Sensory Processing Handouts

3/26/2009
Winnie Dunn, PhD, OTR, FAOTA

Professor and Chair
Department of Occupational Therapy Education
University of Kansas
LEARNING OBJECTIVES
 Delineate the core concepts of sensory
processing to others
 Recognize how sensory processing concepts can

be applied in everyday life situations
 Recognize the occupational therapist’s role as

information broker in the therapeutic process
 Select appropriate evidence to support practice

decisions
 Recognize how to integrate sensory processing

insights into school and home environments
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission. 2
Lessons in This Program

 Core Concepts of Sensory Processing
 Explaining Sensory Processing Concepts to
Others
 Assessment and Interpretation of Sensory
Processing Patterns
 Evidence-Based Intervention Planning
 Applications to School Practice
 Directions for the Future
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I am the author or coauthor of the Sensory Profile measures

discussed in this lesson; they are published by Pearson, Inc.
I am the author of the book Living Sensationally: Understanding Your
Senses, which is referenced in this lesson; it is published by Jessica
Kingsley Publishers.
• Dunn’s (1997) Model of Sensory Processing guides our thinking.

• Sensory processing reflects nervous system activity.
• Sensory processing patterns apply to everyone.
• Sensory processing concepts can be situated with other approaches.
Dunn’s (1997) Model of Sensory

Processing
Responsiveness/
Self-Regulation Strategies
Thresholds/ Passive Active
Reactivity
Registration Seeking
High
Low
Sensitivity Avoiding
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Dunn’s Model of Sensory

Processing
Responsiveness/
Reactivity
High
Low
Dunn’s Model of Sensory

Processing
Responsiveness/
Reactivity
High
Low
Sensory processing reflects

nervous system activity.
(Brown, Tollefson, Dunn, Cromwell, & Filion, 2001)
25
20
15
10
Respond
5 Habituate
Responsivity/ habituation
0 Sensitivity: high/high
Seek
Register
Sensitivity
Avoid
Avoiding: high/low
Registration: low/low
Seeking: low/high
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Sensory processing reflects

nervous system activity.
McIntosh, Miller, Shyu, & Dunn, 1999)
5
4.5
4
3.5
3 Normal EDR
2.5
2 Abnormal EDR
1.5
1
0.5
0
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SHORT SENSORY PROFILE

MEG Brain Imaging Data

18-year-old with
Asperger syndrome
Definite difference:
Sensory sensitivity
Sensation avoiding
Dunn, Popescu, & Gustafson, Study currently underway at University

of Kansas Hoglund Brain Imaging Center
Seeking
Responsiveness/
 High ability to
generate ideas and
Reactivity responses
High  Notices and enjoys all
the activity in the
environment
Low
 May be fidgety,
Sensitivity Avoiding excitable,
continuously
engaging
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Avoiding
Responsiveness/
Self-Regulation Strategies  High ability to
Thresholds/
Reactivity
Passive Active design and
Registration Seeking implement structure
High
 Enjoys routines
Low
 May be reliant on
Avoiding
Sensitivity
rituals, rigid
Sensitivity
 High ability to
Responsiveness/
Thresholds/
Reactivity
Passive Active
notice, vigilant
High  Particular about

task completion
Low
 May seem like a
“complainer,”
distractible
Registration
Responsiveness/
 High ability to focus
Thresholds/ Passive Active on something
Reactivity
 Easygoing
High
 Unaffected by
varying
environments
Low
 May seem
uninterested,
apathetic, self-
absorbed
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Sensory processing patterns

are not unitary constructs.
 Sensory processing patterns apply to
everyone, not just people with
disabilities.
 Everyone has some amount of each

sensory pattern.
 Contexts and activities provide unique

sensory experiences.
Example of Sensory Pattern

SEEKER for food AVOIDER for
tastes, spices, sounds in
variety hallway
WORKING
DINING
SELECTING DECORATING
YOUR YOUR HOME
WARDROBE
SENSOR for clothing textures BYSTANDER who doesn’t notice

and weight of items disarray in home
What sensory processing pattern

for dressing do these people have?
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How do sensory approaches

compare with each other?
Occupational
Therapy Practice
Framework Emphasis
(American for Sensory
Occupational Activity
Therapy Association
Demands Processing
[AOTA], 2008)
Areas of Context and
Occupation Environment
Client Performance
Factors Patterns
Emphasis
Performance
for Sensory Skills
Integration Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission. 20
Occupational Therapy Practice Framework (AOTA,

