meaningful and beneficial, our brain gives us the go-ahead to continue. When inhibition and facilitation are balanced, we can make smooth transitions from one state to another. A ―state‖ refers to our degree of attentiveness, mood, or motor (movement) response. Thus, we can switch gears from inattention to attention, from sulks to smiles, from drowsiness to alertness, and from relaxation to readiness for action. Modulation determines how efficiently we self-regulate, in every aspect of our lives. Here‘s an illustration of how sensory integration works for you. Suppose you are sitting on the couch, leafing though the newspaper. You pay no attention to the upholstery touching your skin, or the car passing by outside. Or the position of your hands. These sensory messages are irrelevant, and you don‘t need to respond to them. Then your child plops down beside you and says, ―I love you‖. Your senses of sight, hearing, touch, movement, and body position (and may be smell, too) are simultaneously stimulated. Sensory receptors throughout your body take in all this information. Via sensory neurons within your central nervous system, the information zooms to your brain. No one part of the central nervous system works alone. Messages must go back and forth from one part to another, so that touch can aid vision, vision can aid

balance, balance can aid body awareness, body awareness can aid movement, movement can aid learning, and so forth. Sensory integration is a term is used to describe both the basic and essential neurological function that involves organizing sensory information for use. Sensory registration, modulation, discrimination, and praxis (Ayres, 1972).

Location of sensation Sensation occur both inside and outside of and individual. Perceptual development requires that a person distinguish types, quality, duration, and intensity from three distinct locations:  From inside the body (Interoception)  From the head and the musculoskeletal system (Proprioception)  From outside the body (exteroception).

Proprioception Proprioception is used to describe sensations that are received from the tendons, muscles, and joints. The Proprioceptive system carries information about joint and movement (Herdman, 1974). The vestibular system detects position and movement of the head relative to gravity. Together, the vestibular and Proprioceptive systems provide information about the body‘s position in space, the body‘s spats relative to each other, and the dynamic movement of the body through space. This information is used to support postural control; balance; and coordinated movement of the eyes, head, neck, and body. Someone who has good vestibular and propriocetive perception is likely to move gracefully, keeping his or her balance while moving with skill and precision. When the vestibular or Proprioceptive system is not working well, individuals have difficulty developing a good body scheme. They will have poor balance; poor postural control; difficulty forming good laterality; and poorly coordinated movements of the body and limbs, both separately and together. Individuals with autism have been noted to have

difficulty integrating vestibular and Proprioceptive information (Ayres, 1979). The vestibular system provides information necessary to support the most primal of relationships; that of the self to earth, then the vestibular system is not working properly, other relationships also may suffer.

Exteroception Exteroception encompasses several different kinds of stimuli that detect information located outside of the body. Touch, smell, and taste are all designed to detect whatever the individual comes into contact with from the environment and differentiate that from parts of self. Vision and hearing are the only sensations that are not perceived through contact receptors. Vision and hearing allow the individual to perceive information that is both close to the body and at a distance. Visual perception is generally considered an area of strength in many individuals with autism; however, auditory processing is more likely to be problematic.

Multimodal processing The interrelationship of sensations is apparent in any functional activity. Typically, the interoceptive, Proprioceptive, and exteroceptive sensations are integrated so that an individual can pay attention to relevant aspects of the environment while the body operates unconsciously. For example, the vestibular and propriocetive systems work together, supporting an upright posture against gravity and making subtle postural adjustments when moving.

Application of Sensory Integration Concepts to the Diagnosis of Autism The current neurological research that relates to understanding provides insight into the sensory integration disorders that are present in many individuals with autism. These disorders have been clinically observed and documented through research.

Sensory integration is necessary to accurately perceive the body‟s relationship to gravity and other objects. Sensory registration, sensory modulation, sensory perception, and praxis.

Sensory Registration Registration of sensation to refer to the way that a child‘s awareness of sensory stimuli is associated with attaching meaning to situations. Occupational therapists have used the term poor sensory registration to mean a failure to notice, record, and respond to relevant information from the environment.

Sensory Modulation Sensory modulation is the interaction between internal processing and the external environment. More specific fully the interaction among physiologic stability, the perceived challenge imposed by the environment, and environmental supports affects a person‘s ability to tolerate stress and find adaptive coping and interaction strategies. Individual behavioural differences vary widely between extreme hyporespositivity and extreme hyperresponsivity, sensory seeking and sensory avoiding, and unusual patterns of sensory play. The children who were hyporesponsitive tended to respond less well to sensory integration procedures than children who were hyperresponsive.

A common indicator of hyper responsiveness is a high pain tolerance. Children who are hyperresponsive show behavior that may include seeking extremely intense movement, such as spinning and twirling, inflicting injuries on themselves, and throwing themselves into things and people for deep pressure and Proprioceptive sensation. The learning and behavior of children with autism may be hindered by inadequate sensory modulation, because this condition is associated with negative emotions. Sensory modulation si addressed through varying the type, intensity, and duration of different sensory stimuli so that children with autism can maintain a calm, alert state. An analysis of environmental aspects that most disturb the child is essential, and environmental modifications are often necessary to accommodate the child‘s peculiar sensory needs and sensitivities. For example, children with autism may enjoy tight-fitted exercise clothing rather than loose clothing, or a quiet atmosphere rather than loose clothing, or quiet atmosphere rather than one in which the television is playing. A child may be able to focus only if he or she can hear white noise in the background, such as the hum of a ceiling fan. A variety of different intensities and combinations of sensations must be explored to find the child‘s comfort level. Jared and Quinn present with varying indications of inadequate sensory modulation.

Sensory Perception        

Visual Auditory Vestibulor-Somatosensory Praxis as it Relates to the Diagnosis of Autism Assessment Intervention Structured Sensory Environment Proprioceptive sensation

Visual Visual perception is a relative strength in children with autism. This finding is verified by personal reports from individuals who have autism. (Grandin, 1995;

Williams, 1992, 1994). Grandin (1995) stated ―one of the most profound mysteries of autism has been the remarkable ability of most autistic people to excel at visual spatial skills, while performing so poorly at verbal skills‖. Understanding the visual perception strengths of many individuals with autism is an important consideration in educational and therapeutic programs because the visual sensory system offers a mean to compensate for other areas of difficulty. For example, relative skills in visual perception often make activities and mechanical tasks (such as constructing) attractive and organizing for individuals with autism. These kinds of tasks may be helpful in providing support for other areas that are more likely to be difficulty, such as social play and language skills. However, an excessive preference for visual tasks can preclude engagement in active play. Children with high-functioning autism, in particular, may prefer to work on puzzles and computer games or to look at books instead of play at a playground or interact with papers.

Auditory Auditory perception is an area more frequently suspected as being inefficient in many individuals with autism. Placing the child at the most appropriate location in the classroom; using other supplemental sensory information; such as visual cues; and limiting extraneous stimuli are all strategies that might enhance auditory processing. The transient nature of adulatory stimuli is often difficult for individuals with autism, who tend to process concrete images better than those that are implied.

Vestibulor-Somatosensory Children with autism are commonly seen searching for ways to receive additional sensory input that is tactile, propriocetive, or vestibular in nature. Examples of sensory- seeking actions include twirling or spinning, jumping, rubbing or squeezing, biting, head banging, and rocking.

Praxis as it Relates to the Diagnosis of Autism Praxis is the ability to have an idea and plan about a future novel activity that involves deciding what to do and how to do it. Although routine and stereotyped motor activities that do not require praxis, such as walking, running, or climbing, are typically easy for individuals diagnosed with autism, motor activities that require adaptation, such as building models or using tools, appear to very difficult for them . Motor execution is frequently intact, meaning that once children with autism learn a motor skill their actions can look exquisitely smooth and coordinated. However, specific aspects of praxis, such as timing, sequencing, initiating, are commonly difficult for these children.

Assessment Because of the common incidence of sensory integration dysfunction present in children with autism, assessment of underlying sensory integration and praxis abilities is generally a critical aspect of an occupational therapy assessment for these children. And occupation-centered assessment considers the effect that engaging in daily activities has on the well being of these individual and on the systems that surround them. Sensory integration and praxis are fundamental components that are essential to an individual‘s ability to use information and participate adaptively within an ever-changing environment. The evaluation uncovers the ―hidden process‖ that contribute to adaptive or mal adaptive interactions.

Intervention Because disorders of sensory integration are prevalent among individuals with autism, it is difficult to imagine a comprehensive therapy program that would not include at least some components of the sensory integration framework. A sensory integration approach uses a variety of strategies to address the range of disorders in sensory integration and praxis that are common in individuals with autism, when using the sensory integration frame of reference alone or in combination with other methods of intervention used in occupational therapy, the overarching goal of the

occupational therapist is to establish or restore a healthy lifestyle for the child and the child‘s family by engaging the child in meaningful occupations. Sensory integration intervention has many unique features. More than just a technique, it is philosophy is based on Ayer‘s style and her belief that human beings have an innate drive to learn, grow, and interact adaptively. Ayres declared the use of this intervention to be both an art and a science. The artistry emerges with the therapist and the child . The following characteristics hallmarks are present when the sensory integration frame of reference is being:  Use of structured sensory environment that highlights the propriocetive, vestibular, and tactile system.  A focus on tapping the inner drive of the child  Delivery of intervention in the context of play.  ―Artful vigilance‖ on the part of therapist  Child – directed sessions  Elicitation of adaptive responses  Delivery of the ―just-right level of challenge‖  Emphasis on active versus passive participation where the engagement in the activity is its own reward.

Structured Sensory Environment Ayres identified the environment as a key element in sensory integration intervention. She discussed a classic clinical setting as having characteristics of a ―naturalistic‖ environment. In developing this therapeutic approach, Ayres tried to provide children with opportunities to participate in multisensory activities that had effect of being calming, alerting, challenging organizing, and fun. Therefore, intervention requires therapists to create, modify, and adapt the sensory environment. The environment provides opportunities to improve body-centered

perceptions through touch, Proprioception, and vestibular sensations. Additionally, the environment provides challenges for the child to develop praxis skills by creating, adapting, and manipulating objects and interactions. Although the perception of visual and auditory sensations is often enhanced through sensory integration intervention.

