SENSORIMOTOR HISTORY QUESTIONNAIRE FOR

PARENTS OF PRESCHOOL CHILDREN

1. Is your child particularly sensitive to touch?

Yes…….No…….

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

Yes…….No…….

3. Does your child show particular caution in approaching activities involving

fast movement or movement of the body through space?

Yes…….No…….

4. Does your child have unusual sensitivities to smell?

Yes…….No…….

5. Is your child particularly sensitive to noise, e.g., putting hands over ears
when others are not bothered by sounds?

Yes…….No…….
6. Have you ever had concerns about your child‘s hearing either in general or
conjunction with ear infections?

Yes…….No…….

7. Have you ever had concerns about your child‘s speech and/or language
skills?

Yes…….No…….

8. Have you ever child concerns about your child‘s vision?

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

Yes…….No…….

10. Does your child have difficulty orienting his/her body effectively for
dressing activities, such as putting arms in sleeves, putting fingers in
mittens, or putting toes in socks?

Yes…….No…….

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

Yes…….No…….

13. Does your child avoid manipulation of small objects?

Yes…….No…….

14. Does your child avoid activities involving the use of ―tools‖ such as crayons,
pencils, markers, and scissors?

Yes…….No…….

15. Do you feel that your child has a short attention span, even for things that
she/he enjoys?

Yes…….No…….

16. Do you feel that your child tends to be restless or ―fidgety‖ during times
when quiet concentration is required?

Yes…….No…….

17. Has your child had difficulty regulating his her sleep patterns

Yes…….No…….
 SENSIMOTOR HISTORY QUESTIONNAIRE FOR
TEACHERS OF ELEMENTARY-SCHOOL-AGE
CHILDREN

I. Touch(Tactile)

1. Overreacts to physically painful experiences.

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

II. Balance and Movement (Vestibular/Proprioceptive)

1. Has a poor balance

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

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

V. Haring (Auditory)
1. Is frightened or irritated loud noises
Yes…….No…….
2. Is very sensitive to background sounds.
Yes…….No…….
3. Has the difficulty paying attention amid surrounding noise.
Yes…….No…….
4. Often shouts or speaks in loud voice.
Yes…….No…….
5. Frequently makes repetitive noises or sounds.
Yes…….No…….
6. Fails to follow through on verbal requests.
Yes…….No…….
7. Needs directions repeated
Yes…….No…….
8. Confuses spoken words.
Yes…….No…….
9. Misses same sounds.
Yes…….No…….
VI. Sight (Visual)

1. Appears sensitive to light, preferring dark or dim lighting

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

VII. Smell (Olfactory)

1. Is factory sensitive to certain smells
Yes…….No…….
2. Ignores noxious odors.
Yes…….No…….
3. Has difficulty discriminating odors.
Yes…….No…….
VIII. Attention And Behaviour

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

1. Likes an activity, food or other?

………………………………………………………………………………...
2. Does not like any activity, food or other?
……………………………………………………………………………...
3. Feels good or happy?
……………………………………………………………………………...
4. Feel ill or in pain?
………………………………………………………………………………...
5. Is hungry?
………………………………………………………………………………...
6. Is uncomfortable?
………………………………………………………………………………...
7. Is anxious or afraid?
………………………………………………………………………………...
8. Wants attention?
………………………………………………………………………………...
9. Wants more of something?
………………………………………………………………………………...
10. Wants you to continue an activity (e.g., playing a game)?
………………………………………………………………………………...
11. Wants you to stop an activity?
………………………………………………………………………………...
12. Wants you start a familiar routing (e.g., fixing a snack)?
………………………………………………………………………………...

13. Wants help?

………………………………………………………………………………...
14. Wants something to eat?
 ………………………………………………………………………………...

15. Wants something to drink?

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

27. Does not want to do something or wants to stop doing something?

__________Describe.
………………………………………………………………………………...
28. Does not want a specific object of food? Describe
………………………………………………………………………………...

