Sensory Processing Difficulties

I came across an interesting article about sensory processing difficulties in the Fall 2011 issue of Autism Spectrum News.  It describes the kinds of sensory issues that children with learning disabilities and developmental disorder sometimes struggle with.  The website does not seem to provide a link for the article, only a downloadable PDF.  I thought it was worth sharing, so it is copied below.  You can visit the website at www.mhnews-autism.org.

Sensory Processing Difficulties - Dressing For Success

By Susan Donohoe, OTR/L
Founder
Prince’s Sensory Delights

Many Children with Aspergers experience sensory processing difficulties or
sensory processing disorder (SPD). Sensory Processing is the neurological processing and interpretation of sensation within one’s own body and from the environment.  In short, it is the brain’s organization and interpretation of the sensory input from everyday use. This is a complex interrelationship of processes, hence the term sensory integration. Modulation is a term you may hear describing the neurological process which the child’s central nervous system appropriately regulates (continually adjusts) behavior responses to continually changing external and internal sensory stimuli. If this modulation is not working well the child may seem under responsive, over responsive (seeking stimuli), or both, or may be overwhelmed to sensory stimuli. When this behavior interferes with a child’s “occupation” in life (social, emotional, play, school, attention, body mechanics, self-care, etc.), then it is termed a disorder, hence sensory processing/ integration disorder. It is important to note that anyone and everyone has some sensory processing or integration problems from time to time because any kind of sensory stimuli can temporarily disrupt ones normal functioning. The three main sensory systems we are referring to are tactile/ touch (influencing motor control and emotional development), proprioception (sense obtain through one’s own muscles, ligaments, deep pressure to the skin - therefore giving a sense of body position, organization, and calibration of movement), and Vestibular (sense of movement and gravity specifically postural control, muscle tone, coordinated use of both sides of the body, coordinating eye movements, etc.). Other sensory systems include olfactory (smell), auditory, visual, and gustatory (taste). 

Sensory processing disorder and sensory processing difficulties are individual to each child. Some may be mildly affected while others have greater difficulty functioning in life. It is important to note that symptoms vary and not all are present.  Also it is a marker of neurological dysfunction that a child may show symptoms one day or with one activity and not the next. The main type of therapy for SPD, with a trained Sensory Certified Occupational Therapist, includes a safe and challenging level of sensory stimulation encouraging movement to focus the child on tolerating and integrating sensory input, which is driven by the child’s interests and the “occupation” of play. Other therapy focuses on making environmental adaptations (such as in the home and school).

Common symptoms of SPD include:

clumsiness (tripping, bumping, falling); poor fine motor skills; delayed self-care skills; poor muscle tone; difficulty initiating tasks; poor timing; poor posture; poor hand-eye coordination; learning disabilities; poor handwriting; poor organization skills; becomes easily frustrated; difficulty with social relations; constantly touching objects; doesn’t like to be groomed (hair, teeth, etc.); difficulty with clothing seams, socks, waistbands; seeks only soft clothes; likes tight clothing, small spaces, weight of blankets; opposed to being touched, would rather be the one to touch; hates being tickled or cuddled; often touches people or objects too hard; difficulty with eye contact; often smells objects; poor attention skills; picky eater; stuffing food or objects into mouth; difficulty with transitioning; hypersensitive to noise (things are too loud); hyposensitive to noise (doesn’t seem to notice); Hypersensitive to touch (certain fabrics, surfaces, etc.); little awareness to pain and temperature; hyposensitive to touch (may not notice when clothes are twisted or on improperly); hypersensitive to light; movement produces an anxious reaction (swinging, roller coasters, bike riding, spinning, rolling); over-seeks movement (swinging, spinning, rolling); takes excessive risks in movement, extreme activity levels; walking on tiptoes.

Dressing for Success!

As mentioned above, making adaptations within the child’s everyday life is also a part of understanding the child. Every child deserves to feel comfortable and adorable in their clothing. What if that same clothing could offer qualities that address sensory discomfort and therapeutic input? The child’s image of themselves and how they feel in their environment can enhance the social and emotional quality of life when that child feels organized and calm. We all have sensory qualities that make us who we are. However, when these neurological qualities interrupt our participation in life in a negative way, it should be recognized and accommodated.

There are many children with an array of diagnoses that are subject to sensory hyper or hypo-sensitivities, motor difficulties, and social differences including Autism and Aspergers, ADHD, Sensory Processing Disabilities, Anxiety, and many other Developmental Disabilities. Why not make their clothing possess some of the very neuroscience qualities that could help enhance their social and emotional well being? As a mother of a child who suffered from sensory processing disorder and as a long time Sensory Pediatric Occupational Therapist and advocate, I know firsthand it is not easy for our children.  Parents, therapists, and educators often express to me the benefits of weighed garments, chew objects, compression garments, and a child’s desire for soft materials.  However, they frequently state that what is offered to them is too “therapeutic looking” and therefore stigmatizing. It’s hard to use many of these garments throughout “normal” life.