2008)
Occupational Therapy Intervention Approaches
Emphasis for
Sensory Processing
Create/ Establish/
Promote Restore Maintain Modify Prevent
Emphasis for
Sensory Integration
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• Using common ―sense‖

• Using clear language
• Linking to everyday life
• Coaching: Talking to family, teachers, friends, and
individuals
• Creating friendly documentation: Useful written
communication
Common “Sense” Key Points

 Use regular words, no jargon.
 Use clients’ own words to link everyday life

to sensory processing knowledge.
 Listen—really listen—to what they need.
 Learn how to coach them toward finding

solutions.
Use clear, understandable,

and precise language. Being
precise
Unclear/jargon filled: Clear/jargon free:
 Your child has  You said your child

difficulty with hits and screams;
somatosensory it may happen
processing. when people and
JARGON objects touch his
ALERT! skin.
Being Regular
unclear words
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Linking to Everyday Life

The general way: The everyday life way:
 ―He would have  ―…that’s why he has
trouble in crowds, trouble standing in line
like at a concert or with the other children;
sporting event.‖ they will bump into him.‖
 (The child does not  (The teacher has told you
encounter these that line behavior is a
experiences.) challenge.)
Shows you are really listening to

what concerns them.
Coaching invites involvement.

Traditional way: Coaching way:
 Are there times  What do you know
when he has about the times
outbursts for no that he has
apparent reason? outbursts for no
apparent reason?
Keeps you in
“Yes” charge
“Well, it seems to be when we
Invites get home from school. . . .”
participation
COACHING: Reflective Questioning

AWARENESS ANALYSIS
What do you know about. . . ? How does that compare with what you
did before?
What have you tried?
What do you think will happen if you. . .
What happened when you. . . ? ?
What supports were most helpful? How is that consistent with your goals?
ALTERNATIVES ACTION
What else could you have done? What do you plan to do?
What would it take for you to be able What supports do you need to take that
to. . . ? step?
What might make it work better next Where will you get the resources you
time? need?
(Rush & Shelden, 2005a, 2005b)
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
27
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Creating Friendly Documentation

Summary Report for Daniel Summary Report for Daniel
Daniel is an 8-year-old third . . . our results show that Daniel is just like
grader. His parents and other children in his responses to what he
teacher are concerned that he sees and hears. These are great
picks fights with other children advantages for Daniel, because school
for no apparent reason. . . . emphasizes using information from eyes and
ears to follow directions, complete work
sheets. . . . Say what is
Our testing included
great!
completing questionnaires
(School Companion: teacher . . . our results show he reacts differently
and Sensory Profile: parents); from his peers when he is touched; in the
interviewing the teacher and normal course of lining up, getting on the
parents; and observing Daniel bus, and playing, children bump into each
in several environments, other. Daniel may be picking fights with other
including. . . . children because his nervous system is
State overreacting to these experiences. . . .
concern in
Use many life. Link to
sources. participation.
Creating Friendly Reports

 Keep participation inthe
FOREFRONT.
 Link sensory patterns with
participation.
 Do NOT write about every score!!!
 Report on patterns.
 Emphasize links to participation:
○ Findings that support participation
○ Findings that seem to interfere with
participation.
Ongoing Assessment and Setting

Goals
DO DON’T
 Focus on the priorities  Retest underlying factors
of the child, family, that contribute to or
and teacher regarding interfere with participation.
participation.
 Measure progress on the
 Measure progress on basis of changes in
the basis of the child’s underlying factors.
effectiveness in life.
 ―Abe will demonstrate
 ―Abe will get on the
better one-foot balance.‖
bus independently.‖
Comprehensive assessment (every 3 years) can include a wider range of

areas for testing.
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• Identifying participation challenges

• Gathering data from standardized measures
• Designing strategic interpretation strategies
• Applying strategies to children’s everyday experiences
Identifying Participation
Challenges
 Review the referral concern and record.
 Interview the client, family, and teacher.
 Conduct skilled observations:
 Participation is successful.
 Participation is challenging.
 Complete formal assessments:
 Performance-based testing
 Informant questionnaires.
(Brown & Dunn, 2002; Dunn, 1999, 2002,

2006a, 2006b)
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Collaborators
Debby Daniels, PhD, CCC
Pat Pohl, PhD, PT PT