When does you child do when

29. Not allowed to do or have something desired? __________Describe.

………………………………………………………………………………...
30. A desired object is taken away? __________Describe.
………………………………………………………………………………...
31. The environment of routine is changed? __________Describe.
………………………………………………………………………………...

Does your child‟s Response to Each of the following:

32. Verbal Directions

………………………………………………………………………………...
33. Questions that begin with, who, where, when, how or why
………………………………………………………………………………...
34. Questions that call for yes or no answer?
………………………………………………………………………………...
35. How does your child greet you or others without direction?
………………………………………………………………………………...
36. How does your child respond when generated by others?
………………………………………………………………………………...
37. Does your child use polite word (such as ―thank you‖ , ‖please‖, or ‖excuse
me‖) appropriately?_________without prompting? __________Describe.
………………………………………………………………………………...
38. If another child asks for a turn or a toy, will your child acknowledge the
request?
………………………………………………………………………………...

Does your child

39. Comment about himself and his own activity? __________Describe.

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

46. Does your child talk to himself about things that don‘t appear to be related to
the current situation? __________Describe.
………………………………………………………………………………...
47. If your child has a limited vocabulary (25 words or so) please list the words
and describe any words that are used in specific or unusual ways or
situations.
………………………………………………………………………………...
48. What functions, concepts, vocabulary, or forms of communication do you
feel are most important for your child to learn this year?
………………………………………………………………………………...
What is sensory integration?
Sensory integration is the neurological process of organizing the information we
get from our bodies and from the world around us for use in daily life. It occurs in
central nervous system, which consists of countless neurons, a spinal cord, and – at
the ―head‖- a brain.

The main task of our central nervous system is to integrate the senses. According
to Dr. Ayres, ―Over 80 percent of the nervous system is involved in processing or
organizing sensory input. And thus the brain is primarily a sensory processing
machine‖.

When our brain efficiently process sensory information. We respond appropriately

and automatically. We do this because our brain is equipped to modulate sensory
messages. Modulation is the term used to describe the brain‘s regulation of its own
activity-and, therefore, of our activity level.

Activity level refers to mental, physical, and emotional behaviour. Activity level
can be high, low, or somewhere in between. For instance, mental activity is high
when a child concentrates on an interesting science lesson, or low when she thinks
the history lecture is dull physical activity is high when she leaps and low when
she sleeps. Emotional activity is high when she feels threatened or exhilarated, and
low when she has no special investment in routine events of the day, like running
errands with Mom.

Modulation balances the flow of sensory information coming into the central
nervous system. The brain turns on, or turn off, the neural switches of all the
sensory systems, so that they work in random to keep us in sync.

Every minute of every day, we receive millions of sensations. Most of these are
irrelevant to our current situation. Therefore, our brains inhibit them.

Inhibition is the neurological process that reduces connections between sensory

intake and behavioural out-put. Inhabitation is a good and healthy thing; without it.
We would be giving full attention to every sensation. Useful or not. For instance, it
is unnecessary to respond to the sensation of air on our skin or of a shift in balance
when we take a step, so we learn to ignore the messages.

Some messages are meaningless now, although they grabbed our attention at one
time, such as the tautness of a seat belt. When we have become accustomed to
familiar messages. Our brain automatically tunes them out because they are no
longer extraordinary. This process is called habituation.

But we must- and do- pay attention to meaningful sensory messages. Some of
these are positive sensations, such as moving rhythmically in a rocking chair.
Others are negative, such as spinning until we feel sick. These messages are
facilitatory.

Facilititation is the neurological process that promotes connections between

sensory intake and behavioral output. If we are doing something meaningful and
beneficial, our brain gives us the go-ahead to continue.

When inhibition and facilitation are balanced, we can make smooth transitions
from one state to another. A ―state‖ refers to our degree of attentiveness, mood, or
motor (movement) response. Thus, we can switch gears from inattention to
attention, from sulks to smiles, from drowsiness to alertness, and from relaxation to
readiness for action. Modulation determines how efficiently we self-regulate, in
every aspect of our lives.