Proprioceptive Sensations Proprioception has been described as the corner stone of sensory integration intervention. Proprioception is both alerting and calming, and, therefore, it is a key sensation that alerts levels of arousal and enhances self-regulation. Proprioception is also the gateway to functional movement. Proprioceptive sensations are achieved through traction, compression, movement of the joints and muscles, or use of the muscles against resistance. Jumping, climbing, hanging, pushing, and pulling activities all provide Proprioception.

Differences in communication Special communication difficulties are central to autism, from early childhood there are difficulties related to development communicative intent. Certain very simple and natural communication intends like. Prodeclarative pointing and joint attentions are extremely limited. Most of the time. We find children with autism taking adults hand and guiding if forwards desired activity or object. It may also be possible that a child with ASD develops speech before understanding meaning and purpose of communication. It has been found out that around 35% - 40% children with ASD do not develop speech. However, studies have revealed that some speech can be developed by using AAC systems. (Attractive Augmentative Communicative) in the diagnosis of autism also emphasis is lack on, Lack of development of non –verbal modes of communication like gestures, facial expressions, etc.. To compensate speech expression  Some common and specific language difficulties in autism. A. Deviant styles of understanding and using language B. Echolalia – right about it C. Repetitive use of language D. Difficulty understanding and using abstract language. E. Lack of prosody(tone variation) Preservative F. Literate understanding of language of pronoun reversal

 Other communication difficulties A. Difficulty in initiating & sustaining conversation B. While speaking difficulty in reciprocity (turn taking) C. Difficulty in sharing available information D. Difficulty in understanding authority and age consideration E. Language aspects like syntax, semantics, may vary F. Across the spectrum. but all individual have problem in pragmatic (usage of language)

Enhancing communication skill Medical Etiology.

ADHD Child Characteristics:

Is divided into four parts. 

Difficulties Identifying Children with Dual Exceptionalities (Children who are gifted and also have a disability)



Characteristics of Gifted Children Who Have an Additional Exceptionalities (Visual impairment, physical disabilities, hearing impairments, or learning disabilities.



Lists of Characteristics Similar in Giftedness and ADHD (Includes a list of questions to ask that help distinguish between the two.)



List of References

Research indicates that in many cases, a child is diagnosed with ADHD when in fact the child is gifted and reacting to an inappropriate curriculum (Webb & Latimer, 1993). The key to distinguishing between the two is the pervasiveness of the "acting out" behaviors. If the acting out is specific to certain situations, the child's behavior is more likely related to giftedness; whereas, if the behavior is consistent across all situations, the child's behavior is more likely related to ADHD. It is also possible for a child to be BOTH gifted and ADHD. The following lists highlight the similarities between giftedness and ADHD. Characteristics of Gifted Students Who Are Bored            

Poor attention and daydreaming when bored Low tolerance for persistence on tasks that seem irrelevant Begin many projects, see few to completion Development of judgment lags behind intellectual growth Intensity may lead to power struggles with authorities High activity level; may need less sleep Difficulty restraining desire to talk; may be disruptive Question rules, customs, and traditions Lose work, forget homework, are disorganized May appear careless Highly sensitive to criticism Do not exhibit problem behaviors in all situations



More consistent levels of performance at a fairly consistent pace (Cline, 1999; Webb & Latimer, 1993)

Characteristics of Students with ADHD               

Poorly sustained attention Diminished persistence on tasks not having immediate consequences Often shift from o ne uncompleted activity to another Impulsivity, poor delay of gratification Impaired adherence to commands to regulate or inhibit behavior in social contexts More active, restless than other children Often talk excessively Often interrupt or intrude on others (e.g., butt into games) Difficulty adhering to rules and regulations Often lose things necessary for tasks or activities at home or school May appear inattentive to details Highly sensitive to criticism Problem behaviors exist in all settings, but in some are more severe Variability in task performance and time used to accomplish tasks. (Barkley, 1990; Cline, 1999; Webb & Latimer, 1993)

Questions to Ask in Differentiating between Giftedness and ADHD      

Could the behaviors be responses to inappropriate placement, insufficient challenge, or lack of intellectual peers? Is the child able to concentrate when interested in the activity? Have any curricular modifications been made in an attempt to change inappropriate behaviors? Has the child been interviewed? What are his/her feelings about the behaviors? Does the child feel out of control? Do the parents perceive the child as being out of control? Do the behaviors occur at certain times of the day, during certain activities, with certain teachers or in certain environments?

Characteristics of ADHD in Children A diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) is based on two primary behavioral dimensions, which appear to cut across ethnic and cultural groups: 1) inattention; and 2) hyperactive-impulsive behavior. Put simply, the former is an inability to focus for long periods of time on any task (especially repetitive ones) without becoming distracted, engaging in off-task behavior, or otherwise becoming less productive. An excessive activity level, fidgeting, inability to stay seated when necessary, talking excessively and loudly, interfering with others, and generally acting as if ―driven by a motor‖ characterize hyperactive-impulsive behavior. While this may describe most young children on occasion, both factors are extreme with those who have ADHD. This behavior may vary according to situation and context (for example, behavior is typically worse later in the day, in the absence of adult supervision, and in more complex situations), and often shows comorbidity with various cognitive abilities. ADHD is diagnosed when a child exhibits six or more each of the Inattention and HyperactivityImpulsivity symptoms listed in the APA‘s DSM-IV criteria for the disorder. While ADHD is a very real disorder, the diagnosis is often suspect. Many argue that ADHD is often used as an excuse for parents to medicinally control children who either a) display behavior normal for young children; or b) have been inadequately disciplined in the traditional manner. Many adults have become intolerant of normal childhood behavior and are unwilling to discipline children, so they turn to Ritalin and other ADHD control drugs for surcease.

Prevalence and Gender Difference Based on parental and teacher descriptions of behavior, the prevalence of ADHD in the juvenile population should be as high as 57%; however, ADHD is clinically diagnosed in only 2-6.3% of children. Younger children are much more likely to be diagnosed with ADHD, with rates falling by as much as half between preschool and the 6-12 year old range, and falling significantly again in adolescence, to 0.9-2% for girls and 1-5.6% for boys. Boys are roughly three times more likely to be diagnosed with ADHD than girls. However, this may be a function of how the diagnostic criteria are applied, especially since the gender differences even out once co-morbid conditions are controlled for. The fact that ADHD prevalence decreases sharply with age underscores the contention that most accounts of ADHD are the result of adult intolerance for ordinary childhood behavior. Younger kids (especially little boys) are naturally more exuberant and noisy than older children, who are undergoing changes related both to physical maturity and enculturation that encourage more adult behavior. The fact that ADHD prevalence dives sharply at adolescence bolsters this argument.

Developmental Problems Associated with ADHD

Individuals with ADHD suffer from a variety of developmental and social defects, some of them quite severe. These include problems with the following: · Cognitive defects (deficits in intelligence, reading ability, poor time-sense) · Language (delayed onset, speech impediments) · Adaptive functioning · Motor development (delayed coordination, sluggishness) · Emotion (poor self-regulation, problems with frustration tolerance) · School performance (disruptive behavior, repeating grades, requiring tutors) · Task performance (poor persistence, decreased productivity) · Health risks (accident prone, growth delays, earlier onset of sexual activity) These problems add up to poor motor coordination, poor academic performance, persistent social problems, and even reduced intelligence. Health may be compromised by proneness to accidental injury, especially when driving, as well as by sleep disorders. The developmental problems associated with ADHD are significant and distressing, almost worse than the disorder itself, and this brings home the seriousness of ADHD. While ADHD may not be as prevalent as many parents and teachers would like us to believe, it‘s clear that it can be a dangerous and debilitating illness.

Etiologies The factors thought to be responsible for ADHD are both complex and multitudinous. One theory is that at least some ADHD symptoms are the result of brain damage, since they are similar to those arising from some types of brain infections and trauma. Neurological studies indicate a connection with dysfunction in the frontal lobes, which regulate attention and inhibition. Neurotransmitter deficiencies may also be responsible. Otherwise, some studies link ADHD to pregnancy and birth factors; younger mothers tend to have more ADHD children. ADHD may also have a genetic basis, or may be due to thyroid disorder, environmental toxins, or psychosocial factors. That ADHD may be caused by a variety of factors, from brain dysfunction to social issues, seems most likely. Too often, researchers try to reduce complex issues to single causes, if only because a single cause would allow for a single ―magic pill‖ solution. However, few things in the human realm — either medical or social — are ever that simple. What we identify as ADHD may be a constellation of related disorders that are lumped together under one term, much as

lump together all the dozens of cancers under one term in general conversation. As our understanding of the disorder evolves, it may in the future become possible to discern and define the different types of ADHD based on cause, in a manner more specific than the divisions we use today.

Theoretical Framework The theoretical framework underlying our current understanding of ADHD remains rather nebulous. Various theories have been put forth, most revolving around defects in behavioral inhibition, deficits in sensitivity to reinforcement, deficits in inattention, arousal, and inhibition in the absence of immediate reward, and neurological explanations for the observed behavior. It is obvious that poor behavioral inhibition is the most important behavioral factor in ADHD. In light of this, one researcher, Dr. Russell A. Barkley, has developed a hybrid model that includes many of the features of previous ADHD models. His theory explains how behavioral inhibition (self-control) and motor control systems (such as persistence, sensitivity to feedback, and execution of responses) are interrelated to and regulated by four executive functions: working nonverbal memory, working verbal memory, self-regulation of effect/motivation/arousal, and reconstitution (internalization of play). He concludes that ADHD is a disorder of performance, not skill; that is, in their behavior ADHD sufferers are unable to apply previously learned knowledge (especially in the social behavior realm) to new situations, even though, at some level, they may realize exactly what they should do in such situation. He suggests various ways to treat ADHD patients, both pharmaceutically and otherwise, especially in regards to making actions and their consequences more temporally contiguous. For the ADHD sufferer, punishment or reward must be immediate to be effective, since those with serious ADHD suffer from what Barkley calls a ―myopia or blindness to time.‖ They do not see or understand distances that lie ahead in time. The key to his theory is the concept of temporal blindness or myopia. Those of us without symptoms of ADHD can see ahead to the future; we not only see what we need to do to reach our goals or maintain the status quo, but have also internalize d the concept of personal accountability. We understand the consequences of our actions, both good and bad. People with ADHD often do not, or are unable to apply the rules they have learned, and so may be blindsided by future events that others, with a minimum of personal inhibition, might have avoided. This theory

seems make imminent sense, though of course the true test of Barkley‘s theory is how well it fits the clinical reality of ADHD, and how well it stands the tests of time.