Speech
Donna Bennett, MS, OTR
Tana Brown, PhD, OTR, FAOTA
Jessica Clark, MS, OTR
Sunday Dove, PhD, OTR
Julie Ermer, MS, OTR
Mary Kientz, MS, OTR
Lucy Miller, PhD, OTR, FAOTA
Kay Westman , MS, OTR
Brenda Myles, PhD

OT Teacher
Bell Curve
Much Less Less Than Typical More Than Much More
Than Others Others Performance Others Than Others
14% 14%
2% 2%
68% of
Population
For more info: http://classes.kumc.edu/sah/resources/sensoryprocessing/

Comparison across groups Bell Curve

on its side
Infant Toddler Sensory Profile
Avoid
60.00
Registration
60.00 +1SD
50.00 Typical
50.00
range
40.00
40.00
mean
30.00
30.00
20.00 20.00
-1SD
10.00 10.00
0.00 0.00
typical autism DD typical autism DD
Dunn, 2002
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Comparisons With the Sensory

Profile
Seek Registration
140.00 80.00
120.00 70.00
100.00 60.00
50.00
80.00
40.00
60.00
30.00
40.00 20.00
20.00 10.00
0.00 0.00
Avoiding Sensitivity
160.00 120.00
140.00 100.00
120.00
80.00
100.00
80.00 60.00
(Dunn, 1999, 2006a,
60.00 40.00
40.00 2006b)
20.00 20.00
0.00 0.00 Note. ADHD = attention
deficit–hyperactivity
disorder.
Sensory Processing Across Groups

(Rogers, Hepburn, & Wehner, 2003)
Short Sensory
Profile Autism Fragile X DD Typical
(McIntosh, Miller, Sh
yu, & Dunn, 1999) (n = 26) (n = 20) (n = 32) (n = 24)
Tactile Signif. more Signif. more Same as others Same as others
sensitivity than others than others
Taste–smell Signif. more Same as others Same as others Same as others
sensitivity than others
Low energy/ Same as others Signif. more Same as others Same as others
weak than others
Auditory Signif. more Signif. more Same as others Same as others
filtering than others than others
Under/seek Same as others Signif. more Same as others Same as others

than others
Differences NOT accounted for by DEVELOPMENTAL LEVEL or IQ

Note. DD = developmentally delayed.
Interpretation Strategies
 Keep participation in the FOREFRONT.
 Link sensory patterns with participation.
 Report about supports to participation.
 Look for patterns in data.

 Concepts from Dunn’s Model of Sensory Processing.
 Consider which sensory systems support or interfere.
 How do interviews and observations link with test
data?
 Prioritize findings within the person’s

life.
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Look for patterns in data.

For example, when two patterns are both “different from others”:
REGISTRATION SEEKING Both high thresholds: may

miss cues when tired or
stressed
[Reg + Seek]
SENSITIVITY AVOIDING Both low thresholds: may
be rigid in situations
[Sens + Avoid]
Both passive self- Both active self-
regulation: May find regulation: Need and
themselves want some control over Expect these
overwhelmed in situations [Seek + Avoid] behavior
situations [Reg + Sens] patterns.
THOMAS: Elementary School

Student
 Struggles with changes in  When getting
routines and with transitions dressed, doesn’t know what
 Uses emotional outbursts when to do next
things don’t go his way  Hates tags on his clothing
 Withdraws or gets angry when in  Hates socks
trouble  Loves being naked
 Loves the shower, but doesn’t
 Shoves and pushes peers use soap or cloth
 Doesn’t understand “personal
space”  Ok academically
 Poor sense of his body  Handwriting poor
 Never recognizes dirt on his face

 Mouths objects, loves to chew
 Poor articulation: When others
don’t understand him, he gets
angry
THOMAS: Elementary
1. Thomas school
is a good student
who might be at risk because of
student difficulty with self-management.
 Struggles with changes in  When getting
routines and with transitions dressed, doesn’t know what
things don’t go his way  Hates tags on his clothing
 Withdraws or gets angry when in  Hates socks
trouble
 Loves being naked
 Loves the shower, but
 Shoves and pushes peers doesn’t use soap or cloth
 Doesn’t understand “personal
space”
 Poor sense of his body  Ok academically
 Handwriting poor
angry
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THOMAS: Elementary school