Here‘s an illustration of how sensory integration works for you. Suppose you are
sitting on the couch, leafing though the newspaper. You pay no attention to the
upholstery touching your skin, or the car passing by outside. Or the position of
your hands. These sensory messages are irrelevant, and you don‘t need to respond
to them.

Then your child plops down beside you and says, ―I love you‖. Your senses of
sight, hearing, touch, movement, and body position (and may be smell, too) are
simultaneously stimulated. Sensory receptors throughout your body take in all this
information. Via sensory neurons within your central nervous system, the
information zooms to your brain.

No one part of the central nervous system works alone. Messages must go back
and forth from one part to another, so that touch can aid vision, vision can aid
balance, balance can aid body awareness, body awareness can aid movement,
movement can aid learning, and so forth.

Sensory integration is a term is used to describe both the basic and essential
neurological function that involves organizing sensory information for use.

Sensory registration, modulation, discrimination, and praxis (Ayres, 1972).

Location of sensation
Sensation occur both inside and outside of and individual. Perceptual development
requires that a person distinguish types, quality, duration, and intensity from three
distinct locations:

 From inside the body (Interoception)

 From the head and the musculoskeletal system (Proprioception)
 From outside the body (exteroception).

Proprioception
Proprioception is used to describe sensations that are received from the tendons,
muscles, and joints. The Proprioceptive system carries information about joint and
movement (Herdman, 1974). The vestibular system detects position and movement
of the head relative to gravity. Together, the vestibular and Proprioceptive systems
provide information about the body‘s position in space, the body‘s spats relative to
each other, and the dynamic movement of the body through space. This
information is used to support postural control; balance; and coordinated
movement of the eyes, head, neck, and body. Someone who has good vestibular
and propriocetive perception is likely to move gracefully, keeping his or her
balance while moving with skill and precision. When the vestibular or
Proprioceptive system is not working well, individuals have difficulty developing a
good body scheme. They will have poor balance; poor postural control; difficulty
forming good laterality; and poorly coordinated movements of the body and limbs,
both separately and together. Individuals with autism have been noted to have
difficulty integrating vestibular and Proprioceptive information (Ayres, 1979). The
vestibular system provides information necessary to support the most primal of
relationships; that of the self to earth, then the vestibular system is not working
properly, other relationships also may suffer.

Exteroception
Exteroception encompasses several different kinds of stimuli that detect
information located outside of the body. Touch, smell, and taste are all designed to
detect whatever the individual comes into contact with from the environment and
differentiate that from parts of self.

Vision and hearing are the only sensations that are not perceived through contact
receptors. Vision and hearing allow the individual to perceive information that is
both close to the body and at a distance. Visual perception is generally considered
an area of strength in many individuals with autism; however, auditory processing
is more likely to be problematic.

Multimodal processing
The interrelationship of sensations is apparent in any functional activity. Typically,
the interoceptive, Proprioceptive, and exteroceptive sensations are integrated so
that an individual can pay attention to relevant aspects of the environment while
the body operates unconsciously. For example, the vestibular and propriocetive
systems work together, supporting an upright posture against gravity and making
subtle postural adjustments when moving.
Application of Sensory Integration Concepts to the
Diagnosis of Autism
The current neurological research that relates to understanding provides insight
into the sensory integration disorders that are present in many individuals with
autism. These disorders have been clinically observed and documented through
research.

Sensory integration is necessary to accurately perceive the

body‟s relationship to gravity and other objects.
Sensory registration, sensory modulation, sensory perception, and praxis.

Sensory Registration

Registration of sensation to refer to the way that a child‘s awareness of sensory

stimuli is associated with attaching meaning to situations.

Occupational therapists have used the term poor sensory registration to mean a
failure to notice, record, and respond to relevant information from the
environment.