What is ADHD? ADHD is a condition of the brain that affects a person's ability to pay attention. It is most common in school-age children.

What are some signs or symptoms of ADHD? ADHD is a chronic disorder , meaning that it affects an individual throughout life. The symptoms are also pervasive , meaning they occur in multiple settings, rather than just one. Current research supports the idea of two distinct characteristics of ADHD, inattention and/or hyperactivity-impulsivity. A child with these characteristics typically demonstrates the following signs:

Inattention         

Has difficulty concentrating Has unrelated thoughts Has problems focusing and sustaining attention Appears to not be listening Performance depends on task May have better attention to enjoyed activities Has difficulty planning, organizing, and completing tasks on time Has problems learning new things Demonstrates poor self-regulation of behavior, that is, he or she has difficulty monitoring and modifying behavior to fit different situations and settings

Hyperactivity

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  

Seems unable to sit still (e.g., squirming in his/her seat, roaming around the room, tapping pencil, wiggling feet, and touching everything) Appears restless and fidgety May bounce from one activity to the next Often tries to do more than one thing at once

Impulsivity 

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Difficulty thinking before acting (e.g., hitting a classmate when he/she is upset or frustrated) Problems waiting his/her turn, such as when playing a game

How is ADHD diagnosed? ADHD is diagnosed by the child's doctor, with input from the family and other professionals. These professionals include the following:     

Speech-language pathologists (slps) Regular, special education, and resource teachers Nurses Psychologists Employers (when applicable)

Assessments by the SLP may include some or all of the following: 

  

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Observing the interactions with peers and authority figures in the classroom/work setting and during formal testing Observing conversation with parents and other family members Interviewing parents/caregivers about speech and language development Interviewing the child to evaluate self-awareness of needs and difficulties, as age appropriate Formally evaluating speech and language skills, such as fluency (whether or not child stutters), speech articulation (pronunciation and clarity of speech), understanding and use of grammar (syntax), understanding and use of vocabulary (semantics ), awareness of speech sounds (phonemic awareness)

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Evaluating the ability to explain or retell a story, centering on a topic and chaining a sequence of events together Assessing social communication skills (pragmatic language) Discussing stories and the points of view of various characters Assessing the ability to plan, organize, and attend to details

What speech and language treatments are available for people with ADHD? Specific speech and language patterns vary from child to child with ADHD. For example, some children with ADHD also have learning disabilities that affect their speech and language. Evaluation of each child's individual speech and language ability is critical to developing an appropriate treatment plan. Speech and language intervention for the person with ADHD is always individualized, as each person has different needs. 

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A physician will work with the family and student to prescribe medication, if needed, to help with attention. If medication is prescribed, the SLP will work with other educational professionals to observe the student's pre- and postmedication behavior. As part of the educational team, the SLP will communicate with the family and physician regarding any post-medication behavioral changes. Is the student drowsy? Is sustained attention better/worse? How long does it take for the medication to take effect? The physician will use these observations to adjust dosage, the time medications are administered, and which medication is used. The SLP, along with other team members, will work with the teacher to change the classroom environment as needed (e.g., sitting the student in the front of the classroom, having the student repeat directions before following them, using checklists and other visual organizers to help with planning and follow-through). Speech-language treatment will focus on individualized language goals, such as teaching better communication in specific social situations, and study skills (planning/organizing/attention to detail). Again, language goals will differ depending on the needs of the individual student.

What other organizations have information about ADHD?

ADHD in Preschool Preschool age children are often easily distracted and do not have long attention spans, however, symptoms of ADHD often become more pronounced at this age. For example, children without ADHD may stay with an activity for between 10 and 15 minutes, while children with ADHD may change activities every few minutes. However, when interest level is higher, children may be able to stay with a task for a longer time. For example, a child may find reading or drawing, activities that require a child to sit still, may not hold attention but more active tasks, such as playing with cars may keep a child‘s attention for longer periods Impulsiveness and hyperactivity also become more apparent during the preschool years. Children with ADHD may be in constant motion, they are always rushing or hurrying from one activity to another, resenting having to take time to eat or even use the bathroom. At this age, children with ADHD may jump from playsets, fall out of windows or run out into the street without thinking. While children without ADHD may be able to sit and play for 10-15 minutes, allowing parents a small break, children with ADHD often must be supervised every moment. According to an article, ―What is ADHD?‖ [―What is ADHD?‖, 2002, Jim Chandler, M.D., Attention Deficit Disorder Resources], states that preschool children with ADHD:    

Have poor social skills Are more aggressive than peers without ADHD Disobey twice as often Display inappropriate behavior 5 times as often

ADHD is difficult to diagnose in preschool children. This is because children develop at different rates and therefore a wider range of behaviors is accepted as normal. Children with hyperactivity or impulsiveness may be easier to diagnose before school age but doctors can be hesitant to make a diagnosis before a child enters school.

Some common characteristics of ADHD in preschool children are:            

Inability to sit still Lack of interest in quiet activities or in listening to stories Changes activities every few minutes Inconsistency in attention skills, may be able to hold attention when an activity is interesting, but not able to keep attention for other activities Always in motion, sometimes running without looking, may run into street or fall often Can be very talkative Poor social skills Behavioral problems, not listening, disobeying or consistent unsafe behaviors Can be clumsy or have underdeveloped coordination May grab toys from classmates, siblings or friends Difficulty waiting for their turn May be aggressive, causing fights or hitting other children

What is occupational Therapy? The fundamental concern of Occupational Therapy is the development and maintenance of capacity throughout one‘s lifespan to perform with satisfaction to both oneself and others, those tasks and roles essential to productive living, and to the mastery of both self and the environment.

Definition of Occupational Therapy Occupational therapy is a health and rehabilitation profession, the goal of which is, ―To achieve functional outcomes that promote health, prevent injury or disability and develop, improve, sustain, or restore the highest possible level of independence (to) any individual who has an injury, illness, cognitive impairment, psycho–social dysfunction, mental illness, developmental or learning disability, physical disability, or other disorder or condition‖ (American Journal of Occupational Therapy, 48, 1072–1073). It is the art and science of directing man‘s participation in select tasks to restore, reinforce and enhance performance, facilitate learning of those skills and functions essential for adaptation and productivity, diminish or correct pathology and promote and maintain health.

Occupational therapy became established as a profession when services were needed to rehabilitate wounded and disabled soldiers after World War I, which lasted from 1914 to 1918. Occupational therapists evaluate, adapt, and teach daily living skills to help people attain maximum functional independence. People who are limited by physical injury or illness, psycho–social dysfunction, developmental delays, or the aging process, can benefit from occupational therapy.

What is Occupational Therapy? Ten-year-old Jason was in an accident while riding on his bicycle. Although he survived the accident, it left him with a brain injury. To improve some of his cognitive (thinking) skills, comprehension skills, and coordination, Jason's doctors recommended that he receive occupational therapy (OT). At first, his parents were slightly skeptical about whether occupational therapy could benefit their son. They had never heard of OT and wondered if it was more appropriate for adults. But after watching the activities and Jason's improvements, his parents felt hopeful that Jason was on the road to recovery. Occupational therapy — a treatment that focuses on helping people achieve independence in all areas of their lives — can offer kids with various needs positive, fun activities to improve their cognitive, physical, and motor skills and enhance their self-esteem and sense of accomplishment. Some people may think that occupational therapy is only for adults; children, after all, do not have occupations. But a child's main job is playing and learning, and an occupational therapist can evaluate a child's skills for play activities, school performance, and activities of daily living and compare them with what is developmentally appropriate for that age group. According to the American Occupational Therapy Association (AOTA), in addition to dealing with an individual's physical well-being, OT practitioners address psychological, social, and environmental factors that may hinder an individual's functioning in different ways. This unique approach makes occupational therapy a vital part of health care for some kids.

Who Might Need Occupational Therapy? So who might use an occupational therapy practitioner? According to AOTA, kids with the following medical problems may benefit from OT:                 

Birth injuries or birth defects Sensory processing/integrative disorders Traumatic injuries (brain or spinal cord) Learning problems autism pervasive developmental disorders juvenile rheumatoid arthritis Mental health or behavioral problems broken bones or other orthopedic injuries Developmental delays Post-surgical conditions burns Spinal bifida Traumatic amputations Cancer Severe hand injuries Multiple sclerosis, cerebral palsy, and other chronic illnesses

One of the activities that occupational therapists can address to meet children's needs is working on fine motor skills so that kids can grasp and release toys and develop good handwriting skills. Occupational therapists also address hand–eye coordination to improve play skills, such as hitting a target, batting a ball, or copying from a blackboard.

An occupational therapist can also: help kids with severe developmental delays learn some basic tasks, such as bathing, getting dressed, brushing their teeth, and feeding themselves help kids with behavioral disorders learn anger-management techniques (i.e., instead of hitting others or acting out, the children would learn positive ways to deal with anger, such as writing about feelings or participating in a physical activity)

teach kids with physical disabilities the coordination skills required to feed themselves, use a computer, or increase the speed and legibility of their handwriting evaluate each child's needs for specialized equipment, such as wheelchairs, splints, bathing equipment, dressing devices, or communication aids work with kids who have sensory and intentional issues to improve focus and social skill

How Physical Therapy and Occupational Therapy Differ Although both types of therapy help kids improve the quality of their lives, there are differences. Physical therapy deals with the issues of pain, strength, joint range of motion, endurance, and gross motor functioning, whereas occupational therapy deals more with fine motor skills, visual-perceptual skills, cognitive skills, and sensory-processing deficits.

Occupational Therapy Practitioners There are two professional levels of occupational practice — occupational therapist (OT) and occupational therapist assistant (OTA). Since 2007, an occupational therapist (OT) is required to complete a master's degree program. Before 2007, only a bachelor's degree was required. An occupational therapist assistant is only required to complete an associate's degree program. OTAs are able to carry out treatment plans developed by the occupational therapist but can't complete evaluations. All occupational therapy practitioners must complete supervised fieldwork programs and pass a national certification examination. Most states also require a license to practice and require occupational therapy practitioners to take continuing education classes throughout their careers to maintain that licensure. Occupational therapists work in a variety of settings, including:   

hospitals schools rehabilitation centers

   

mental health facilities private practices children's clinics nursing home

2. What is the role of occupational therapy in autism? People with autism can benefit from occupational therapy, both at home and at school. Autism is a complex developmental disorder. A person who has autism often has trouble communicating and interacting with other people. The person‘s interests, activities, and play skills may be very limited.

