Sensory Profile In September, 2015, the Sensory Profile 2 (by Winnie Dunn) was used to look at Student. The following results were obtained with the Caregiver Questionnaire:

Sections maximum # of points

Score Much Less Than

Others

Less Than Others

Typical Performance

More Than Others

Much More Than

Others

Sensory ProcessingAuditory Processing (40) 33 XVisual Processing (30) 24 XTouch Processing (55) 29 XMovement Processing (40) 23 XBody Position Processing (40) 22 XOral Sensory Processing (50) 23 XBehavioural Sections

Conduct (45) 28 XSocial-Emotional (70) 62 XAttentional (50) 31 XQuadrant Scores/ Sensory Temperament

Seeking/Seeker (95) 51 XAvoiding/Avoider (100) 84 XSensitivity/Sensory (95) 66 XRegistration/Bystander (110) 63 X

-2sd -1sd +1sd +2sd

2% 14% 68% 14% 2%

Seeking/Seeker - The degree to which a child obtains sensory input. A child with a Much More Than Others score in this pattern seeks sensory input at a higher rate than others.

Avoiding/Avoider - The degree to which a child is bothered by sensory input. A child with a Much More Than Others score in this pattern moves away from sensory input at a higher rate than others.

Sensitivity/Sensor - The degree to which a child detects sensory input. A child with a Much More Than Others score in this pattern notices sensory input at a higher rate than others.

Registration/Bystander - The degree to which a child misses sensory input. A child with a Much More Than Others score in this pattern misses sensory input at a higher rate than others.

Scores between one and two standard deviations from the mean are expressed as “More Than Others” and “Less Than Others”, respectively. Scores two standard deviations or more from the mean are expressed as “Much More Than Others” or “Much Less Than Others”, respectively. Scores within one standard deviation from the mean are considered ‘typical’.

-2sd -1sd +1sd +2sd

Occupational Therapy Report based on The Sensory Profile 2 Student Page of 2 10

The following results were obtained with the Sensory Profile 2 teacher questionnaire:

Because of differences in e n v i r o n m e n t s , l e v e l s o f stimulation, and interpersonal f ac tors , d i f ferences a re expected to be seen when comparing the information. Looking into sections and individual items, a lot can be learned.

Student has some significant sensory issues, and these are part of his personality, his temperament, and his every day life. By understanding his sensory temperament and his sensory processing, those who support Student will be able to support his development with more information and understanding. When people have these significant sensory challenges, self regulation is also affected. It is more difficult to be calm and focused when there is too much sensory input, and negative thoughts and stress can be more difficult to manage.

School Factor 1 This factor reflects the student’s need for external supports to participate in learning.

School Factor 2 This factor reflects the student’s awareness and attention within the learning environment.

School Factor 3 This factor reflects the student’s tolerance within the learning environment.

School Factor 4 This factor reflects the student’s availability for learning within the learning environment.

Sections maximum # of points

Score Much Less Than

Others

Less Than Others

Typical Performance

More Than Others

Much More Than

Others

Sensory ProcessingAuditory Processing (35) 17 XVisual Processing (35) 23 XTouch Processing (40) 15 XMovement Processing (40) 26 XBehavioural Results (55) 53 XSchool Factors

School factor 1 (65) 47 XSchool factor 2 (50) 20 XSchool factor 3 (60) 41 XSchool factor 4 (45) 34 XQuadrant Scores/ Sensory Temperament

Seeking/Seeker (40) 16 XAvoiding/Avoider (60) 46 XSensitivity/Sensory (55) 31 XRegistration/Bystander (65) 49 X

Occupational Therapy Report based on The Sensory Profile 2 Student Page of 3 10

Student has very significant issues with auditory processing, related to sensitivity. He reacts strongly to sudden, loud, unexpected noises, almost always putting his hands over his ears when this happens. This is an indication that these situations activate his stress response system and push him into ‘defence mode’. When there is noise around him, it is very hard for Student to get his work done, as the noises interfere with his attention and he appears distracted. Even background noise can make it hard for him to attend and get his work done. Many schools have noise reducers available to students to use when the noise level is bothersome.