Sensory Modulation
Sensory modulation is the interaction between internal processing and the external
environment. More specific fully the interaction among physiologic stability, the
perceived challenge imposed by the environment, and environmental supports
affects a person‘s ability to tolerate stress and find adaptive coping and interaction
strategies.

Individual behavioural differences vary widely between extreme hyporespositivity

and extreme hyperresponsivity, sensory seeking and sensory avoiding, and unusual
patterns of sensory play.

The children who were hyporesponsitive tended to respond less well to sensory
integration procedures than children who were hyperresponsive.
 A common indicator of hyper responsiveness is a high pain tolerance. Children
who are hyperresponsive show behavior that may include seeking extremely
intense movement, such as spinning and twirling, inflicting injuries on themselves,
and throwing themselves into things and people for deep pressure and
Proprioceptive sensation.

The learning and behavior of children with autism may be hindered by inadequate
sensory modulation, because this condition is associated with negative emotions.
Sensory modulation si addressed through varying the type, intensity, and duration
of different sensory stimuli so that children with autism can maintain a calm, alert
state. An analysis of environmental aspects that most disturb the child is essential,
and environmental modifications are often necessary to accommodate the child‘s
peculiar sensory needs and sensitivities. For example, children with autism may
enjoy tight-fitted exercise clothing rather than loose clothing, or a quiet atmosphere
rather than loose clothing, or quiet atmosphere rather than one in which the
television is playing. A child may be able to focus only if he or she can hear white
noise in the background, such as the hum of a ceiling fan. A variety of different
intensities and combinations of sensations must be explored to find the child‘s
comfort level. Jared and Quinn present with varying indications of inadequate
sensory modulation.

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

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

Auditory
Auditory perception is an area more frequently suspected as being inefficient in
many individuals with autism.

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

Vestibulor-Somatosensory
Children with autism are commonly seen searching for ways to receive additional
sensory input that is tactile, propriocetive, or vestibular in nature. Examples of
sensory- seeking actions include twirling or spinning, jumping, rubbing or
squeezing, biting, head banging, and rocking.
Praxis as it Relates to the Diagnosis of Autism
Praxis is the ability to have an idea and plan about a future novel activity that
involves deciding what to do and how to do it. Although routine and stereotyped
motor activities that do not require praxis, such as walking, running, or climbing,
are typically easy for individuals diagnosed with autism, motor activities that
require adaptation, such as building models or using tools, appear to very difficult
for them . Motor execution is frequently intact, meaning that once children with
autism learn a motor skill their actions can look exquisitely smooth and
coordinated. However, specific aspects of praxis, such as timing, sequencing,
initiating, are commonly difficult for these children.

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

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

Sensory integration intervention has many unique features. More than just a
technique, it is philosophy is based on Ayer‘s style and her belief that human
beings have an innate drive to learn, grow, and interact adaptively.

Ayres declared the use of this intervention to be both an art and a science. The
artistry emerges with the therapist and the child .

The following characteristics hallmarks are present when the sensory integration
frame of reference is being:

 Use of structured sensory environment that highlights the

propriocetive, vestibular, and tactile system.
 A focus on tapping the inner drive of the child
 Delivery of intervention in the context of play.
 ―Artful vigilance‖ on the part of therapist
 Child – directed sessions
 Elicitation of adaptive responses
 Delivery of the ―just-right level of challenge‖
 Emphasis on active versus passive participation where the
engagement in the activity is its own reward.

Structured Sensory Environment

Ayres identified the environment as a key element in sensory integration
intervention. She discussed a classic clinical setting as having characteristics of a
―naturalistic‖ environment.

In developing this therapeutic approach, Ayres tried to provide children with

opportunities to participate in multisensory activities that had effect of being
calming, alerting, challenging organizing, and fun.

Therefore, intervention requires therapists to create, modify, and adapt the sensory
environment. The environment provides opportunities to improve body-centered
perceptions through touch, Proprioception, and vestibular sensations. Additionally,
the environment provides challenges for the child to develop praxis skills by
creating, adapting, and manipulating objects and interactions. Although the
perception of visual and auditory sensations is often enhanced through sensory
integration intervention.