2. Thomas may have oral–

student
Struggles with changes in
sensory difficulties.
routines and with transitions
 When getting
 Uses emotional outbursts when dressed, doesn’t know what
things don’t go his way to do next
 Withdraws or gets angry when in  Hates tags on his clothing
trouble
 Hates socks
 Shoves and pushes peers  Loves being naked
 Doesn’t understand “personal  Loves the shower, but
space” doesn’t use soap or cloth
 Poor sense of his body
 Ok academically
 Never recognizes dirt on his face  Handwriting poor
angry
3. Thomas
THOMAS: Elementary may have poor body
school
awareness due to difficulty
student interpreting touch input.
 Struggles with changes in
routines and with transitions  When getting
 Uses emotional outbursts when dressed, doesn’t know what
things don’t go his way to do next
 Withdraws or gets angry when in  Hates tags on his clothing
trouble  Hates socks
 Shoves and pushes peers
 Loves the shower, but
 Doesn’t understand “personal doesn’t use soap or cloth
space”
 Poor sense of his body
 Ok academically
 Never recognizes dirt on his face  Handwriting poor
angry
THOMAS:4.Elementary
Thomas may have school
poor body awareness
due to difficulty interpreting movement
student [Vestib] and body position [Proprio] input
 Struggles with changes in routines  When getting
and with transitions dressed, doesn’t know what
things don’t go his way
 Hates tags on his clothing
 Withdraws or gets angry when in
trouble
 Hates socks
 Shoves and pushes peers  Loves the shower, but
 Doesn’t understand “personal doesn’t use soap or cloth
space”
 Poor sense of his body  Ok academically
 Handwriting poor
 Poor articulation: when others don’t
understand him, he gets angry
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Thomas Case Study: SP

Data
Much Same as Much What do you see?
Less Less Others More More
Notices just like
SEEK X
others [Reg]
AVOID X
SENS X Seek + Avoid =
need for control
REG X
Vestib and Oral
AUD X same as others!
VIS X
VEST X Tactile much more
than others [2%]
TAC X
MULTI X Aud and Vis: some
concerns
ORAL X
Note. SP = Sensory Profile.
Thomas Case Study: SP Data

(cont.)
Much Same as Much What do you see?
Less Less Others More More
TONE X Proprioception/tone
POS/MVMT X is ok.
Modulation
Section
ACTIVE X
It may be harder for
SENSORY/ X Thomas when
EMOT stimuli are combined
MULTI X (modulation sections
are “more”).
EMOT/ X
SOC Difficulty with
BEH X managing self is
verified [Emot/soc and
THRESH X
Beh scores].
Decision Hypotheses Findings

Hypothesis 1. Thomas is a good student + Skilled observations
supported who might be at risk + Parent and teacher report
because of difficulty with + Emot/soc score; Beh score SP
self-management. + Seek, Avoid, and Sens scores SP
+ Tactile score SP
+ Modulation scores SP
+ Aud and Vis scores SP
Hypothesis 2. Thomas may have oral– + Parent and teacher report
rejected sensory difficulties. ok Oral score SP is typical.
Hypothesis 3. Thomas may have poor + Parent and teacher report

supported body awareness due to + Skilled observations
difficulty interpreting touch + Tactile score SP
input.
Hypothesis 4. Thomas may have poor + Parent and teacher report

rejected body awareness due to + Skilled observations
difficulty interpreting ok Vestibular score SP is typical.
movement [Vestib] and body ok ―Tone‖ score SP is typical.
position [Proprio] input.
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• Reviewing evidence on traditional interventions

• Framing decision making with interdisciplinary evidence
• Using evidence to create a participation focus
• Implementing an evidence-based sensory processing approach within daily life
Summary Review of Sensory–

Motor Interventions in Autism
 Design educational programs that accommodate unique sensory
processing patterns.
 Make task and environmental modifications.
 Use systematic data collection to chart progress.
 Consider that traditional sensory integrative (SI) therapy is

beneficial ANECTODALLY, but evidence does not substantiate
effects.
 Increase generalization with functional activities in daily routines

within natural contexts.
(as reported in Baranek, 2002)

Evidence Brief on
Sensory Integration
Refer to Evidence Brief: Keeping Current in Sensory
Integration (Pollock, 2006; www.canchild.ca/Default.aspx?tabid=1237).
 Some studies report positive changes in behavior;

treatment efficacy is still unknown because of
limitations in designs.
 Better designed studies do not show a difference in

