SIPT & John's Results

Last month, John went through a series of 17 tests that are incorporated into the SIPT. (Sensory Integration).   The tests themselves and the results were fascinating.  One of his new Occupational Therapists recognized that he could benefit from the test and administered it to him over a four week period.  She felt that his current program was trying to correct certain behavior and teach certain skills, but wasn't looking at "why" he had certain deficits and "why" he wasn't excelling in certain areas.  As he develops and we get more in depth into the "why" behind his behavior, the diagnosis seems to be moving away from autism, however sensory integration and autism are highly connected, so caution needs to be taken before making this kind of judgment.  Over the last year, his social awareness and behavior has blossomed.  Many of his deficits are now in motor planning, with praxis problems and a delay in behavioral/emotional.   The SIPT gave us very interesting results and a very good plan of how to correct what we are seeing.

Since the purpose of the blog is to journal, as well as educate and explain, I am going to go into depth on the test, as well as the specific results for John and what it means for kids with these issues.


(the following information was taken from information put together by Casa Colina taken from A. Jean Ayres, Ph.D)

SIPT, Sensory Integration, and Praxis Defined
SIPT stands for Sensory Integration and Praxis Tests.  They help us understand why some children have difficulty learning or behaving the way we expect them to.  They are not measuring intelligence, language, academic achievement, or social behavior.  But, the test assess sensory processing that relates to those functions and the ability of the child to perform in those arenas.  The test also evaluates praxis, or the ability to cope with the tangible, physical, 2 and 3-D world.

I've blogged about Sensory Integration before, but to re-define it here, it is the neurological process by which sensations (through skin, eyes, joints, gravity, and movement) are organized for use.  Our brain is working in the background to filter, discriminate, and modulate all the sensory information it receives.

Praxis is the ability by which we figure out how to use our hands and body in skilled tasks. (like playing with toys, using a fork, building a structure, cleaning a room, working a job)  This includes knowing WHAT to do, as well as HOW to do it.

Children with a dysfunction in Sensory Integration and Praxis have difficulties with visual perception tasks and are inefficient with their interpretation of the sensations they receive from their body.  In basic terms, these children have difficulty in organizing their body and their behavior.

SIPT in depth
There are 17 SIPT tests.  Those tests fall into 4 Categories
1. Motor-Free Visual Perception

• ability to visually perceive and discriminate form and space without motor coordination
• child shown puzzle pieces and a form board; has to look at pieces and visually perceive which piece would fit without placing it or trying it in formboard
• when child makes decision, picks it up; examiner notes which hand was used, whether they crossed the midline
• continues to more advanced, where pictures are hidden among other pictures and child has to perceive a figure against a confusing background

2. Somatosensory

•  assesses tactile, muscle, and joint perception  ("Soma" means "body")
• Child is encouraged to "feel", not "see"
• child must identify what shapes they are holding in their hand without looking
• Using cardboard, child's hands are placed underneath; examiner touches child on one of his/her fingers. Child must tell examiner which finger was touched
• being touched can make child uncomfortable, so examiner is looking for "tactile defensiveness"
• The conscious sense of joint position and movement is evaluated by the child's attempt to put his or her finger at the same place the therapist put it
• the therapist will draw simple designs on back of child's hand and child must attempt to copy
• the therapist will lightly touch the child's arm with a black pen, leaving a dot (while child's arm is under cardboard). Child must try to touch the dot without looking (assessing whether the child felt the pen touching their skin and the accuracy of the sensation)

3. Praxis

•  assesses ability of child to interpret verbal instructions to assume certain positions with the body "put hands on top of head"
• evaluates the ability to copy simple designs
• evaluates ability to build with blocks (therapist models a structure they built and child must copy) ;  evaulates visual form and space perception
• child imitates unusual body postures that are done by the therapist
• the child imitates movements and positions of the tongue, lips, and jaw ( oral praxis, oral motor)---a child with a deficit here would have eating and speech issues
• child imitates a series of simple arm and hand positions