What‟s the role of occupational therapy (OT) in treating autism? Occupational therapists study human growth and development. They are experts in social, emotional, and physiological effects of illness and injury. This knowledge helps them promote skills for independent living in people with autism. Occupational therapists work as part of a team that includes parents, teachers, and other professionals. They help set specific goals for the person with autism. These goals often involve social interaction, behavior, and classroom performance. Occupational therapists can help in two main ways: with evaluation and therapy.

How is occupational therapy useful for evaluation with autism? The therapist observes children to see if they can do tasks they are expected to do at their ages. These might relate to certain self-help skills, such as getting dressed. Or they might involve knowing how to play a game. Sometimes, it helps to videotape a child during the normal course of the day. This will help the occupational therapist better assess what is needed for care. With the tape, the

therapist might learn about the child‘s reactions to the environment. For example the therapist might note any of the following:        

Attention span and stamina Transition to new activities Play skills Need for personal space Responses to touch or other types of stimuli Motor skills such as posture, balance, or manipulation of small objects Aggression or other types of behaviors Interactions between the child and caregivers

How does occupational therapy help a person with autism? Once an occupational therapist has gathered information, he or she can develop a program for your child. There is no single ideal treatment program. But early, structured, individualized care appears to work best. Occupational therapy may combine a variety of strategies. These can help your child respond better to his or her environment. These OT strategies include:    

physical activities, such as stringing beads or doing puzzles, to help a child develop coordination and body awareness play activities to help with interaction and communication developmental activities, such as brushing teeth and combing hair adaptive strategies, including coping with transitions

What are the benefits of occupational therapy for autism? The overall goal of occupational therapy is to help the person with autism improve his or her quality of life. This includes life at home and at school. The therapist helps introduce, maintain, and improve skills. That way, people with autism can be as independent as possible. These are some of the skills occupational therapy may foster:    

daily living skills, such as toilet training, dressing, brushing teeth, and other grooming skills fine motor skills required for holding objects while handwriting or cutting with scissors gross motor skills used for walking or riding a bike sitting, posture, or perceptual skills, such as telling the differences between colors, shapes, and sizes

 

visual skills for reading and writing play, coping, self-help, problem solving, communication, and social skills By working on these skills during occupational therapy, a child with autism may also do the following:

     

develop peer and adult relationships learn how to focus on tasks learn how to delay gratification express feelings in more appropriate ways engage in play with peers learn how to self-regulate

Why Would a Person With Autism Need to See an Occupational Therapist? In the case of autism, occupational therapists (OT's) have vastly expanded the usual breadth of their job. In the past, for example, an occupational therapist might have worked with an autistic person to develop skills for handwriting, shirt buttoning, shoe tying, and so forth. But today's occupational therapists specializing in autism may also be experts in sensory integration (difficulty with processing information through the senses), or may work with their clients on play skills, social skills and more.

What Does an Occupational Therapist Do for People with Autism? Since people with autism often lack some of the basic social and personal skills required for independent living, occupational therapists have developed techniques for working on all of these needs. For example: 



Provide interventions to help a child appropriately respond to information coming through the senses. Intervention may include swinging, brushing, playing in a ball pit and a whole gamut of other activities aimed at helping a child better manage his body in space. Facilitate play activities that instruct as well as aid a child in interacting and communicating with others. For the OT specializing in autism, this can translate specifically into structured play therapies, such as Floortime, which were developed to build intellectual and emotional skills as well as physical skills.

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Devise strategies to help the individual transition from one setting to another, from one person to another, and from one life phase to another. For a child with autism, this may involve soothing strategies for managing transition from home to school; for adults with autism it may involve vocational skills, cooking skills and more. Develop adaptive techniques and strategies to get around apparent disabilities (for example, teaching keyboarding when handwriting is simply impossible; selecting a weighted vest to enhance focus; etc.)

Why Would a Person With Autism Need to See an Occupational Therapist? In the case of autism, occupational therapists (OT's) have vastly expanded the usual breadth of their job. In the past, for example, an occupational therapist might have worked with an autistic person to develop skills for handwriting, shirt buttoning, shoe tying, and so forth. But today's occupational therapists specializing in autism may also be experts in sensory integration (difficulty with processing information through the senses), or may work with their clients on play skills, social skills and more.

What Does an Occupational Therapist Do for People with Autism? Since people with autism often lack some of the basic social and personal skills required for independent living, occupational therapists have developed techniques for working on all of these needs. For example: 





Provide interventions to help a child appropriately respond to information coming through the senses. Intervention may include swinging, brushing, playing in a ball pit and a whole gamut of other activities aimed at helping a child better manage his body in space. Facilitate play activities that instruct as well as aid a child in interacting and communicating with others. For the OT specializing in autism, this can translate specifically into structured play therapies, such as Floortime, which were developed to build intellectual and emotional skills as well as physical skills. Devise strategies to help the individual transition from one setting to another, from one person to another, and from one life phase to another. For a child with autism, this may involve soothing strategies for managing transition from home to school; for adults with autism it may involve vocational skills, cooking skills and more.



Develop adaptive techniques and strategies to get around apparent disabilities (for example, teaching keyboarding when handwriting is simply impossible; selecting a weighted vest to enhance focus; etc.)

Sensory Integration Dysfunction? SI Dysfunction vs. Attention Deficit Disorder: A brief comparison of two "look-alike" disabilities By Carol S. Kranowitz, M.A.

In my book, The Out-of-Sync Child, I define Sensory Integration Dysfunction (DSI) as the "inefficient neurological processing of information received through the senses, causing problems with learning, development, and behavior." Picture a child who has trouble processing and interpreting sensory messages about how things feel and what it feels like to be touched. Touch stimulation overwhelms this oversensitive child. How does his problem play out? He is bothered by the label in his tee-shirt, the approach of a classmate, the lumps in his mashed potatoes, the stickiness of the play dough. Fidgeting and squirming, he pays a lot of attention to avoiding these ordinary sensations. Meanwhile, he is unable to pay much attention at all to the teacher's words or to playground rules. Say a child with another form of SI dysfunction has trouble processing movement and balance sensations. Say this under-responsive child needs to move around -much more than her peers -- in order to rev up and get going. What is the fallout of her problem? This impulsive "bumper and crasher" craves intense, vigorous movement. She often rocks, sways, twirls, jumps, climbs, leaps, gyrates and gets into upside-down positions. She pays a lot of attention to satisfying her need for movement, and not much attention to her mother's instructions or to where she left her shoes. Inattention . . . impulsivity….fidgety movement . . . these are definitely symptoms of SI Dysfunction.

Now consider my definition for Attention Deficit Disorder (ADD): "a neurological syndrome characterized by serious and persistent inattention and impulsivity. When constant, fidgety movement (hyperactivity) is an additional characteristic, the syndrome is called Attention Deficit Disorder with Hyperactivity (ADHD)."  Inattention  impulsivity  fidgety movement These are definitely symptoms of ADD/ADHD -- and of many other difficulties, as well. In my book, I discuss other "look-alike" conditions which share symptoms with sensory integration dysfunction (pp. 17-20). SI Dysfunction may look like ADHD, and some symptoms may overlap. However, optimum treatment for the two problems is different. Before jumping to conclusions and leaping to drug therapy, parents and professionals need to look at the whole child. Then, we can thoughtfully determine what will help the most. If the child is frequently -- but not always -- inattentive, it is useful to ask some questions: Where, when, and how often does this inattention occur? What is the stimulus? What does the child do as self-therapy? What is happening -- or not happening -- when the child concentrates well? What does the child need, and what helps? An overloaded child needs less stimulation. So, dim the lights and turn down the radio. Comfort him with "deep pressure" bear hugs. Help him fix up a retreat, with pillows and blankets, under the dining room table. An under-responsive child needs more sensory stimulation. So, take her to the playground each day, jog together around the block, engage her in gentle roughhousing, and provide her with a chinning bar, a punching bag, and a trampoline. SI Dysfunction is a neurological problem, which affects behavior and learning. Medicine doesn't fix it. One needs a therapeutic sensory program that addresses the child's underlying difficulties processing sensations rather than just the symptoms of inattention, not psycho stimulants. A therapeutic sensory program may be a major component in treating the child with an attention problem. Taking a

conservative approach can't hurt and often helps the inattentive child whose problem is not ADD, but developmentally delayed sensory processing.

Sensory Integration Dysfunction - Topic Overview What is sensory integration dysfunction? Children with sensory integration dysfunction have difficulty processing information from the senses (touch, movement, smell, taste, vision, and hearing) and responding appropriately to that information. These children typically have one or more senses that either over- or underreact to stimulation. Sensory integration dysfunction can cause problems with a child's development and behavior.

Who has sensory integration dysfunction? Children with autism and other developmental disabilities often have sensory integration dysfunction. But sensory integration dysfunction can also be associated with premature birth, brain injury, learning disorders, and other conditions.

What causes sensory integration dysfunction? The exact cause of sensory integration dysfunction is not known. It is commonly seen in people with autism, Asperser‘s syndrome, and other developmental disabilities. Most research suggests that people with autism have irregular brain function. More study is needed to determine the cause of these irregularities, but current research indicates they can be inherited.

What are the symptoms? Children with sensory integration dysfunction cannot properly process sensory stimulation from the outside world. Your child may:      

Either be in constant motion or fatigue easily or go back and forth between the two. Withdraw when being touched. Refuse to eat certain foods because of how the foods feel when chewed. Be oversensitive to odors. Be hypersensitive to certain fabrics and only wear clothes that are soft or that they find pleasing. Dislike getting his or her hands dirty.

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      

Be uncomfortable with some movements, such as swinging, sliding, or going down ramps or other inclines. Your young child may have trouble learning to climb, go down stairs, or ride an escalator. Have difficulty calming himself or herself after exercise or after becoming upset. Jump, swing, and spin excessively. Appear clumsy, trip easily, or have poor balance. Have odd posture. Have difficulty handling small objects such as buttons or snaps. Be overly sensitive to sound. Vacuum cleaners, lawn mowers, hair dryers, leaf blowers, or sirens may upset your child. Lack creativity and variety in play. For instance, your child may play with the same toys in the same manner over and over or prefer only to watch TV or videos.