SI therapy.
 SI therapy (classical) should be considered a trial.
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So . . . Now What?
 There is a difference between knowledge

and the application of knowledge.
 Neuroscientists and others have provided

evidence about how the brain works.
 Applied scientists make use of knowledge in

particular ways.
Evidence About the

Structure of Services
 Teachers are 4 times more likely to
implement practices learned through
partnerships than to implement practices
learned in traditional in-service training.
 Implementation of strategies rates:

 From traditional in-services: 10%
 From partnership approach: 85%
(Knight, 2004, 2008; Showers & Joyce, 1996)

Evidence About Using

Children’s Routines as Context
for Intervention
 Using children’s routines provides more varied
opportunities for practice.
 Using everyday activities has a positive impact on
children’s development.
 Parent-facilitated child learning is equally or more
effective than therapist-implemented interventions.
 Must be active, intentional, purposeful, and contextual
 Must be interest-based, responsive interactions.
(Dunst, 2001; 2006; Dunst, Bruder, et al., 2001; Dunst, Trivette, & Hamby, 2006;
Gibbard, Coglan, & MacDonald, 2004; Kellegrew, 1998; Law et al., 1998;
Law, Garret, & Nye, 2004; McLean & Cripe, 1997; Roper & Dunst, 2003;
Trivette, Dunst, & Hamby, 2004)
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Evidence About Capacity

Building
 Family-, person-, and school-centered care has a
capacity-building effect.
 Build capacity by teaching care providers how to
interact with children within natural learning
opportunities.
 Capacity building:
 Therapists support strengths and abilities.
 Care providers recognize, learn, and use their abilities.
 Therapists and care providers assume responsibility for
working toward desired outcomes.
(Davies, 1995; Dempsey & Dunst, 2004; Dunst, Trivette, & Snyder, 2005; Law et
al., 1998, 2004; Shelton & Stepanek, 1994; Trivette et al., 2004)
Evidence Related to
Natural Environment Interventions
 Providing theoretically sound interventions
during daily life routines improves
PARTICIPATION.
 Skill development develops isolated skills.
(Dunst, Bruder, Trivette, & Hamby, 2006; Dunst, Bruder, et al., 2001; Dunst, Hamby, Trivette, & Raab, 2002;
Dunst, Hamby, et al., 2000; Dunst, Herter, & Shields, 2000; Dunst, Humphries, & Trivette, 2002;
Dunst, Trivette, & Cross, 2002; Dunst, Trivette, Humphries, Raab, & Roper, 2001)
 Sensory processing interventions need to be part

of the natural context to support generalization.
(Baranek 2002; Hanft & Pilkington, 2000)
Copyright © 2009 by Winnie Dunn, PhD,

@ winnie
OTR,dunn
FAOTA.
2009Used with permission. 56
Summary: Key Tips for Practice

Here’s What to Do Here’s Why
Create partnerships with To increase implementation fidelity and

care providers. achieve better child outcomes
Provide person-centered To increase capacity of care providers

care. and achieve children’s developmental
outcomes
Embed your expertise To provide more practice and foster

within children’s daily generalization
routines and natural
contexts.
Provide theoretically sound To provide a structure for data collection
interventions. and decision making
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Impact of
Caregiver-Implemented Routines
 Multiple-baseline  Multiple-baseline
design with 4 toddlers design with 5
with developmental children with autism
delays
 Train parents during
 Train parents during certain daily routines
indoor play
 Test for
 Test for generalization
in outdoor play and
generalization in
caregiving routines other daily routines
 Positive parent and  Positive parent and
child outcomes child outcomes
(Kashinath, Woods, & Goldstein, 2006;
Woods, Kashinath, & Goldstein, 2004)
58
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission.
Comparison of Traditional and

Functional Physical Therapy
(Ketelaar, Vermeer, Hart, Beek, & Helders, 2001)
 55 children with cerebral palsy
 Compared functional physical therapy (PT) to
normalization of movement
 Measured quality of movement, skill
development, and movement in daily routines
 BOTH groups improved gross and fine motor
skills.
 Functional PT group did better in daily
routines (Pediatric Evaluation of Disability Inventory;
Haley, Coster, Ludlow, Haltiwanger, & Andrellos, 1992).
Use of Touch Pressure and