Proprioceptive Sensations
Proprioception has been described as the corner stone of sensory integration
intervention. Proprioception is both alerting and calming, and, therefore, it is a key
sensation that alerts levels of arousal and enhances self-regulation. Proprioception
is also the gateway to functional movement. Proprioceptive sensations are achieved
through traction, compression, movement of the joints and muscles, or use of the
muscles against resistance. Jumping, climbing, hanging, pushing, and pulling
activities all provide Proprioception.
Differences in communication
Special communication difficulties are central to autism, from early childhood
there are difficulties related to development communicative intent. Certain very
simple and natural communication intends like.

Prodeclarative pointing and joint attentions are extremely limited. Most of the
time. We find children with autism taking adults hand and guiding if forwards
desired activity or object. It may also be possible that a child with ASD develops
speech before understanding meaning and purpose of communication.

It has been found out that around 35% - 40% children with ASD do not develop
speech. However, studies have revealed that some speech can be developed by
using AAC systems. (Attractive Augmentative Communicative) in the diagnosis of
autism also emphasis is lack on,

Lack of development of non –verbal modes of communication like gestures, facial

expressions, etc.. To compensate speech expression

 Some common and specific language difficulties in autism.

A. Deviant styles of understanding and using language
B. Echolalia – right about it
C. Repetitive use of language
D. Difficulty understanding and using abstract language.
E. Lack of prosody(tone variation) Preservative
F. Literate understanding of language of pronoun reversal

 Other communication difficulties

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

Medical Etiology.
ADHD Child Characteristics:

Is divided into four parts.

 Difficulties Identifying Children with Dual Exceptionalities (Children who are

gifted and also have a disability)
 Characteristics of Gifted Children Who Have an Additional Exceptionalities
(Visual impairment, physical disabilities, hearing impairments, or learning
disabilities.
 Lists of Characteristics Similar in Giftedness and ADHD (Includes a list of
questions to ask that help distinguish between the two.)
 List of References

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

Characteristics of Gifted Students Who Are Bored

 Poor attention and daydreaming when bored

 Low tolerance for persistence on tasks that seem irrelevant
 Begin many projects, see few to completion
 Development of judgment lags behind intellectual growth
 Intensity may lead to power struggles with authorities
 High activity level; may need less sleep
 Difficulty restraining desire to talk; may be disruptive
 Question rules, customs, and traditions
 Lose work, forget homework, are disorganized
 May appear careless
 Highly sensitive to criticism
 Do not exhibit problem behaviors in all situations
 More consistent levels of performance at a fairly consistent pace
(Cline, 1999; Webb & Latimer, 1993)

Characteristics of Students with ADHD

 Poorly sustained attention

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

Questions to Ask in Differentiating between Giftedness and ADHD

 Could the behaviors be responses to inappropriate placement, insufficient

challenge, or lack of intellectual peers?
 Is the child able to concentrate when interested in the activity?
 Have any curricular modifications been made in an attempt to change
inappropriate behaviors?
 Has the child been interviewed? What are his/her feelings about the behaviors?
 Does the child feel out of control? Do the parents perceive the child as being out
of control?
 Do the behaviors occur at certain times of the day, during certain activities, with
certain teachers or in certain environments?
Characteristics of ADHD in Children
A diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) is based on two primary
behavioral dimensions, which appear to cut across ethnic and cultural groups: 1) inattention; and
2) hyperactive-impulsive behavior. Put simply, the former is an inability to focus for long
periods of time on any task (especially repetitive ones) without becoming distracted, engaging in
off-task behavior, or otherwise becoming less productive. An excessive activity level, fidgeting,
inability to stay seated when necessary, talking excessively and loudly, interfering with others,
and generally acting as if ―driven by a motor‖ characterize hyperactive-impulsive behavior.