How is sensory integration dysfunction diagnosed? A health professional, often an occupational or physical therapist, will evaluate your child by observing his or her responses to sensory stimulation, posture, balance, coordination, and eye movements. While many children have a few of the symptoms described above, your health professional will look for a pattern of behavior when diagnosing sensory integration dysfunction.

How is it treated? Sensory integration therapy, usually conducted by an occupational or physical therapist, is often recommended for children with sensory integration dysfunction. It focuses on activities that challenge the child with sensory input. The therapist then helps the child respond appropriately to this sensory stimulus. Therapy might include applying deep touch pressure to a child's skin with the goal of allowing him or her to become more used to and process being touched. Also, play such as tug-of-war or with heavy objects, such as a medicine ball, can help increase a child's awareness of her or his own body in space and how it relates to other people. Although it has not been widely studied, many therapists have found that sensory integration therapy improves problem behaviors.

What is sensory integration dysfunction? Children with sensory integration dysfunction have difficulty processing information from the senses (touch, movement, smell, taste, vision, and hearing) and responding appropriately to that information. These children typically have one or more senses that either over- or under react to stimulation. Sensory integration dysfunction can cause problems with a child's development and behaviour.

Who has sensory integration dysfunction? Children with autism and other developmental disabilities often have sensory integration dysfunction. But sensory integration dysfunction can also be associated with premature birth, brain injury, learning disorders, and other conditions .

What causes sensory integration dysfunction? The exact cause of sensory integration dysfunction is not known. It is commonly seen in people with autism, Asperser‘s syndrome, and other developmental disabilities. Most research suggests that people with autism have irregular brain function. More study is needed to determine the cause of these irregularities, but current research indicates they can be inherited.

What are the symptoms? Children with sensory integration dysfunction cannot properly process sensory stimulation from the outside world. Your child may:    

Either be in constant motion or fatigue easily or go back and forth between the two. Withdraw when being touched. Refuse to eat certain foods because of how the foods feel when chewed. Be over-sensitive to odours.

  

      

Be hypersensitive to certain fabrics and only wear clothes that are soft or that they find pleasing. Dislike getting his or her hands dirty. Be uncomfortable with some movements, such as swinging, sliding, or going down ramps or other inclines. Your young child may have trouble learning to climb, go down stairs, or ride an escalator. Have difficulty calming himself or herself after exercise or after becoming upset. Jump, swing, and spin excessively. Appear clumsy, trip easily, or have poor balance. Have odd posture. Have difficulty handling small objects such as buttons or snaps. Be overly sensitive to sound. Vacuum cleaners, lawn mowers, hair dryers, leaf blowers, or sirens may upset your child. Lack creativity and variety in play. For instance, your child may play with the same toys in the same manner over and over or prefer only to watch TV or videos.

How is sensory integration dysfunction diagnosed? A health professional, often an occupational or physiotherapist will evaluate your child by observing his or her responses to sensory stimulation, posture, balance, coordination, and eye movements. While many children have a few of the symptoms described above, your health professional will look for a pattern of behaviour when diagnosing sensory integration dysfunction.

How is it treated? Sensory integration therapy, usually conducted by an occupational or physiotherapist, is often recommended for children with sensory integration dysfunction. It focuses on activities that challenge the child with sensory input. The therapist then helps the child respond appropriately to this sensory stimulus. Therapy might include applying deep touch pressure to a child's skin with the goal of allowing him or her to become more used to and process being touched. Also, play such as tug-of-war or with heavy objects, such as a medicine ball, can help increase a child's awareness of her or his own body in space and how it relates to other people.

Although it has not been widely studied, many therapists have found that sensory integration therapy improves problem behaviors.

Definition of Sensory integration Sensory integration: A form of occupational therapy in which special exercises are used to strengthen the patient's sense of touch (tactile), sense of balance (vestibular), and sense of where the body and its parts are in space (proprioceptive). It appears to be effective for helping patients with movement disorders or severe under- or over-sensitivity to sensory input.

The field of Sensory Integration exists as both a theory of neurological function and the process of the human body and mind interacting with the environment. Sensory Integration was first identified by Dr. A. Jean Ayres, an Occupational Therapist who noticed children struggling with functional tasks who did not fit into specific categories of disability commonly used in the 1960 - 1970'. These children did not have clear cut diagnoses, but were obviously having difficulty with work behavior, self-care and recreational activities. She saw the challenges as neurologically based and developed the term "Sensory Integrative Dysfunction" to describe the problems faced by children whose brains do not consistently receive process or respond to sensory input with adaptive, functional behaviors.

Traditionally, 3 types of sensory input comprise the cornerstone of the SI approach. These are the tactile, proprioceptive and vestibular systems. Tactile is our sense of touch, and is especially regulated through sensitive areas such as the hands, feet and head. Proprioception is an umbrella term for the sense of body position and is involved in body awareness in space, planning and coordinating movements, emotional security and confidence. Proprioceptive input is sent to the brain through receptors in the muscles, joints, tendons and ligaments. The vestibular system is comprised of sense receptors in the inner ear, as well as the fibers of Cranial Nerve VIII (Vestibulocochlear) connected to internal brain structures. Sensory Integration theory teaches that the ability of the vestibular system to modulate sensory input has a powerful impact on the development of functional skills. The vestibular system is related to the regulation of muscle tone, balance, motor control, postural stability, visual space perception, visual motor control, auditory language skills and attention. Sensory Integration is also known as Sensory Motor Integration, a global understanding of how the human body and mind operate on a daily basis. We receive and process sensory input constantly, and respond by producing desirable "outcome" behaviors. For example: you are sitting near an open window reading as the sun goes down. It begins to get both cool and dark in the room, and your brain registers that visual and tactile/temperature information. The brain processing this information then attaches meaning: I can't see, I am cold. We then identify solutions: I need to close the window, turn on a light, get a sweater. The "adaptive response" is the actual standing up, walking over to the window, reaching up, pulling it down, locking it, etc.

In the big picture, Sensory Motor Integration is a continuous, fundamental constant of human life at all ages. Seeing the children we work with as whole and complete beings is a central aspect of the SMILY approach. Providing them with purposeful, multi-sensory based activities that are both fun and effective is the overall objective of the SMILY program. In this regard, SMILY is indeed a process of Sensory Motor Integration. The SMILY book includes more detailed about how yoga itself is an SI approach, including handy tables and lists that are easily accessible and understood.

Person with sensory dysfunction?

Our bodies are intended to function as "well-oiled machines," which receive input from the senses, and organize and process that information to be able to use it appropriately, or to act on it. Our senses include hearing, seeing, touching, tasting, and feeling, as well as the processes of movement and gravity. When these systems are all working properly, and the brain is able to correctly interpret the information they send, we refer to this process as sensory integration; the senses are working together! However, when there are imperfections in this system, we call that "sensory integration dysfunction." Although there are many variations in the ways that sensory integration dysfunction (or sensory processing difficulties) can present itself, there are two main underlying problems. The first is when a person receives too much sensory input; in effect, their brain is overloaded. The second is when a person does not receive enough sensory input, resulting in a "craving" of sensory information. The following section will discuss how each of the senses affects behaviors, as well as potential problems which arise when sensory integration dysfunction is present. Hearing. We use our ears to hear voices, music, alarms and sirens, as well as "noise" around us generated by electronic equipment, nature, etc. When our brains are able to properly receive and organize the data they receive through our ears, we are able to sense danger, process information and instructions, and feel pleasure through music or sounds of nature. A person whose senses are well-integrated can sit in the middle of a noisy party with music, talking, glasses and silverware clinking, and dogs barking, and still be able to carry on a conversation with the person sitting across the table. This person‘s brain simply filters out the unnecessary information, and focuses on the words the individual speaker is saying. In contrast, a person with sensory integration dysfunction may hear all of the above sounds at the same level, in effect being bombarded by each of the sounds. This person will be unlikely to follow the conversation directed at them by the person across the table. Imagine a similar child in a classroom, surrounded by pencils being sharpened, children talking, music playing, feet shuffling, and chairs being scraped across the tile floor. This child may not be able to complete the math or reading assignments correctly with all of the other stimuli overloading his brain. In fact, this child may even exhibit behavioral problems resulting from his frustration and inability to screen out unnecessary sensory input. The teacher may notice the child "clowning around," staring into space, or flapping his hands. This child may become terrified of the fire alarm, perceiving that sound as painful. Another child may struggle when the room is quiet, because that child is not receiving enough input through his hearing. This child may begin tapping his pencil, humming,

kicking his desk, or otherwise producing his own noise. All children are different in their needs, but the teacher should be sensitive to the child with sensory integration dysfunction, taking time to determine whether that child needs a quiet area to study, a set of headphones to block out extra sounds, or perhaps a stereo headset to provide quiet music. Seeing. Our eyes provide us with input regarding such things as color, light, movement, locations, body language, and facial expressions. This information, when properly received and analyzed by our brains, allows us to find our way around, read, interpret body language and facial expressions, anticipate movement, and sense danger. A child who is under-reactive to sight stimuli might flick her fingers in front of her face, or hold a book close to her eyes. On the other hand, a child who is overly-sensitive or overly-reactive to visual input might be frightened in a crowded mall, or become either withdrawn or hyperactive in a room with bright lights and an abundance of color or movement. People with sensory integration dysfunction may not respond appropriately to others‘ facial expressions, due to their inability to properly organize visual input. A large classroom which is visually stimulating, with colored posters, stacks of books, bright lights and windows, rows of desks, and many children, can be very distracting to the person with sensory integration disorder, and may require that special accommodations be made for that person. Smelling. We are often surrounded by fragrant scents from perfume and flowers, and delicious smells of popcorn and freshly-baked bread or cookies. Other smells we encounter in our environment include cleaning agents, newly mowed grass, car exhaust, and smoke. Our sense of smell can bring us pleasure, enhance our ability to taste our food, and warn us of danger. However, as with the other senses, the sense of smell can cause frustration for a person whose brain is not able to properly analyze, screen out, or respond to the information it receives. Some people are overly sensitive to smells, and a whiff of perfume or cleansers can be very distressing to them. Other people are under-reactive to smells, and may hold things close to their nose to be able to smell them better. Whether they are overly- or under-reactive to smells, students who are keenly aware of the smells around them in the classroom may be unable to concentrate on the work they should be doing. Taste. Taste often brings us pleasure. We tend to eat the things that taste good! But taste can also warn us of danger. We know that milk may be sour or food may be spoiled based on the way they taste. But a person with sensory integration dysfunction may be either a very picky eater, avoiding certain (or many) tastes and textures, or may be an indiscriminate eater, eating almost anything! Taste is an area