Proprioception to Support Participation
Fertel-Daly, Bedell, & Hinojosa VandenBerg (2001)
(2001)  4 students with ADHD
 5 preschoolers with  Wore vests for 15 min (put on
pervasive developmental 5 min before observation)
disorder
 5% of the child’s weight
 Wore vests for 2 hr (data
collected at 1.5-hr mark)
 1 lb of weight Outcome
 On-task behavior improved
Outcome 18% to 25%.
 Improvements in behavioral  Students asked to use the
repertoire included vest again.
– < Self-stimulation,  One student noticed
– < Distractibility, and
difference in weight.
– > Focused attention.
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Use of Postural and Vestibular

Activation to Support Participation
Schilling, Washington, Billing Schilling & Schwartz (2004)
sley, & Deitz (2003)
 4 preschool boys with autism
 Used ball chairs in fourth-grade  Used ball chairs with molded
classrooms to study in-seat feet in preschool classrooms to
behavior and legible word study in-seat behavior and
productivity engagement
 ABAB design (3-wk alternating  Teacher chose time of day
chair and ball)  ABAB design (2-wk alternating
 Significant increase in in-seat chair and bench seat)
behavior and legible writing  Significant increase in in-seat
behavior and engagement
Sensory Processing Patterns of

Teachers Related to Their
Students
seeker PERSONAL–SOCIAL
• Happy
• Cheerful
Personal–Social
• Honest
• Sense of humor
• Sincere
• Confident
(Teachable Pupil Inventory

avoider [Kornblau, 1982]; this study by Johnson-
Coffelt, 2001)
Creative art High Seeking

Building materials
Miniature pretend toys
no toy preference
vehicles
High Avoiding
Varied body
positions No body position
changes
(Mische-Lawson & Dunn, 2008)
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• Gaining insights about the teachers’ points of view

• Understanding the special context of school
• Learning about the data available from school context
• Practicing how to meet the demands of learning and
interacting at school
Providing insights about the teacher’s point of view
(Dunn, 2006a)
Understanding the special context of school…

What are the benefits and risks?
What are the benefits? What are the risks?
 Sensory Profile (SP) is  We might compare
not appropriate for teachers and parents to
teachers. see who is RIGHT.
 We need context-specific  We might abandon parent
data. information because
 School is a major life teachers are more
context for children. convenient.
 We might get
overwhelmed with
complexity of data.
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Data Available From the

Sensory Profile School Companion
Comparable Info to SP New Info Available
 Quadrant Scores  School Factor Scores
 SEEK  School Factor 1
 AVOID  School Factor 2
 SENSITIVITY  School Factor 3
 REGISTRATION  School Factor 4
 System Scores
 Auditory
 Visual
 Touch
 Movement
 Behavior
School Factor 1
Degree to which a child
School needs someone else to
Factor 1 manage or influence the
actions
 Teacher interacts to change
the course of events with the
child
 External influences affect
Registration Seeking behavior
 Combination of SEEK and
High
Thresholds
REG [Registration]
School Factor 1 Examples

REGISTRATION SEEKING
 Misses oral directions  Hums, whistles, sings, or

in class more than makes other noises
other students throughout the day
 Has trouble keeping  Gets up and moves
materials and around more than other
supplies organized for students
use during the day
23
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School Factor 2
Level of child’s attention and
School awareness of self and
environment
Factor 2
 Busy, engaged, alert, resp
onsive, detail oriented
 Combination of SEEK and
SENS
Seeking Sensitivity

SEEKING SENSITIVITY
 Adds more details to  Comments on small

drawing and coloring details in objects or
than other students pictures that others
 Seems more curious haven’t noticed
than other students  Is bossy with
classmates and
peers
School Factor 3
Range of tolerance for
School what is going on in the
Factor 3 environment
 Hyperawareness, rigidit
y, bothered, defiant
 Combination of SENS
Sensitivity Avoiding and AVOID
Low
Thresholds
24
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SENSITIVITY AVOIDING
 Is easily upset by  Withdraws when

minor injuries changes in the
(e.g., bumps, scrape environment or
s, cuts) routine occur
 Becomes distressed  Flinches when
during people get in close
assemblies, lunch, o proximity to or touch
r other large his or her body
gatherings
School Factor 4
Level of availability for
School
Factor 4
learning
 Removed, stoic, dista
nt, disengaged, inacti
ve
 Combination of
AVOID and REG
Registration Avoiding