One school in Surrey has 2 pairs of noise reducers available in every classroom, s o t h a t t h e i r u s e i s normalized for students who might benefit from them. Student should try noise reducers and see if he can get used to them. He could also use headphones or earbuds with an iPod or iPad to provide background music that can help to d r o w n o u t t h e offend ing no i ses . There is a lot of n a t u r e m u s i c ,

instrumental music, and Sonic-Aid music that helps to balance the brain while drowning out offending noises from the environment. When he identifies strategies that work for him, these should be incorporated into his IEP and his daily life. In a school setting or public area, there are a lot of small unavoidable noises that can have a cumulative effect and cause Student to feel stressed and escalated. While carpeted classrooms and rooms with good acoustics are not as hostile, it is felt that Student may need to use supportive strategies in most environments. With some

learners, sitting near to a bubbling fountain or a sound machine can be helpful blocking out noise in the environment. When learners are sensitive mostly to high pitched noises, listening to EASe music and playing EASe video games can gradually re-train the brain to be less

sensitive to these sounds. Others find that sensitivity becomes less intense with a program like the Integrated Listening System offers.

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When used in homework environments, living areas, and busy classrooms, these strategies can improve performance in the face of distractors and multi-

sensory challenges.

SonicAid music can be purchased through iTunes, and is ideal for playing in school or library. Sonic Aid sleep music also helps people to sleep better if they are sound sensitive. www.bartelcameronassoc.com/sonic-aid-music.htm

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Occupational Therapy Report based on The Sensory Profile 2 Student Page of 4 10Combined with this extreme auditory sensitivity is a uni-sensory processing style. That is, when he is focused on something using his visual and tactile systems, he may not hear language that is intended for him. This can make it seem like Student is ignoring, but he has a harder time making an attention shift when it comes to language. As this is fairly common with boys in school, most teachers have learned strategies to prompt an attention shift. Some use a clapping rhythm, some flick the lights, and some use a small chime or bell. If no strategy is used, Student may miss the first part of the instruction or directions, and this can impact on performance. Uni-sensory individuals have an easier time listening in a lecture situation compared to a group discussion where language is coming from all around, as this requires near constant attention shifts.

Student’s sensitivities carry over into the realm of vision as well. He does not like the sun shining on him, and overly bright environments can increase stress levels, especially fluorescent lighting. Often, wearing a hat with a brim can reduce glare, and tinted glasses

can also help with this. Sometimes, a person can manage this through creative positioning, so that artificial light is coming from behind (over the shoulders) rather than coming from t h e f r o n t a n d i n t o t h e e y e s . Sometimes, sitting off to one side and facing a bland wall can support focused attention. Student does enjoy colour and other visual details, and his visual system is probably dominant when it is not too intense. Student is likely to

notice and remember visual details that others may miss. Supporting his learning with visuals (pictures, charts, graphs, videos) is more likely to embed them into his memory and facilitate learning. Bulletin boards that are cluttered and over-stimulating visually can cause escalation and contribute to overload. Calm visual scenes and pleasant visual input, however, are likely to be soothing and grounding. Being sensitive visually also means that it is harder for Student to focus on details that others would not be challenged by. In a cluttered visual field, for example, it may be harder for Student to find his shoes when only

parts of them are visible in a pile. This is not laziness or deliberate; it is a function of visual sensitivity. Student can counter this by focusing on organizational skills, so that he does not have to work in a cluttered environment and he knows where things are. It can be difficult to introduce and support good organizational skills, but this can be an important skill in terms of focus and also in terms of arousal. Student