which will likely cause more distress and grief for the parents of children with sensory problems, than for teachers and peers. Touch. We only have two eyes, two ears, and one nose, but our bodies are covered with very sensitive touch receptors. Through them we get information about hot and cold, hard and soft, smooth and rough, and pain and pleasure. When a person‘s brain is receiving and analyzing this information from the tactile system correctly, he will quickly remove his hand from a hot stove, put mittens on when going out into the snow, and smile when receiving a caress from a loved one. However, a person who has sensory integration dysfunction may react violently to a warm surface or a gentle pat on the back. He may not remember to wear mittens even on an extremely cold day, or he may always wear long sleeves, even when it‘s warm, because he dislikes having his skin exposed. If he is under-reactive to touch, he may receive a serious wound, acting as though it is merely a scratch. He may hate to get his hands dirty and to touch unfamiliar objects, or may have an intense need to touch anything and everything. A child with sensory integration dysfunction is going to present unique challenges to the science teacher leading a lab dissecting frogs. This child is either going to resent having to be involved in such a messy endeavor, or is going to be attacking the frog to find and to handle every slimy bit of the innards. Similar problems may arise in art class and in the cafeteria. This child may have difficulty standing in line, because either he will be touching everyone, or he will be complaining that everyone is touching him. Often he may perceive a light touch from a classmate as a hit, and he may strike out at the other child. Parents may have difficulty choosing a wardrobe for this child, because there are certain fabrics or articles of clothing that he refuses to wear, or the tags in the back are bothersome to him. A child with tactile defensiveness or a need to touch things, may benefit from carrying a stimulating object in his pocket. This may be a small textured ball, a key ring, or something that vibrates. When the child needs help concentrating, or needs to be able to touch something, he can reach into his pocket for that item. Many children with sensory integration dysfunction twirl their hair, rub their fingers together, or even chew their fingernails. Vestibular System. Although most people are familiar with the above senses, there are actually two other systems that play a very large role in our brains‘ ability to receive information and to respond to it. The first is the vestibular system, which has to do with movement and balance. A person with sensory integration dysfunction may be hyper-responsive (over-reactive) to movement, or hypo-

responsive (under-reactive) to movement. Hyper-responsiveness to movement may cause a person to experience motion sickness in the car or on an amusement park ride. This person may be afraid of heights or dislike being upside down, which is referred to as gravitational insecurity. This person may seem stiff, and even hold his head upright, to avoid excessive movement. (Problems with their vestibular system may have caused the strange crawl that both of my sons developed; they did not like to put their heads down, so crawled in a way that allowed them to keep their heads upright.) A child with these difficulties may struggle on the playground or in physical education classes, where they may be expected to swing, go on a merry-go-round, hang upside down, or run. Hypo-responsiveness to movement may result in a child who is always moving: spinning, swinging, rocking, flapping her hands, and fidgeting. Many children with sensory integration dysfunction appear as though they have Attention Deficit with Hyperactivity Disorder (ADHD) simply because they rarely stop moving. These children often exhibit poor balance, and may have difficulty navigating around objects, bumping into walls and tripping over chairs. They might enjoy hanging upside down, and appear able to spin without becoming dizzy. While a child with sensitivity to movement is going to be presented with many frustrations outdoors, hyperactive children are likely to be more challenged indoors, especially during times when they are expected to be quiet, focused and attentive. Proprioceptive System. The last system deals with body position, and is known as the proprioceptive system. This system is often referred to as "awareness of body in space." When this system functions properly, it allows us to sit down onto a chair without falling, walk up and down stairs without watching our feet, close a door with just the right amount of effort, squeeze a glue bottle just hard enough to squirt out a small dot of glue, and walk down a crowded sidewalk without bumping into anyone. Disturbances in this system can obviously lead to problems. A person who does not know how far her arm extends may end up hitting someone as she reaches for an object. This person may step on someone‘s foot as she walks, not realizing that a foot was in her way. She may slam doors, or close them so lightly that they do not latch. She may be clumsy, and may be unable to climb a piece of playground equipment or walk up stairs without difficulty, perhaps needing to watch her feet to see where to place them. Problems with the proprioceptive system can be the main contributor to difficulties with motor planning, which is the ability to figure out how to use one‘s body. For example, when walking under a low doorway, most people know just how far to bend down to avoid hitting their head. A person with motor planning difficulties may bend over too far, or not far enough. This person may not know how to climb up the monkey bars on the

playground, or may not be able to get down once she is up there! Routine tasks such as dressing, tying shoes, eating with utensils, and writing can be challenges for people with motor planning difficulties. Remember that not all individual preferences or behavioral problems are caused by sensory integration dysfunction. Some people prefer to work with the radio on. Some people like "dirty work" more than others. Generally, a person who has sensory processing difficulties will manifest this in several different areas. However, if you recognize your child in the preceding descriptions, do not despair! Many things can be done to enable a person‘s brain to properly receive and respond to sensory stimuli. First, provide your child with an environment that is full of a variety of sensory input: colors, light and dark, sounds, music, things to climb on, different textures, and opportunities for movement and exploration, exposing all of the senses to various types of input. This varied exposure to sensory input (targeting specific needs) is often referred to as a sensory diet. It is important to learn what excites your child, what calms him, and what frightens him. Allow your child to choose activities that fit his needs and interests. Providing different experiences, along with support and encouragement, will be a good foundation for helping your child with sensory problems. Second, knowing that your child may encounter things that are disturbing or overwhelming, help her to adapt the activity, or even avoid it when necessary. If your child does not like light touch (many people with sensory integration dysfunction do not), make a point of using a firm, calming, deep pressure touch. If your child cannot study in an environment with a high level of noise and other stimuli, help him to find a quiet place to complete assignments and prepare for tests. Remember that your child may not be able to process a lot of sensory input simultaneously. For example, she may not be able to talk while she is walking on a balance beam. She may not be able to look at you when you are giving her verbal instructions. Although you might encourage a child to make eye contact with people when greeting them, asking a question, or beginning or ending an interaction, he or she might not be able to look at you when you are giving instructions or discipline. Instead, when we finished, we ask the child to rephrase what was said in order to monitor his or her comprehension.

Many children benefit from Sensory Integration (SI) Therapy, either through their schools (if their sensory integration dysfunction is interfering with their ability to learn or to participate in the school environment), or through private therapy. Usually, SI therapy focuses on the tactile, vestibular, and proprioceptive systems. This therapy does not teach specific skills; rather, it provides exposure to sensory input in a controlled environment. Once children are able to tolerate and subsequently process the sensory input, they are able to catch up on skills that they may have been missing. Sensory Integration Therapy can be a wonderful way for parents to learn activities to do with their children at home! Once you learn about SI from occupational therapists, you can begin incorporating many different activities into your daily routine, including trips to the playground, "messy" play with paint, modeling clay, and sand, and a variety of exercises. Trained therapists can also provide an evaluation of a child to better determine what that child‘s needs are. Some children need deep pressure in order to calm themselves and to help their brains organize and process sensory input. Children who crave deep pressure may benefit from using a weighted vest, blanket, or wrist or ankle weights. I recommend talking with an occupational therapist for specific suggestions regarding your child‘s needs. There are many deep pressure activities you can do with children. Swinging in a blanket, being rolled in a blanket like a "hot dog," pulling each other across the room in a laundry basket, and carrying heavy milk cartons are all excellent activities. The Wilbarger Brushing Method, developed by Patricia and Julia Wilbarger, uses a surgical scrub brush to stimulate the touch receptors, followed by deep pressure (proprioception) on the joints. A trained therapist could determine whether a child might benefit from brushing, and could instruct parents on how to use this method with their child. Although adults are generally able to control their environment by making decisions about the sights, smells, and sounds that surround them, as well as the activities that they engage in, children rarely have the "luxury" of avoiding uncomfortable sensory stimuli in this way. In a crowded, activity-filled classroom, there is often no opportunity to escape the noise and confusion. Activities such as finger painting, sculpting with clay, or dissecting a frog are planned for the entire class to participate in, and frequently, the student‘s performance is rated based on the successful completion of these tasks. It is important to talk with your child and his teacher to determine what activities and situations may be presenting challenges in the classroom and in other environments, and to help to provide a

solution. There is much that can be done to help a child with sensory integration dysfunction!

What is Speech Therapy, Sensory Integration Therapy & Occupational Therapy? What is Speech Therapy? Speech therapy is a corrective and or rehabilitative treatment for individuals with difficulties in verbal communication and expression. It includes speech – articulation, pronunciation, intonation and language training- receptive and expressive language, syntax, semantics, pragmatics, phonology and morphology of speech. Who is an SLP? ‗Speech and Language pathologist‘, In India, also know as a „Speech therapist‘, these professionals‘ asses, diagnose and remediate issues related to speech and language of the individual. Does my child need Speech therapy?

If you feel your child is not using age appropriate communication tools, is not talking as much and with as much ease as kids of his/her age, has unclear speech and his/her language is not developing as per his/her age, consult a Speech Therapist. Where can I find one? • Your physician/pediatrician could refer you to one. • The diagnostic center would have contacts of good SLPs in your area. • Hospitals/ pediatric clinics • Special schools • Private practice What is Sensory Integration Therapy (SI) and “Sensory Diet”? Many children on the autism spectrum have difficulty managing the sensory input (sights, sounds, touch, smells, heights, depths). They may over react (hyper sensitivity) or under-react (hypo- sensitivity) to visual, tactile and aural input. These imbalances in reactions are sometimes to the point where the child is unable to participate in typical life activities. These differences in sensory reactiveness are labeled "sensory processing disorder" or "sensory processing dysfunction‖ and as a result of these differences, many children with autism receive therapy for sensory issues, known as "sensory integration therapy" or SI therapy Sensory integration therapy is a form of occupational therapy, generally offered by specially trained occupational therapists. The concept of sensory integration therapy was first developed by Dr. Jean Ayres

It involves specific sensory activities that are intended to help the child regulate his or her sensory responses. A SI therapist focuses on the three main sensory systems of the body- tactile, vetsibular and proprioceptive systems. In simpler terms, the therapist works on normalizing the child‘s reactions to touch, odors, help children become better aware of their body in space, and help their ability to manage their bodies more appropriately- run and jump when it's time to run and jump, sit and focus when it's time to sit and focus, etc.