REGISTRATION AVOIDING
 Shows little emotion  Stands or sits at the side

regardless of the of the playground during
situation recess
 Seems oblivious  Withdraws from active
within an active environments or
environment (i.e., is situations (e.g., retreats
unaware of activity) to a quiet area in the
classroom)
25
3/26/2009
Zachary’s Participation
Zachary is a 6-year-old first grader.
SCHOOL HOME
 Zachary is doing fine at  Zachary doesn’t respond to his

school. parents’ calls.
 He has more challenges in  He is particular about

group situations situations, including getting
(e.g., lunch, hall, group dressed.
projects).
 Zachary’s parents want him to
 Zachary fiddles with small be successful at school.
toys at his desk but won’t use
glue during art.
Zachary’s Sensory Profile and School

Companion Quadrant Scores
Much Much What do you see?
Less Less Same More More
Seeking scores are
SP home
Same.
SEEK Seek
SENS Sens Both parents and
teacher see Zach as
AVOID Avoid
having low thresholds
REG Reg [Sens and Avoid scores
SP school More Than others on
both].
SEEK Seek
SENS Sens Parents see Zach as
AVOID Avoid failing to
notice, whereas teacher
REG Reg sees Zach as noticing
just like everyone else
[Reg scores].
Hypotheses About Registration for

Zachary
 He has enough models at school to see
what to do if he misses directions; if he
misses directions at home, he is lost.
 The teacher has seen many more 6-
year-olds and thus has a different idea
about ―missing cues.‖
 The family and teacher see Zach in
different situations that might bring out
his noticing or missing information.
26
3/26/2009
Zachary’s Sensory Profile

School Companion Scores What do you see?
Zach is just like
Much Much
other students in
the amount of
SP school guidance he needs
Visual X from the teacher
[Factor 1],
Auditory X
and
Touch X he is just as available
Movement X for learning as
other students
Behavior X
[Factor 4].
School Factor 1 X He is more sensitive

to touch and sound.
School Factor 2 X
School Factor 3 X He is more busy and
School Factor 4 X less tolerant
[Factors 2 and 3].
Victoria’s Participation
Victoria is an 11-year-old middle
school student.
 Teachers agree that she is bright;
grades are lower because she doesn’t
turn in homework.
 Parents report that she does homework
every night.
 Some teachers are resistant to ―taking
over Victoria’s responsibilities for her.‖
Victoria’s Scores What do you see?
Much Much Victoria completed

Less Less Same More More the AASP on herself.
AASP*
The teacher and
SEEK Seek Victoria agree about
SENS Sens her patterns of
AVOID Avoid sensory processing.
REG Reg Victoria sees herself

SP school as more avoiding
SEEK Seek than does the
teacher.
SENS Sens
AVOID Avoid
REG Reg
*Victoria completed the Adolescent/Adult Sensory Profile because she is 11 years old.
27
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Victoria’s Scores (cont.)

Much Much What do you see?
SP school Visual and Movement
sensation scores are
Visual X “More Than Others.”
Auditory X
Touch X School Factors 1 and
4 both involve
Movement X Registration.
Behavior X
School Factor 1 X
School Factor 2 X
School Factor 3 X
School Factor 4 X
Maria’s Participation
Maria is a 4-year-old attending
the neighborhood preschool
program.
 Maria does great during free play at
preschool.
 Maria does great during teacher
directed activities.
 Maria is out of control during snack
time.
 Mom and Dad say Maria is fine at
mealtime at home.
Maria’s Sensory Profile and School

Companion Quadrant ScoresWhat do you see?
Much Much
Less Less Same More More Maria has some
sensitivity at home and
SP home at school.
SEEK Seek
Maria is mostly like other
SENS Sens children at preschool
AVOID Avoid [Same scores on School
Companion].
REG Reg
SP school Maria’s reactions at
home are mostly more
SEEK Seek intense and frequent
SENS Sens than would be expected
of children her age
AVOID Avoid [scores More and Much
REG Reg More than others on
Sensory Profile].
28
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Maria’s Sensory Profile School

Companion scores (cont.) What do you see?
Muc
Much h Maria needs the
Less Less Same More More same amount of
support as others
SP school [Factor 1].
Visual X
Auditory X Maria is just as
available for learning
Touch X as others [Factor 4].
Movement X
Maria reacts more
Behavior X
than others to sound
and touch stimuli.
School Factor 1 X
School Factor 2 X Maria is more active
School Factor 3 X and needs more
structure in the
School Factor 4 X school environment
NOTE: on the SP, scores more than others on
auditory, touch, multisensory and oral processing than others [Factors
Copyright © 2009 by Winnie Dunn, PhD, OTR, FAOTA. Used with permission. 2 and 3]. 85
• What is on the horizon to invite us to higher ground?
Consider Other Points of

View
 Is normalcy . . .
 Overrated?
 Underrated?
 An artificial parameter?
 Are too many people being

labeled with illnesses?
29
3/26/2009
Consider Other Points of

View
 Is our perspective about disability . . .
 Too negative?
 Too narrow?
 Does our perspective about intervention . . .