4. Sensorimotor

• evaluates the ability to coordinate the two sides of the body
• assesses the degree of sensory integration of the proprioceptive sense (muscle and joint) and vestibular Sense (gravity and head movement)
• Eye hand coordination is measured; how well a child draws a line on top of a printed line -- executing this takes eye muscle control, practive ability, visual perception, and motor coordination
• measures the duration of the reflexive back and forth eye movements following the rotation of the body; it is a way to tell how well the nervous system integrates with the sensations from the vestibular system

Motor Planning, Dysfunction, and the Nervous System
When we need to do something with our bodies (play with a toy, write a note, type on the computer, walk across a room, do a jumping jack, lay down, sit on a chair, etc.), we need to:
1. have the idea of what to do
2.know how to execute it
3. physically execute what we want to do

In executing movement of our bodies, it involves fluidity and  muscle control, as well as the actual execution of the movement.  Children with sensory integration dysfunction cannot execute the movement accurately due to the inability of the brain to interpret and communicate the sensory information to the rest of the body.  The nervous system is not receiving the appropriate "feedback" it needs to remain in a "calm" state and therefore, these children's nervous systems are always on "high alert" and in defense mode. 

John's Results
The tests revealed that John has Dyspraxia and a Modulation Disorder;
specifically Visuo-and-Somotodyspraxia


Children in this group have low scores in Design Copying, Finger Identification, Graphesthesia(copying design therapist drew on hand), Postual Praxis, Sequencing Praxis, Bilateral Motor Coordination, Standing and Walking Balance, Motor Accuracy, and Kinesthesia (joint position and movement)

Understanding Modulation Disorder
A child out of the "normal", also known as "out of sync" can either fall into under responsive or over responsive to the sensory information.

Our brains are discriminating every sensation and then sending the message to our bodies to react to the sensation.  A normal modulation leads to appropriate "feedback" for the nervous system, resulting in a calming, positive experience.

When our brains do not discriminate that information correctly, there is a modulation problem, leading to the under and over-responsive behaviors.

A child who is over-responsive to touch, for example, would over-react to stepping into sand.  They won't be able to tolerate that touch and their behavior will reflect that, keeping the nervous system from ever receiving appropriate "feedback" to calm and enjoy it.

A child who is under-responsive takes longer to discriminate that sensation, therefore resulting in the need for "more" of the sensation, craving an abnormal amount of that sensation before the nervous system can become calm.  In sand, that child may need to bury their bodies in it, roll around in it, squish in their hands, etc.

For John, he is under-responsive in tactile, vestibular, and proprioception.  He may not know what he is feeling as he touches something if he is not looking at it.  He craves lots of movement, swinging really high, thrill rides, bounces up and down, crashes into things like couches and furniture to get "feedback" for his nervous system, etc. Because of this, if he doesn't get "enough" feedback, then his behavior,  his attention span, and his ability to sit and learn become effected.

He also seems to modulate sound and smell in the opposite direction, being over-responsive to those senses.  If something smells bad, he no longer can concentrate, starts acting "crazy" and "loopy" and is no longer "in control" of his behavior.  Loud sounds scare him, and can lead to anxiety over the anticipation of things like fireworks, blenders, hair dryers, etc.

What can be done to correct the modulation disorder, dyspraxia, and Sensory Processing Dysfunction?

The good news: LOTS OF THINGS can be done!!!