bell to prompt attention shift

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Occupational Therapy Report based on The Sensory Profile 2 Student Page of 5 10would do well to have bold lines dividing areas of a worksheet, or to use creative folding so that only part of a worksheet is visible. On some crowded worksheets, Student might do best using a separate page to do his work on. These strategies will have to be supported and communicated at each level so that they are not discouraged in different classrooms or different situations. As Student is empowered to find and use solutions that work for him, he will become a better self-advocate. Direct eye contact may be too intense for Student, especially when he is close to his communication partner. When there is a bit more distance between people, it may be less stressful to look into someone’s eyes. If this is the case, try to initiate conversation when there is a distance between you and Student. As he is comfortable with his partner and with the subject discussed, try to close-in the distance a little. Eventually, this may become more comfortable, if not pushed. This will be harder with emotional content and with authority figures, but if he is not pushed, this should get easier as he feels safer and more grounded. While Student should learn that it is important to turn himself to face someone speaking to him, eye contact should not be forced. When one cannot look into the eyes of another, it can be hard to gauge what the other person is feeling, which is important in communication and in building empathy. With some people on the spectrum, it can be valuable to practice reading facial expressions and labeling emotions. Simon Baron Cohen’s Mind-Reading program teaches this in a structured way using a variety of faces.

Student also has real sensitivities in the area of touch. Sudden and unexpected touch may trigger a defensive reaction, and when the input surprises him, Student cannot distinguish between a gentle touch and a hard hit. He should always be warned before he is to be touched, and it should be understood that sudden touch elicits a startle reaction; Student’s actions are not voluntary or consciously mediated, they are fight/flight reactions initiated by his stress system. Some grooming tasks also trigger a negative reaction, and these will have to be desensitized gradually. Being close to others raises the spectre of a sudden touch, and this can also put Student into defensive mode. As he gets older, he may learn strategies to prevent himself from being bumped and jostled in a crowd. He would do better to be first or last in line, or to meet the group at the destination. He can increase the buffer zone around him by carrying something in front of him, and by facing sideways in a line or by side-stepping away from the line and using a shopping basket or backpack to hold his spot in line. In school settings, this extra space is often not allowed nor tolerated, and this is not OK. If he cannot have the space he needs, then the behaviour that results is actually caused by those who do not respect his sensory differences. Because his tactile system is hard-wired to his stress system, Student is not likely to get enough of the grounding touch that we all need. He will therefore tend to touch things more than would be expected, and he would benefit from having things he likes to touch, as he chooses. Many people with touch sensitivities feel much better and more grounded when wearing comfortable, snug underclothes. They have to be comfortable to Student and he would have to try them over time to desensitize and notice benefit. This type of undergarment means more consistent skin sensations with less little

Occupational Therapy Report based on The Sensory Profile 2 Student Page of 6 10contact touches from seams and fabrics. If Student wants to remain grounded and connected in busy environments, he will at times crash and bump into things on purpose. (This is very different from the bumping discussed above, which comes as a surprise and activates his stress system.) Student needs opportunities to crash and bump, as these deliver proprioceptive input which is organizing. Some people love heavy work activities that provide this input, but Student avoids heavy work activities and instead crashes into anything he can.

This same input can come from jumping off of things and crashing into the floor/earth. In some schools, a crash mat (thick soft mat used for vaulting) can be placed near a stage or raised balance beam, and the student can fall onto the crash mat. After a few times of doing this, a sensory person tends to feel more calm, collected, and ready to face the world. People with this profile tend to like dropping into a big bean bag chair or a crash mat. A crash mat is made by sewing 2 large blankets/sheets together and filling it with chunks of foam and other soft objects. People with this profile often tend to like being squeezed and being snug. Student likes to

sleep between heavy blankets, which are tucked in tightly, and he would prefer to squeeze in with any large soft squishy items he can find. I would consider trying him with a large weighted blanket, which may not overheat him as using too many heavy blankets can. I would also have him sleep with several large body pillows. Many people with this type of tactile processing like to wear deep pressure vests, snug vests, or heavy lap pads. Since Student does not seek or crave deep hugs, he might not like the pressure vests unless he gradually

gets used to them, perhaps by learning to wear snug underwear.