 Need to be more universally focused?
 Need to be reconsidered?
Returning to Sensory Processing
Seeker: Bystander:
Creates Easygoing and
excitement and can maintain
change focus
Avoider: Sensor:
Creates routines Notices details
to manage day and has precise
ideas
Dunn, W. (2008) Living sensationally:
Understanding your senses.
http://livingsensationally.blogspot.com/ London: Jessica Kingsley Publishers
Acknowledgments
Images of the Sensory Profile assessments are reproduced with the permission
of NCS Pearson, Inc., as follows:
 Sensory Profile. Copyright © 1999 by NCS Pearson, Inc. Reproduced with

permission. All rights reserved.
 Infant/Toddler Sensory Profile. Copyright © 2002 by NCS Pearson, Inc.
Reproduced with permission. All rights reserved.
 Adolescent/Adult Sensory Profile. Copyright © 2002 by NCS Pearson, Inc.
 Sensory Profile School Companion. Copyright © 2006 by NCS Pearson, Inc.
 Sensory Profile Supplement. Copyright © 2006 by NCS Pearson, Inc.
―Sensory Profile‖ is a trademark in the United States and other countries of

Pearson Education, Inc., or its affiliate(s).
30
3/26/2009
Acknowledgments (cont.)
The image on the cover of Living
Sensationally: Understanding Your
Senses, by W. Dunn, is reproduced with
the permission of Jessica Kingsley
Publishers.
References
For course references and bibliography, go
to the References tab on the main menu.
A course bibliography is included in the

course resources.
31

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3/26/2009

Winnie Dunn, PhD, OTR, FAOTA

 Recognize how sensory processing concepts can

 Recognize the occupational therapist’s role as

 Select appropriate evidence to support practice

 Recognize how to integrate sensory processing

Lessons in This Program

I am the author or coauthor of the Sensory Profile measures

• Dunn’s (1997) Model of Sensory Processing guides our thinking.

Dunn’s (1997) Model of Sensory

Dunn’s Model of Sensory

Dunn’s Model of Sensory

Sensory processing reflects

Sensory processing reflects

SHORT SENSORY PROFILE

MEG Brain Imaging Data

Dunn, Popescu, & Gustafson, Study currently underway at University

High  Particular about

Sensory processing patterns

 Everyone has some amount of each

 Contexts and activities provide unique

Example of Sensory Pattern

SENSOR for clothing textures BYSTANDER who doesn’t notice

What sensory processing pattern

How do sensory approaches

Occupational Therapy Practice Framework (AOTA,

• Using common ―sense‖

Common “Sense” Key Points

 Use clients’ own words to link everyday life

 Listen—really listen—to what they need.

 Learn how to coach them toward finding

Use clear, understandable,

 Your child has  You said your child

Linking to Everyday Life

Shows you are really listening to

Coaching invites involvement.

COACHING: Reflective Questioning

Creating Friendly Documentation

Creating Friendly Reports

Ongoing Assessment and Setting

Comprehensive assessment (every 3 years) can include a wider range of

• Identifying participation challenges

(Brown & Dunn, 2002; Dunn, 1999, 2002,

Pat Pohl, PhD, PT PT

Brenda Myles, PhD

For more info: http://classes.kumc.edu/sah/resources/sensoryprocessing/

Comparison across groups Bell Curve

typical autism DD typical autism DD

Comparisons With the Sensory

Sensory Processing Across Groups

sensitivity than others than others

Taste–smell Signif. more Same as others Same as others Same as others

sensitivity than others

weak than others

Auditory Signif. more Signif. more Same as others Same as others

filtering than others than others

Under/seek Same as others Signif. more Same as others Same as others

Differences NOT accounted for by DEVELOPMENTAL LEVEL or IQ

 Look for patterns in data.

 Prioritize findings within the person’s

Look for patterns in data.

REGISTRATION SEEKING Both high thresholds: may

THOMAS: Elementary School

 Never recognizes dirt on his face