The key to John's success in overcoming the modulation, dyspraxia, and sensory processing issues will be to INTENSIFY every sensory experience he has to make sure his nervous system receives the "feedback" it needs from those experiences, so it can learn to be in a calm state.  Our brains can learn to regulate themselves.  Many of the things we have been doing over the last year incorporated many of these things, which would explain the significant gains he has made.  Here are examples of things we can do in the home, as well as in therapy, to help John receive the appropriate level of sensory "feedback" to help regulate him to a "calm" state, for lack of better terms.  ;)

Heavy in Proprioception; Intensifying every sensory experience

• Fingerpainting with sand in the fingerpaint
• Swimming
• Deep Pressure hugs, squeezes, massages
• Heavy "work" (push, carry, move)
• Use ankle weights (3 lbs. each ankle)
• Large trampoline
• Swing Set with tire swing, rock climbing wall, slides, swings, etc
• Shaving Cream in bathtub to fingerpaint with
• Barefoot outside
• Sandbox in backyard
• Bury toys in sand
• Hide toys in play dough
• "touch game" - find hidden objects where vision is blocked so only using hands to find the object

To help with Oral Praxia issues (EATING ISSUES)

• start meals off with something more resistant / harder to chew like bagel, beef jerky, starburst, granola bar
• Extreme temp foods (not burning, but very hot or very cold)
• Use of straw in cups
• Use of twisty loop straw
• thick smoothie, shakes
• more sweet
• more tang
• INTENSIFY eating experience

You Know You're Teaching an SPD Kid when....

 This was an original blog post on "Hartley's Life With 3 Boys" and can be found here.
Hartley Steiner is a blogger with 3 boys, one whom is adopted and suffers from SPD, High Functioning Autism, Bi-Polar, and learning disabilities.  She is an advocate for kids with special needs. She has a very large blog following and lots of information and external links can be found on her site.

I am going to re-post her list here because I think it gives you an idea on how Sensory Processing Disorder may affect your child in a typical classroom environment.



You Know You're Teaching an SPD Kiddo When...(a list for teachers and all of us who watch our kids struggle in school)

1. He chews his pencil, both the eraser and the lead, all day long.

2. He can’t seem to stay seated for over 30 seconds.

3. He constantly wants to get a “drink” but really he is just playing in the sink.

4. During circle time he sits virtually on top of the kid next to him.

5. You have to remind him that he cannot touch the hair of the girl next to him—no matter how cool it looks.

6. You implement Handwriting Without Tears program the first day — because you can’t read anything he writes.

7. He wears the same pair of Soft sweatpants (made to look like jeans) every single day.

8. He is the only one in class standing at his desk.

9. He BLURTS out the answers to every question, and talks all through story time.

10. At recess he climbs on the very TIP TOP of the jungle gym, where he is NOT allow.

11. He spends more time under the table than sitting at it.

12. He lit up when he saw the ball pit in the resource room.

13. He refuses to eat in the cafeteria on “Sloppy Joe Day” because it smells awful.

14. The collar, the sleeves, and a strange place directly in the center of his shirt are all dripping with spit from being chewed on all day.

15. Everyone around him gets a HUGE bear hug, whether they like it or not.

16. He covers his ears when you raise your voice to get the children’s attention.

17. His mother came in with two 3 inch binders, labeled and color-coded, lectured you about the DSM-IV and gave you an ear-marked and highlighted copy of The Ultimate Guide to Sensory Processing Disorder. 

18. During art, he spent most of his time trying to glue his hands together instead of completing the project.

19. He is very proud of being the first kid in the entire school to do the monkey bars backwards.

20. He complains that the lights are too loud for him to concentrate, when you don’t hear a thing.

21. He simply cannot stop himself from using the “off limits” stapler on the teacher’s desk.

22. He knows by memory everything hanging on the classroom walls.

23. He asks you to 'push' him.

24. He can’t keep his hands to himself when standing in line; he is pushing or bumping the entire time but doesn't seem upset by it.

25. He spends his entire recess spinning in circles, but is never dizzy.

26. He is a little too enthusiastic about banging the drum during music class.

27. He takes pride in being the “door opener” or “lunch wagon puller”

28. He can repeat conversations you had with another teacher in the hallway

29. You find things in his desk that don’t belong there; teacher scissors, bingo markers, beads, crayons and other assorted small fun things

30. The bus ride to school seems to wind him UP UP UP— (and so does the bus ride home) no matter how tired you thought he was

Occupational Therapy -with an SI approach

John is attending OT (occupational therapy) two times a week right now at Casa Colina Rehabilitation Hospital.  The therapists working with him are working with a SI (Sensory Integration) approach.  To understand this a bit more, I thought I would define SPD (Sensory Processing Disorder), the treatment, and how it all affects behavior, emotions, social skills, and motor skills.