Sometimes he will be looking for touch to ground himself, but often Student is benefitting from the movement input that comes with fidgeting, doodling, and drawing. Because he has a higher than average need for movement, even small movement in his hands can give his brain movement to process. If he is not getting the movement he needs, Student will be likely to experience decreased attention and slouching or leaning over his desk because of lower muscle tone and postural reactions. At his desk, he should have a small pad available that he

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Occupational Therapy Report based on The Sensory Profile 2 Student Page of 7 10

can use to draw or doodle when he is listening or thinking. He should be verbally probed from time to time for attention, but it should be easy for Student to develop doodling into a thinking tool, if he is not already doing that. Student should use strategies for movement and understand that his brain needs to move and work for his brain to connect. He should have a loop of exercise band around the front legs of his chair or of his desk. Ideally, Student could explore dynamic seating options as well as fidget items and movement strategies.

In introducing thinking tools, two approaches can be used. 1. Student can use tools at home when watching TV, when conversing, and choose any which

work for him and he feels comfortable bringing to school. or 2. Introduce dynamic seating options and thinking tools to the classroom, using principles of

Zones of Regulation. Allow Student to observe others using sensory tools before he has a chance to try them.

Over time, see which he gravitates toward and which do nothing for him. If they are introduced and not forced but not forgotten then it is more likely that Student will begin to choose sensory tools that work for him and feel comfortable with using them.

Student complains of being weak and of being tired, and these are felt to be related to his level of arousal. He has good strength, but he does not often use it. In part, with people who are strong visual learners, co-contraction and core stabilization can be very hard to teach because they do not have visual markers, unless really pointed out. When one does not stabilize the core or the joints involved, one’s performance can give the appearance of being ‘weak’, when this is not the case. If one does not stabilize the trunk and the muscles around the scapula (shoulder girdle), one will not be able to throw a ball well, even if the arm muscles are very strong. When Student is trying to increase the sensory input from his body through movement and through crashing, he is trying to wake up his body so that his muscle tone can be normalized, and small muscle inputs can be noticed by the brain and incorporated into motor planning. I would suspect that Student would perform with more efficiency and more

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Occupational Therapy Report based on The Sensory Profile 2 Student Page of 8 10strength after getting a lot of movement and crashing into a crash mat. This would probably

apply to other alerting input as well, as sensory input seems to influence the nervous system as a whole. This would suggest that Student might use better strength and motor planning even after crunching on some ice cubes, having a tart drink, or having a brisk body rub. Supporting Student to have an active sensory diet is therefore important to him, in terms of arousal, learning, and motor performance. When he is not getting the touch and the movement that he needs, Student often licks his lips. This indicates that he

needs more movement and more oral-sensory input. Commonly, this behaviour will increase when movement-deprived, when anxiety or stress build, and when exerting effort on a task. It would be great to channel this energy in other directions, so Student does not end up with chapped lips, a rash, or even worse, starting to bite/chew lips or inside of mouth. Student might do well with an ice cold water bottle, some lemon juice or pure lemon essential oil in his water, or with chewing gum, a straw to chew, or other oral sensory input of his choosing. I also believe that if Student had fidget items in his hands, or used dynamic seating, that these would channel the energy and the oral-sensory licking would diminish.

Sensory sensitive individuals take in too much information. While memory and information can be high, taking in this much input can overload the brainstem. When not able to regulate and leave stimulating environments or use calming strategies, sensory sensitive individuals tend to be very rigid and inflexible. Doing something in a slightly different manner can be very stressful, and Student can get hung up on rules and small details, as well as unexpected change. Most often, calmly listening to his feelings and reassuring him about the current situation can be enough, but this may not work with a cumulative load that has been building, as might be the case in school. It is also very likely that with his orientation to detail, that Student notices small errors and imperfections in his work, and that this bothers him more than it would bother most of his peers. Again, this can be supported with calm narrative and an accepting attitude. It can take some people a lifetime to understand that being human, by definition, must include being imperfect and making errors, and to learn to not become frazzled by this. As Student begins to accept this, he should be less easily frustrated, and this would allow him to be less frazzled and stressed in high performance tasks and social situations. Student should gradually learn to handle more change, especially when this starts with small but positive change. This is always easier to handle when it is expected, and especially when this is made visible. Eventually, he may learn to use little sticky-notes in his environment to