Depending upon the child‟s needs, the SI therapist may use various techniques such as: • Swinging • Deep pressure-squeezing, rolling in weighted blankets etc • Jumping on trampolines • Playing with toys that vibrates, are squeezable, etc. • Gross motor play such as wall climbing, ladder climbing, balance beam, etc. • Brushing extremities • Small and big joint compression The outcome of these activities may be better focus, improved behavior, child being more in control of his/her body and even lowered anxiety. Just like a balanced meal includes all the essential nutrients for the body, a ‗SI Diet‘ is a combination of various motor activities and therapist provided interventions such as deep pressure, brushing, compression etc that aim to balance the child‘s sensorial system and its responses to the outside world. For more details on Sensory Processing Disorder and sensory integration.

What is Occupational Therapy? According to the American Occupational Therapy Association, , occupational therapy is "skilled treatment that helps individuals achieve independence in all facets of their lives. Occupational therapy assists people in developing the 'skills for living' necessary for independent and satisfying lives". In day to day usage, an Occupational Therapist actually deals with strengthening ‗fine-motor skills‘ * of an individual. Today's Occupational therapists specializing in autism may also be experts in sensory integration (difficulty with processing information through the senses) and may work with the child on his/her play skills, social skills and more.

Does my Child need Occupational therapy (OT)? Your child would need OT if there is a disruption in function of one or more of the following the areas: • Gross Motor Skills : movement of the large muscles in the arms, and legs. Abilities like rolling, crawling walking, running, jumping, hopping, skipping,

mobility across space etc • Fine Motor Skills : movement and dexterity of the small muscles in the hands and fingers. If you feel abilities like ‗in-hand manipulation‘, picking small things, shifting small objects, scribbling, writing etc are affected, consult an OT. • Cognitive Perceptual Skills: Ability to pay attention to the task at hand, concentration, memory, comprehending information, thinking, reasoning, problem solving, understanding concept of shape, size and colors etc come under cognitive perceptual skills. • Sensory Integration : The ability to take in, sort out, and respond to the various visual, aural, olfactory, tactile inputs received from the world. If you feel your child responds • Visual Motor Skills : a child's movement based on the perception of visual information. Abilities like copying. • Motor Planning Skills : ability to plan, implement, and sequence motor tasks. • Oral Motor Skills : movement of muscles in the mouth, lips, tongue, and jaw, including sucking, biting, chewing, blowing and licking. • Activities of daily living: if you feel your child is having difficulties in learning and/or implementing self-care skills like daily dressing, eating, grooming, toilet tasks and manipulation of environmental hardware like door knobs, remotes, latch/keys etc consult an OT. • OT's area of work also includes evaluating home and work environments and giving recommendations for necessary adaptation, recommending adaptive equipment for permanent/temporary loss of function, such as wheel chairs, splints, aids for eating and dressing needed for the child and training them in its use. For e.g.- if your child has a tough time while eating, the OT may suggest the use of an adaptive spoon/bowl for better grip while eating * Fine Motor-Fine motor refers to movements that require a high degree of control and precision. These include ability to-hold and use pencil, drawing shapes, writing, cutting with a scissors, lacing, tying shoe laces, picking tiny things with a pincer with fore finger and thumb, buttoning- unbuttoning, using eating utensils etc.

Where can I find an OT? • Your physician/pediatrician could refer you to one. • The diagnostic center would have contacts of good OT‘s in your area. • Hospitals/ pediatric clinics • Special schools

Sensory Integration Therapy for Children with Autism What is it? Most of us unconsciously learn to combine our senses (sight, sound, smell, touch, taste, balance, body in space) in order to make sense of our environment. Children with autism have trouble learning to do this. Sensory integration therapy is a type of occupational therapy (OT) that places a child in a room specifically designed to stimulate and challenge all of the senses. During the session, the therapist works closely with the child to encourage movement within the room. Sensory integration therapy is driven by four key principles (1): 1. the child must be able to successfully meet the challenges that are presented through playful activities (Just Right Challenge); 2. the child adapts her behavior with new and useful strategies in response to the challenges presented (Adaptive Response); 3. the child will want to participate because the activities are fun (Active Engagement); and 4. the child's preferences are used to initiate therapeutic experiences within the session (Child Directed). Sensory integration therapy is based on the assumption that the child is either over stimulated or under stimulated by the environment (2). Therefore, the aim of sensory integration therapy is to improve the ability of the brain to process sensory information so that the child will function better in his daily activities (2). Recently another sensory-related therapy has been reported called Sensory Stories . Sensory Stories are similar to social stories (see Social Stories Therapy Fact Sheet ) in that they use individualized stories about sensory situations that an individual

child may encounter, and then provides instructions on appropriate behaviors for the child to use in response (3). What's it like? A sensory integration room is designed to make the child want to run into it and play. During sensory integration therapy, the child interacts one-on-one with the occupational therapist and performs an activity that combines sensory input with motion. Examples of such activities include: 

Swinging in a hammock (movement through space);

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Dancing to music (sound);

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Playing in boxes filled with beans (touch);

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Crawling through tunnels (touch and movement through space);

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Hitting swinging balls (eye-hand coordination);

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Spinning on a chair (balance and vision); and

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Balancing on a beam (balance). The child is guided through all of these activities in a way that is stimulating and challenging. The focus of sensory integration therapy is helping children with autism combine appropriate movements with input they get from the different senses. A parent can integrate sensory integration into the home by providing many opportunities for a child to move in different ways and feel different things. For example, a swing set can be a form of sensory integration therapy, as can a ball pit or a lambskin rug.

What is the theory behind it? On a daily basis, most people experience events that simultaneously stimulate more than one sense. We use our multiple senses to take in this varied information, and combine them to give us a clear understanding of the world around us. We learn during childhood how to do this. Thus, through childhood experiences we gain the ability to use all of our senses together to plan a response to anything we notice in our environment. Children with autism are less capable of this kind of synthesis and therefore they may have trouble responding appropriately to differently stimuli. Children with autism may also have a difficult time listening when they are preoccupied with looking with at something. This is an example of their difficulty in receiving information via more than one sense simultaneously. Physicians who treat children with autism believe that these difficulties are the result of differences between the brains of children with autism and other children. The underlying concepts of sensory integration therapy are based on research in the areas of neuroscience, developmental psychology, occupational therapy, and education. Research suggests that sensory information received from the environment is critical; interactions between the child and the environment shape the brain and influence learning. Furthermore, research suggests that the brain can change in response to environmental input, and rich sensory experiences can stimulate change in the brain. Does it work? The effectiveness of sensory integration therapy is controversial and there are very few well-designed studies upon which to base a clear assessment of whether or not it works. Approximately half of the reports in the scientific literature show some type of effectiveness with sensory integration therapy, and half show no benefits at

all. Some researchers suggest that sensory integration therapy would be more useful for younger children than for older children. It is also possible that it might work for some children and not others. Some experts suggest that sensory integration therapy be discontinued if effects are not apparent during a specified time frame or if the child has a negative reaction. Successful sensory integration therapy has been able to decrease sensitivities to touch and other stimuli. The result is that the children are better able to play, learn, and interact with people and surroundings.

Is it harmful? While sensory integration therapy is not harmful, some forms of sensory therapy may be uncomfortable for the child. Children with autism can be especially sensitive to certain types of sensory stimulation; the therapist should respond appropriately to each child. Children should be closely monitored for any negative reactions or self-soothing behavior which might indicate the child is feeling uncomfortable.

Sensory Integration Program Sensory Integration Program (SIP) Sensory integrative dysfunction is a disorder in which sensory input is not fully integrated or organized functionally in the brain, and may produce various degrees of problems in development, information processing, and behavior. Sensory integration focuses primarily on three basic senses: tactile, vestibular, and proprioceptive.

Sensory Integration Therapy allows for controlled sensory input in a way that allows the individual to make an adaptive response that integrates the senses and helps enhance the organization of the brain. The Sensory Integration Program provides Sensory Integration Toolkits filled with many different types of therapeutic tools and technology to aid in this process. The Toolkits are available for therapists to use for evaluation purposes, and to assist them in making appropriate recommendations for sensory activities and programs. Training is provided to therapists and others in the functional use and application of the Toolkit.

Sensory Integration Toolkit

Sensory Integration Program Human beings have been growing and learning for many thousands of years. So why the focus on Sensory Integration Programs now? Why put so much attention to this very normal, well-established process? The reason is that for most of these thousands of years human beings have had demanding physical activity at the center of their lives and their survival. In the modern world with all our conveniences and passive entertainment we no longer need this kind of ongoing activity to survive; BUT we do need it to thrive. We still have the same neurological systems with the same needs that we have had since our beginnings.

Activity, or movement, is - and always has been – the central way we educate our neurological wellbeing. At the base of this is the nourishment and integration of our senses. In the modern world particular attention needs to go to educating these senses. We are used to thinking of the five senses as sight, sound, taste, touch, and smell. However, all but one of these is actually the secondary layer of senses, often called the higher senses. Their full development depends on the development and integration of our base senses. These base senses are the tactile or touch system, the vestibular or balance system, and proprioceptive or muscle/joint system. Unless the base senses are well nourished and integrated, the higher senses will struggle with intake and processing, and remain unsure how to interpret the incoming sensation. This will leave the nervous system on alarm and in ―survival‖

mode. When a child – or any one else – cannot integrate the sensory information he is receiving he is overwhelmed. Imagine we are standing in a subway with a train approaching, smelling freshly baked chocolate chip cookies, while a mosquito buzzes overhead and the poison ivy rash on our legs is itching – and then someone asks us to write a job application. Sense your own reactions; then we may have some glimpse of the child‘s experience. Of course he becomes agitated and shuts down or becomes hyper-reactive. Any of us would react this way if this was our moment to moment experience. It is our job as adults to help the child build a healthy foundation through the integration of his base senses. Each of the three base systems plays a central role in telling us what is happening internally, where we are in space, and where the ―I‖ ends and ―other‖ begins. Together they give us our fundamental security. Since we are, wisely, programmed to put survival above all else, if these are not functioning well, both individually and in an integrated manner, we are at the mercy of our most instinctual selves – the reflexes. Like any automatic response, these are far more rigid and lack the

freedom of response we gain as more advanced systems develop and integrate – in this case the base senses. For example, the child who has to turn his book away and contort his body in order to write, may well be trying to overcome an infant reflex to turn away when a hand comes toward him. He cannot override this reaction because his base senses are not giving him the information he needs to be secure in world that is driven by choice and not reflex. Our ability to navigate life freely, and not be locked in patterns that do not serve us, depends on the health of these base systems – vestibular, proprioceptive, and tactile. The of

nourishment and integration these three systems is fundamental to our sense of wellbeing and our ability to function and learn throughout life. As the following chart shows, our ability to do complex tasks and to think at a high level depends on the integration of our senses.