What is SPD?
First, to understand SPD, we need to look at what Sensory Processing (sometimes called Sensory Integration) is all about.  According to the Sensory Processing Foundation, sensory processing is our nervous systems way of receiving messages from the senses and turning them into appropriate motor and behavioral responses.  If you touch something that is too hot, your nervous system interprets that touch and you react accordingly, realizing it is too hot.  If you hear something that is too soft, you are able to react by turning the volume up because the nervous system interpreted the sense of hearing and sent the message that the volume was too low. 

SPD, or sensory processing disorder, is when the signals do not get interpreted correctly and therefore, responses are not organized appropriately.  The brain receives the sensory information incorrectly and inappropriate responses in behavior, emotions, motor planning, social skills, etc. 

Some people with SPD may over-react to one of their senses, while others under-react.  Some people are bothered by textures, tags on their clothing, certain foods, loud noises, bright lights, etc.  Some people with SPD have poor posture, low motor planning, low muscle tone, appear klutzy, etc.  Others crave sensations in what appears to be "overdrive", where they can't seem to get enough of a particular texture, swinging on a swing, spinning in circles, etc.

MANY PEOPLE THAT HAVE SPD GET MISDIAGNOSED FOR OTHER PROBLEMS BECAUSE THE BEHAVIORAL, EMOTIONAL, SOCIAL, MOTOR PLANNING, ETC. ARE AFFECTED AND CAN APPEAR AS SOMETHING DIFFERENT.

There have often been times throughout our journey where I have wondered if the "at risk" for autism diganosis or the PDD-NOS diagnosis for John was really just SPD.   Children on the Autistic Spectrum have Sensory Processing problems, so oftentimes, both SPD and an Autistic disorder are present.  I hit a point a long time ago where the actual label didn't matter to me anymore.  I know what John's current needs are and I'm addressing those as they come up.  About 3 months ago, it was obvious that he needed OT above all other help.

OT with an SI (sensory Integration) approach is when an occupational therapist works with the child in a "sensory rich" environment in an OT gym.  The therapist will guide the child through play activities that challenges the child in areas where he/she need improvement.   For John, they are currently working on fine motor skills (buttoning buttons, writing, hand games), motor planning (using yoga positions to challenge him to manipulate his body to match a photo and hold position without falling, using obstacle course where he crawls through tunnels, climbs over obstacles, hits a baseball, kicks a soccer ball, bounces on a trampoline, jumps in a ball pit, swings on a trapeze bar, etc), stengthening posture by having him use his upper body more (this week they had him lying on his stomach on a skateboard and had to use his hands, arms, and upper body to move the skateboard through the bases of baseball).

John has a problem with organization in his brain.  There are days where he becomes over-stimulated through  the day and can no longer organize his body, his responses, etc.  There are times you will see him slumped over in a chair---standing facing the chair, with his head in the chair--- constantly moving to get comfortable or he might appear "tired" where he wants to be carried and slumps over ones shoulder like a young infant.   He sometimes throws his head back and shakes his head so his eyes move back and forth.  These are all signs that his brain is "disorganized" and he can't appropriately focus or react to what is going on around him.    Occupational Therapy teaches him how to regulate himself when he gets that way, as well as helps him learn everyday activities through play therapy.

weighted blankets

I am researching weighted blankets and came across these sites. I am not endorsing them over any other site, but providing you links for you to easily access, read, and decide for yourself.