vibration wakes up the body, unites body and mind

Occupational Therapy Report based on The Sensory Profile 2 Student Page of 9 10remind him of small changes in routine and expectations. Schedules, lists, and visual reminders will be important to Student, and he should be supported to develop these, and to use them on his own, both at school and at home. Having a large desktop calendar that he can learn to use to record special events and small changes may be helpful, unless he is more comfortable with an electronic counterpart. It would also be great for Student to learn about interpreting social cues and changing social rules/expectations. It is hard to learn that ‘rules’ change and bend depending on situations, and this also can take a lifetime to learn.

Student can learn to feel more empowered in his environments and

to advocate for himself, as he learns to notice and accept sensory issues, and how they can help to support or to interfere with function. The “what works” form can be downloaded in an editable format, and Student can be supported to use this to document how his brain works with different sensory inputs, if

this is done in a non-judgemental manner. When Student learns that it is often a small sensory issue that changes his level of arousal and ability to focus, then he may become less self critical, and he may naturally learn to initiate or request strategies that will work for him, in different

situations.

Using Zones of Regulation is a great way to support this learning,

What Works? What Bothers Me?Mouth MouthMove MoveTouch TouchLook LookListen ListenSmell Smell

Pressure / Heavy Work Pressure / Heavy WorkSensory Supplement Working Forms at http://www.marclandry.ca/Marcs_Sensory_Oasis/Workshop_Materials.html

Occupational Therapy Report based on The Sensory Profile 2 Student Page of 10 10and to develop self regulation tools and strategies. This program has been adopted by many school districts for use with all students, although schools seem to lag behind in terms of accepting sensory differences and sensory strategies. The app is a great way to learn the concepts, although many boys require some supervision to prevent them from just clicking through the educational parts of the video game. The app also contains great visual cues to

slow down breathing as a short break. The program teaches that we can all be in any of the Zones, and that this is not right or wrong, it’s just part of being human. We learn that we each have our own “triggers” which can move us from one zone (level of arousal) to another. We can then learn to self identify tools that help us to return to a calm-alert (just right) level of arousal. When these concepts are normalized and recognized as being very individual, then students using sensory tools to enhance performance becomes more accepted and less of an issue. A very important tool for Student is likely to include sensory reduction, and he should have a calm and pleasant retreat in all of his environments.

Most people in our society are not aware of our own unique sensory issues and how they drive our levels of arousal. We therefore tend to blame the wrong things when we feel frazzled, stressed, or lethargic, and this interferes not only with task performance but with social connectedness. We are also less able to use effective tools and strategies when we incorrectly mis-attribute the causes of our arousal challenges. It is hoped that, over time, those who support Student can become better able to understand Student’s sensory issues, and how to support him with self understanding and fitting into the world.

I would also suggest that those who support Student might review these handouts: http://www.marclandry.ca/Marcs_Sensory_Oasis/Handouts_files/Quadrant-Sensory%20Sensitive.pdf http://www.marclandry.ca/Marcs_Sensory_Oasis/Handouts_files/Quadrant-Sensory%20Avoidant.pdf http://www.marclandry.ca/Marcs_Sensory_Oasis/Handouts_files/Quadrant-Low%20Registration.pdf

The Zones of Regulation appby Selosoft, Inc

www.marclandry.ca/Marcs_Sensory_Oasis/Workshop_Materials_files/gauge%20%204%20colour.pdf

Marc Landry occupational therapist 1701-1188 Howe St. Vancouver, BC V6Z 2S8 marclandryot@gmail.com www.marclandry.ca