When a garment is being constructed to address children who suffer sensory processing difficulties, specific consideration should be made to address ease of function, tactile sensitivity, relevant design, safety, consistency in design for spatial orientation, and proprioceptive input (the unconscious awareness of sensations coming from receptor’s in one’s joints, muscles, tendons and ligaments).

This helps promote independence as well as organization, alertness, and simplicity where quickness of dressing is often expected throughout the child’s day. When choosing a weighted vest or blanket for instance, it is significant to hear the child ask specifically for the “soft one,” the “cool one,” or the “nice one.” It is as significant to give their parents beautiful, easy to use, and superior fabrics that are relevant and stylish. It is the right of the child and their parents to have non-stigmatizing products. Just as important is the idea of play, and accommodating products should express the darling nature and playfulness inherent in children.

Respect, pleasure, playfulness, comfort, and a feeling of security are aspects that can be inherent in children’s clothing.  As the design of the child’s apparel and play products are considered, it is important that as many of their personal characteristics are taken into consideration, in addition to the ability for children to take some therapeutic qualities along with them anywhere all day long.

There are so many strategies that help a child with Sensory Processing Difficulties.  Considering the aspects in their clothing is just another way a parent can simply use a non-invasive strategy aimed at helping their child and letting the child know that you understand and accept what they are feeling!

Susan Donohoe, OTR/L is a Pediatric Occupational Therapist with certification in Sensory Integration and an advocate for children with special needs. Susan graduated from the University of Pennsylvania and has been practicing O.T. for 30 years. Through many years of active practice and working closely with educators ,therapists, manufacturers, and experts in Design founded Prince’s Sensory Delights (www.princessensorydelights.com) in 2006 as a way to incorporate Neuroscience Principles into relevant designed apparel for children with special needs. With her passion and commitment, she developed the concept for a line of adorable coordinated sportswear and products that offer therapeutic value which are non-stigmatizing.

Controller John Liu Blasts The DOE For Failure To Deliver Special Ed Services

An audit of the services delivered by the DOE during the 2009-2010 school year revealed that special education students were grossly underserved where they were entitled to services such as speech therapy, occupational therapy, physical therapy, etc.  Although I am not surprised by the findings (the DOE is woefully understaffed), I am surprised that results from an audit regarding 09-10 are first being released now.  Or is that a normal amount of time for this kind of audit?  I'm not sure.  But the city was clearly neglecting to provide a big chunk of the services it was obligated to provide.  This continues to be a problem today.  Any suggestions about how we go about fixing it?

The story is available at:
http://www.nydailynews.com/new-york/education/controller-audit-city-fails-provide-individual-special-ed-services-72-306-students-2009-10-article-1.1011359?localLinksEnabled=false

A copy of the audit report is available here:
http://www.comptroller.nyc.gov/bureaus/audit/audits_2012/1-24-12_FK10-147A.shtm

SRO Annuls IHO's Determination Regarding Pendency And "Comparable Service Plan"

In Appeal No 11-158, the SRO considers an appeal by the district from an IHO's pendency order, making this more of an interlocutory appeal than one based on a final order.  The facts of the case are interesting.  A child with autism had been attending a public school outside of New York City for the last few years.  That program, which appears to have been a robust one, provided a 6:1:3 class, related services, an after-school program focused on socialization, and ample opportunities for mainstreaming (or what is described by the school as "reverse mainstreaming").  At some point around the end of the 2010-2011 school year the parent moved to New York City.  A meeting was convened with the local CSE toward the end of the summer to figure out how to implement the out-of-district IEP or come up with a new IEP with comparable services which could be implemented in NYC.  NYC's IEP recommended only a 6:1:1, did not recommend an after-school program, and did not address mainstreaming.   

The IHO in this case determined that the NYC IEP was not comparable to the out-of-district committee's IEP and, therefore, ordered NYC to continue to fund the out-of-district placement, including related services and transportation, until such time as the merits of the case are finally decided.

On appeal, the SRO agreed that the IEP created by NYC was not comparable to the one from the out-of-district committee.  The SRO held, however, that the appropriate remedy was not to fund the child's out-of-district placement, but rather to order NYC to add the missing component's to the child's NYC program - i.e., additional paraprofessional support, the opportunity for mainstreaming to the maximum extent possible, and, if available to others in the district, after-school services.  In light of this decision, NYC will have to provide the additional support, but the IHO will still have to consider the merits of the due process complaint and determine what is an appropriate program for the 2011-2012 school year.    

Proposed Amendments To The Regulations Relating To Impartial Hearings

As was indicated in a previous post, the state has come down hard on hearing officers and the manner in which impartial hearings have been conducted.  As part of this firestorm, the state education department has proposed amendments to the regulations relating to special education impartial hearings to address issues of noncompliance.  The areas of focus are: certification and appointment of IHO's; consolidation of multiple due process requests for the same student; pre-hearing conferences; withdrawals of due process requests; and the timeline for rendering a decision.  The proposed effective date is May 16, 2012.  

For a more comprehensive summary, check out:
http://www.regents.nysed.gov/meetings/2012Meetings/January2012/112p12d3.pdf

TONIGHT: Series Premiere Of Television Show About A Boy With Autism

Check out the series premiere of Touch, a drama about a widower and single father (Kiefer Sutherland) who discovers that his 11-year-old son who has autism and is mute can predict events before they happen.