Weighted blankets are thought to calm, relax, and aid in sleeping for kids with Sensory Processing Disorder, who are anxious, have trouble sleeping, or crave deep pressure. They come as small as lap blankets to help a child sit still when seated at a table or desk, doing homework, busy work, computer time, listening to someone lecture/read/talk, or eat. They also have toddler size, twin, full, and queen sizes for sleeping. They come in different fabrics and with different amount of weight. Most OTs agree that the weight of the blanket should not be more than 10% of a child's body weight.

http://www.weightedblanket.net/index.htm Monthly Giveaway of a blanket
https://www.cozycalm.com/ Owned and Designed by a woman with Asperger's
http://www.quietquilt.com/ Owned and Designed by parents with a son on the Autistic spectrum
http://www.affordableweightedblankets.com/ Owned by grandparents of a boy with Autism who is non-verbal

Signs to look For

I received an email with a question regarding someone who believed a family member might have a child with autism. She was interested in learning more about autism and things you could look for to see if the issues that were being observed could be related to autism. So, I thought I'd take a portion of the email I wrote to her and discuss some of the signs or red flags one might notice in a child as he/she are developing.

Some signs to look for (every autistic kid does not have every one of these -- the severity of the autism has to do with how much, how often and how many of them):

Age Appropriate Toys -- does the child play with age appropriate toys or still hold on to baby toys or cause and effect toys (by 3, children should move on to more imaginary play toys like cars, dolls, action figures, drawing, etc)
Tip toe walking --- some do, some don't, but it is a sign of autism
Hand flapping --- some do, some don't, but another sign of autism (often referred to as "self stimulating behavior" -- if over stimulated, the child may wave his hands up by his face to show excitement or nervousness)
Eye Contact --- many children with autism have no eye contact issues with family and close friends/relatives, but can't look strangers or acquaintances in the eyes -- they may glance, but nothing sustained
Joint attention -- does the child point to objects when asked (whether in a book or out on a walk, like point to the tree, or fire hydrant or stop sign) they look for finger pointing -- actual single finger pointing to an object - autistic children often do not point out things and have "poor joint attention", only picking and choosing what to draw their attention to
Interest in things that spin --- many children will spin themselves (another form of self stimulating behavior, but do not get dizzy); others like objects that spin and will stare at it for unusually long periods of time
Appropriate use of everyday objects -- does the child know how to use a hair brush on a doll or self, or know that a spoon is used to stir, -- autistic kids often need to be taught about what an object is used for and these kids do not learn by imitation; how do they play with cars -- line them up & stare at the pattern or spinning the tires are 2 signs that they look for
Interest in shiny objects --- many kids will stare for unusually long periods to shiny objects
Attention span- many autistic kids have a very short attention span; many can't sit through the reading of a book or show no interest in books as infants/toddlers
Chewing/Mouthing objects -- many autistic kids chew or mouth objects as tiny babies without teeth would do; these kids have shirt collars constantly in their mouths, seatbelt straps, toys, etc.
Interest in new toys - does the child have a hard time wanting or knowing what to do with a new toy; does the child show interest in the new toy or pick it up and then move on
Attention to task - this one has to do with two extremes --- either the child bounces from one task to another without long attention or the child is sooo attentive to the task that they can't move away from it or won't do anything else -- both extremes are signs of autism like behavior
Response to own name - a majority of the time will ignore their own name when called
Speech/Language - Most autistic kids have some sort of language or speech delay; extreme cases never gain speech; some have cognitive/receptive issues; others have pronunciation; many/most have both; almost all are late talkers
Dietary Concerns - many kids are "sickly"; have food allergies, bowel issues, stomach problems; weight loss/weight gain; picky eaters; many hate textured foods; many need food purified -- each need is different but there is usually some sort of "feeding" issue one way or another; some are messy eaters and don't know how to use utensils correctly, others can, but prefer to use hands,
**Sensory Issues - Most kids have some sort of Sensory Integration issues which is the source of the manifestation of some of the above listed behaviors -- the brain processing the sensory information received through the senses incorrectly -- some are "sensory seekers", constantly looking for sensory input -- these kids are "crashing into" things like furniture and people's legs; they might spin and not get dizzy; they love "messy" play like paint and glue and might put it all over their hands and arms -- others "avoid" all the sensory input -- they might hate touching certain textures, glue, sand, etc. --- then on the auditory side, they may fear loud noises, including hair dryers or toilets flushing, while the other extreme is that they don't even notice sound and seem like they might have 'hearing' issues, but test within range for hearing (hence not reacting to own name);
on the sensory issues -- there are a ton -- other issues may be poor gross motor skills -- may walk unstably, may have a hard time avoiding obstacles, may avoid or seek swinging for long periods of time, may feel more "grounded" with feet always touching the floor, so can't sit still at a chair with feet up or on a toilet without feet touching a stool