Informed by the work of Jean Ayres, PhD – the founder of Sensory Integration Therapy - our Sensory Integration Program works with specific and targeted movement activities in the context of the developmental issues of the child. For example, we can look at the younger children who are focused on leaving home for adventure and returning safely. For them the specific movements would be accompanied by a verse about Mama Swan or the Peepers hatching form the mud.

The imaginative world so alive in young children is nourished, as is their connection to nature – all the while their base senses are being fed. This kind of work weaves right through our days. It might be in the focused physical activities of the morning, five minutes of targeted movement here and there, or having a child who misbehaves run around a track rather than sit in his seat or his room. In both the home school and classroom we work with specific movement and handwork activities and with the very natural opportunities to n

ourish and integrate the senses.

We might find opportunity shoveling snow from the walk, hauling desks into place, carting water to feed animals or set up painting, playing in the mud . . . or even noisy rough-housing or the nightly pillow fight! In all we do in the Enki program, we look always to the integration of the base senses as the ground of learning and wellbeing for all.

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Increases Body Awareness Improves Balance & Coordination Increases Focus & Concentration Improves Comprehension & Learning Dramatically Reduces Hyperactivity Maximizes Benefits of Therapy Sessions Increases Therapy Carryover

Sensory Aids benefit teens & adults with o o o o o o o o o

Autism Attention Deficit Disorder (ADD) Attention Deficit Hyperactivity Disorder (ADHD) Angelman syndrome Aspergers syndrome Ataxia Cerebral Palsy Down syndrome Fetal alcohol syndrome

o o o o o

Pervasive Developmental Disorder (PDD-NOS) Peripheral Neuropathy Rett syndrome Sensory Integration Disorder (SID) Sensory Processing Disorder (SPD)

Sensory Aids are helpful in these therapies o o o o

Behavior Therapy Occupational Therapy Physical Therapy Speech Therapy

Sensory Aids are Useful o o o

At Home At School At Work

Story from Autism ? Hope for autistic children BANGALORE Sept. 29. Every week, at Prathibha Karanth's consulting rooms, at least two sets of frantic parents bring their toddlers, plying her with questions, scared and mystified, as to why the children are violent, unresponsive, anti-social, incapable of feeling emotions, and unable to take care of themselves. Or in less alarming degrees, not displaying the normal social skills or responses appropriate to their age.

Autism and related pervasive developmental disorders (PDD) affects at least 15 in every 10,000 people, and research is advanced just enough to link them to biological or neurological disorders. The search has been on to find a cure since autism and PDD first became known, and to help the affected people enter the mainstream. The past couple of decades have seen if nothing else, a coming together of parents and families of autistic children to make common cause, share the problems, and work towards a solution. But the eminent speech-language pathologist, Prathibha Karanth, is impatient, with answers that elude research and experiment. Dr. Karanth, who trained at NIMHANS and worked at the Mysore-based All-India Institute of Speech and Hearing, pioneered the Communication DEALL (Developmental Eclectic Approach to Language Learning). And less than two years since it was initiated, DEALL has proved to be the light at the end of the tunnel for more than 50 children. Five children on the DEALL programme are already in regular schools, and for Dr. Karanth, they are the vindication of her conviction that earlier the intervention, easier the integration of the child into the mainstream. Parents of one child have relocated from the Middle East so that it can overcome the debilitating disorder, and another mother brings her three-year-old from Peenya, although there is another baby for her to look after. Another child, who finished therapy with Dr. Karanth, is happily attending regular school, and his mother is volunteering her time, and sharing her experience to encourage parents who continue to be devastated on discovering their child's condition. Communication DEALL, says Dr. Karanth, a winner of the Young Scientists' Award early in her career, was a response to the virtual absence of intensive early intervention for alleviation of these disorders. DEALL aims to provide intensive stimulation and training to small groups of pre-school children with developmental disorders, in the areas of communication, cognition, behaviour, and socialisation, enabling their integration into the normal school set-up.

Parents are wary of being candid about their child's disorder history, as they fear, with justification, that it may mean a prejudice against the child. "I tell them to call only if some problem develops, and there are indications of a regression, although it is remote,'' she says. There is nothing that sensitivity and understanding cannot handle, but school managements and other parents are often short on those, when it comes to autism, as any parent of an autistic child knows. This has only made Dr. Karanth all the more determined to show that autism is conquerable. She has put 15 toddlers on DEALL in a new Montessori school, Creative Foundation, in Fraser town. The school's Neelam Calla, who had no qualms about "mixing these extraordinarily gifted children with others'', however, sent off letters to all parents, and was touched to find that nearly every one of them welcomed the idea. For Dr. Karanth, this means autism or PDD can be "erased'' and the child integrated without the trauma or ignominy associated with the disorder.

“Autistic children need genuine friends, not sympathy”

Great show: Samuel Ashish Marcus, performing at a conference at the Pondicherry University on Tuesday PUDUCHERRY: ―I like music very much,‖ said 22-year-old Samuel Ashish Marcus, a person with autism, who plays guitar and keyboard and has over 10 compositions to his credit. Thanks to early recognition and proper nurturing of his

skills, Marcus, who wants to achieve much more with music, comes as an example of how autistic children should be reached at an early age. Marcus, who lives in Hyderabad, was in Puducherry for a two-day international conference on ‗Autism: Social Skills and Creativity‘ organised by the Pondicherry University. He enthralled the audience with a music performance on Tuesday evening. For his mother, Annamma, the journey has been filled with a myriad of experiences. ―Marcus was a premature, Caesarean child. A week after birth, he had very high fever and was given high dose of drugs. He was a healthy baby and was fond of music from a young age. Yet, we sensed that he never demanded anything like other children and was aloof. By the age of four, we found he was a highfunctioning autistic child after medical assessment,‖ she recalled. Filled with passion for music, Marcus started to learn to play instruments from 1995. ―He learned to play guitar using an advanced guitar learning book and is now doing the sixth grade in keyboard with the Trinity College of Music. He is part of the church choir and is good at special numbers. Marcus is more of a soloist than a group performer. His compositions are more devotional, about beauty and people,‖ she said. Marcus studied up to Standard VII under ICSE board. Presently, he is studying computer science at a centre for exceptional children in Hyderabad. He has passed English and Computer Science through open school and has to clear three to four subjects more. ―Music is his life. We have given him an own room with musical instruments. In fact, Marcus wants to bring out an album of his compositions,‖ she stated. She exhorted parents of autistic children not to give up, to explore, let the child be himself/herself and give all help. ―These children need genuine friends and not sympathy,‖ she insisted. With plenty of love for music, Marcus said: ―I want to learn violin.‖

Chennai: Most of us would help a blind person cross the road. But when it comes to an autistic child, people turn indifferent. In an age where communication is the most important of all skills, how does an autistic child cope with a communication disorder? Tamil actor Prithvi Raj‘s 11-year-old son Ahed was not allowed to board a plane in Bangalore because airport security seemed to think that his disability made him dangerous. "Our struggle is to make my son acceptable in the main stream society. We don't want special privileges, don‘t make his life miserable please," Prithvi Raj says. Autistic children like Ahed face insensitivity and discrimination almost everyday. When an autistic child does not make eye contact, or doesn't return a greeting, people think he's either rude or indifferent. While the truth is that autistic children find it difficult to communicate verbally or even through gestures. "For our children, just to look, to blow, to turn around when called. Each and everything needs to be worked upon," 'We CAN' Resource center for autism founder Hema Jairam says. A popular misconception about autism is that it is a disability of the super intelligent and that all autistic children have a special talent. However, therapists say that such cases are extremely rare, and most autistic children are like regular kids who could love music, hate math and be great athletes.

The first rigorous study of behavior treatment in autistic children as young as 18 months found two years of therapy can vastly improve symptoms,

Autism treatment works in kids as young as 18 mos. (Getty Images)

The study was small just 48 children evaluated at the University of Washington but the results were so encouraging it has been expanded to several other sites, said Geraldine Dawson, chief science officer of the advocacy group Autism Speaks. Dawson, a former University of Washington professor, led the research team. Early autism treatment has been getting more attention, but it remains controversial because there's scant rigorous evidence showing it really works. The study is thus ``a landmark of great import,‘ said Tony Charman, an autism education specialist at the Institute of Education in London. There's also a growing emphasis on diagnosing autism at the earliest possible age, and the study shows that can pay off with early, effective treatment, said Laura Schreibman, an autism researcher at the University of California at San Diego. The National Institute of Mental Health funded the study, which was published online Monday in Pediatrics.

Children aged 18 months to 30 months were randomly assigned to receive behavior treatment called the Early Start Denver model from therapists and parents, or they were referred to others for less comprehensive care. The therapy is similar to other types of autism behavior treatment. It focused on social interaction and communication _ which are both difficult for many autistic children. For example, therapists or parents would repeatedly hold a toy near a child's face to encourage the child to have eye contact _ a common problem in autism. Or they'd reward children when they used words to ask for toys. Children in the specialized group had four hours of therapist-led treatment five days a week, plus at least five hours weekly from parents. After two years, IQ increased an average of almost 18 points in the specialized group, versus seven points in the others. Language skills also improved more in the specialized group. Almost 30 percent in the specialized group were re-diagnosed with a less severe form of autism after two years, versus 5 percent of the others. No children were considered ``cured.‘ Ashton Faller of Everett, Washington, got specialized treatment, starting at age 2. ``He had no verbal speech whatsoever, no eye contact, he was very withdrawn,‘ recalled his mother, Lisa Faller. Within two years, Ashton had made ``amazing‘ gains, she said. Now almost 6, he's in a normal kindergarten class, and though he still has mild delays in social skills, people have a hard time believing he is autistic, Faller said. The treatment is expensive; participants didn't pay, but it can cost $50,000 a year, Dawson said. Some states require insurers to cover such costs, and Autism Speaks is working to expand those laws.