Tonight @ 9:00 on FOX.

http://www.fox.com/programming/shows/?sh=touch 

P.S. Apparently this was just a "preview" (not sure I've ever heard of that before).  The series will begin in earnest sometime in March. 

Redefining Autism

What do you think would be the effect of changing the way that we define autism?  Looks like we will soon find out.  The front page of today's New York Times summarizes proposed changes to the DSM which have been the topic of conversation for months.  What they want to do is narrow the definition in a way that would, effectively, weed out the "higher-functioning" (and I use that term cautiously) individuals and capture those with more severe forms of autism.  People previously diagnosed with Asperger's or PDD might no longer be recognized as having autism.  There is disagreement about how many people would be excluded as a result of the changes.  It seems to me that it would be a significant chunk of the autism population.  And even if it is mathematically a small percentage, aren't they still entitled to receive therapeutic services - whether it be because they struggle socially, emotionally, or in some other way?  To the extent that a diagnosis is a sine qua non for receiving services, where does it leave those people who were previously diagnosed but from whom that diagnosis was stripped?  

http://www.nytimes.com/2012/01/20/health/research/new-autism-definition-would-exclude-many-study-suggests.html?pagewanted=all

N.T. v. District of Columbia Public Schools

A recent decision by the Washington, D.C. district court in the case of N.T. v. District of Columbia Public Schools (DCPS) considered the issue of tuition reimbursement for a private special education school, The Lab School.  Based on my reading of the case, D.C. appears to differ from New York in two noteworthy ways: D.C. is a one-tiered system whereby appeals from administrative law judge determinations are appealed directly into state or federal court; and D.C. state law places the burden of proof on the party bringing the claim (whereas, in New York, that burden lies with the school district except in tuition reimbursement cases).  I find it curious that, in paragraph II reviewing the law, the Court does not explicitly state the legal standard for tuition reimbursement. 

Regardless, the first step in any analysis about tuition reimbursement is whether FAPE was offered by the school district.  Everyone seems to agree that the child needed a small class setting and that the IEP created by the school district failed to include a recommendation for a small class.  The Court, however, seemed to bypass that point by focusing on what could have been recommended:

"In the present case, the parents have not even argued, let alone demonstrated, that Key Elementary or another D.C. public school could not provide N.T. an appropriate education with smaller class sizes for N.T.'s core academic subjects. . . .  If DCPS had been unwilling or unable to modify the IEP to meet N.T.'s needs for small group instruction, then private placement and reimbursement might be an appropriate remedy."

What does it matter if the district could have put it on the IEP, or could have recommended a school with a small class.  It didn't.  The Court goes on to say "Because DCPS can craft an appropriate IEP to provide a FAPE, it is not required to pay for N.T.'s placement at The Lab School."  So everyone agrees that the district did not provide FAPE, but theoretically it could have, so they're off the hook?

Also confusing is the Court's analysis of the appropriateness of the private placement.  Footnote 3 says: "Plaintiffs are correct that a parental placement need not be the least restrictive environment.  They are incorrect, however, in arguing that the Hearing Officer could not consider whether The Lab School was the least restrictive environment in evaluating whether private placement was the proper remedy."  Huh? 

I'm not sure what to make of this decision but it looks like, barring an appeal, the parents won't be getting reimbursed. 

Compton Unified School District v. Addison: Update

I read an article yesterday discussing the U.S. Supreme Court declination to hear the case of Compton Unified School District v. Addison.  Some of you may remember a previous blog post about this case.  It is a case that I discuss when presenting to an audience about the special education process in order to illustrate the IDEA's child find requirement.  That is, a school district has an obligation to identify students who may be in need of special education.  A school district should be responsible where it is in a position to notice obvious signs of a child struggling, even if a parent is not knowledgeable enough to reach out to the appropriate channels.  The facts of the case are somewhat appalling.  The school district passively stood by while the child was struggling in a very serious way.  The ultimate question in the case was whether school districts should be liable if they fail to identify a child's special needs.  The answer in this case was "yes."  So held the administrative law judge and the 9th circuit, and the Supreme Court is not going to upset that determination.     

Happy 2012

In the words of Liz Lemon in the opening scene of 30 Rock's season premiere, Happy 2012!

A belated happy new year to all.  2012 promises to be a year of change, which I guess can be said of every year, and every day for that matter.  The year has gotten off to a tumultuous start.  The reverberations of the State Education Department coming down hard on impartial hearing officers is being felt at the local level.  Mayor Bloomberg's State of the City address emphasized education reform, including specific proposals for merit-based pay and teacher evaluations.  Martin Luther King Day was used as a call to action with both Mayor Bloomberg and Governor Cuomo urging to cut through the bureaucracy and implement change.  "It is this simple: It is not about the adults; it is about the children," Cuomo said.  Somewhere along the way Rupert Murdoch called Cuomo a chicken - anyone know what that was about?  In any event, if New York wants to recoup the hundreds of millions of dollars in federal aid that it has missed out on as a result of not implementing a teacher evaluation system, now would be a good time to act.