I have a good book that talks about sensory issues that is a good introduction into children that just seem to be a bit different -- not necessarily autistic, but have Sensory Processing Disorder. It's called The Out of Sync Child by Carol Stock Kranowitz. She also wrote a companion book called The Out of Sync Child has fun, which is a workbook that teaches parents tips to practice in the home to help your child overcome the sensory issues. The good news is that if it's Sensory Processing Disorder by itself, then there are things that you can do that helps the child and makes it go away. Many kids with autism have Sensory Processing Disorder, but not every child with it has Autism. It is a good resource for a parent to read who has just begun to understood their child is a bit "different".

Recognizing Sensory Processing Disorder

I am continuing to read the book, The Out-of-Sync Child, by Carol Stock Kranowitz and am positive that an OT evaluation will reveal that John has Sensory Processing Disorder. (SPD)

According to Carol Stock Kranowitz, SPD is the inability to use information received through the senses in order to function smoothly in daily life.

There are 3 categories within Sensory Processing Disorder and 5 sub-categories under those 3 main ones. The three Disorders are:
1. Sensory Modulation Disorder
2. Sensory Discrimination Disorder
3. Sensory Based Motor Disorder

Under the Sensory Modulation Disorder, the subgroups are :
1. Sensory Over-responsivity
2. Sensory Under-responsivity
3. Sensory Seeking

Under the Sensory-Based Motor Disorder, the subgroups are:
1. Postural Disorder
2. Dyspraxia

John falls under the Sensory Modulation Disorder as a Sensory Seeking Child, based on my own evaluation using Carol Stock Kranowitz' checklists.

This kind of child wants "more" -- wallows in mud, dumps out toys (rummaging through them for the texture), chews on objects and shirt collars, runs and 'crashes' into furniture on purpose, moves constantly, fidgets, loves being upside down, takes bold risks, craves bear hugs, loves being squeezed, seeks heavy work and vigorous playground activities.

With sound, I see John having aspects of all 3 main categories -- he covers his ears to close out normal everyday sounds (microwave and hair dryer) -- overresponsive child
He ignores ordinary sounds and 'turns on" to exagerrated sounds -- underresponsive child
He loves crowds and places with noisy action --- sensory seeking child

I also notices some motor skills issues -- low muscle tone and fine motor planning with his mouth (although with speech therapy, this is getting so much better -- this week, he can now blow bubbles consistently!)

Many issues can arise because of sensory processing issues. Such as:
Self Regulation - inability to adjust mood (calm down once aroused)
Sleep Issues - want or need to sleep with parents, difficult falling asleep, staying asleep, and waking up
Eating Issues - picky eater, texture issues, lack of coordination to chew, swallow, and breathe
High Activity Level
Inattention
Impulsivity
Poor Communication
Other issues like Autism, ADHD, Selective Mutism, Down Syndrome, etc may accompany SPD

So, to sum it up for the day, Sensory Processing Disorder is difficulty in the way the brain takes in, organizes and uses sensory information, causing a person to have problems interacting effectively in the everyday environment. Through OT/SI (Occupational Therapy Sensory Integration), children learn to develop their nervous system. A professional evaluation and diagnosis is necessary to begin OT/SI therapy. John has had a primlimary screening through Casa Colina, in which they determined he needed a full evaluation.

*This information was taken from Carol Stock Kranowitz' book, The Out-of-Sync Child.