While this may describe most young children on occasion, both factors are extreme with those
who have ADHD. This behavior may vary according to situation and context (for example,
behavior is typically worse later in the day, in the absence of adult supervision, and in more
complex situations), and often shows comorbidity with various cognitive abilities. ADHD is
diagnosed when a child exhibits six or more each of the Inattention and Hyperactivity-
Impulsivity symptoms listed in the APA‘s DSM-IV criteria for the disorder.

While ADHD is a very real disorder, the diagnosis is often suspect. Many argue that ADHD is
often used as an excuse for parents to medicinally control children who either a) display behavior
normal for young children; or b) have been inadequately disciplined in the traditional manner.
Many adults have become intolerant of normal childhood behavior and are unwilling to
discipline children, so they turn to Ritalin and other ADHD control drugs for surcease.

Prevalence and Gender Difference

Based on parental and teacher descriptions of behavior, the prevalence of ADHD in the juvenile
population should be as high as 57%; however, ADHD is clinically diagnosed in only 2-6.3% of
children. Younger children are much more likely to be diagnosed with ADHD, with rates falling
by as much as half between preschool and the 6-12 year old range, and falling significantly again
in adolescence, to 0.9-2% for girls and 1-5.6% for boys. Boys are roughly three times more
likely to be diagnosed with ADHD than girls. However, this may be a function of how the
diagnostic criteria are applied, especially since the gender differences even out once co-morbid
conditions are controlled for.

The fact that ADHD prevalence decreases sharply with age underscores the contention that most
accounts of ADHD are the result of adult intolerance for ordinary childhood behavior. Younger
kids (especially little boys) are naturally more exuberant and noisy than older children, who are
undergoing changes related both to physical maturity and enculturation that encourage more
adult behavior. The fact that ADHD prevalence dives sharply at adolescence bolsters this
argument.

Developmental Problems Associated with ADHD

Individuals with ADHD suffer from a variety of developmental and social defects,
some of them quite severe. These include problems with the following:
· Cognitive defects (deficits in intelligence, reading ability, poor time-sense)
· Language (delayed onset, speech impediments)
· Adaptive functioning
· Motor development (delayed coordination, sluggishness)
· Emotion (poor self-regulation, problems with frustration tolerance)
· School performance (disruptive behavior, repeating grades, requiring tutors)
· Task performance (poor persistence, decreased productivity)
· Health risks (accident prone, growth delays, earlier onset of sexual activity)

These problems add up to poor motor coordination, poor academic performance,

persistent social problems, and even reduced intelligence. Health may be
compromised by proneness to accidental injury, especially when driving, as well as
by sleep disorders.

The developmental problems associated with ADHD are significant and

distressing, almost worse than the disorder itself, and this brings home the
seriousness of ADHD. While ADHD may not be as prevalent as many parents and
teachers would like us to believe, it‘s clear that it can be a dangerous and
debilitating illness.

Etiologies
The factors thought to be responsible for ADHD are both complex and
multitudinous. One theory is that at least some ADHD symptoms are the result of
brain damage, since they are similar to those arising from some types of brain
infections and trauma. Neurological studies indicate a connection with dysfunction
in the frontal lobes, which regulate attention and inhibition. Neurotransmitter
deficiencies may also be responsible. Otherwise, some studies link ADHD to
pregnancy and birth factors; younger mothers tend to have more ADHD children.
ADHD may also have a genetic basis, or may be due to thyroid disorder,
environmental toxins, or psychosocial factors.

That ADHD may be caused by a variety of factors, from brain dysfunction to

social issues, seems most likely. Too often, researchers try to reduce complex
issues to single causes, if only because a single cause would allow for a single
―magic pill‖ solution. However, few things in the human realm — either medical
or social — are ever that simple. What we identify as ADHD may be a
constellation of related disorders that are lumped together under one term, much as
lump together all the dozens of cancers under one term in general conversation. As
our understanding of the disorder evolves, it may in the future become possible to
discern and define the different types of ADHD based on cause, in a manner more
specific than the divisions we use today.

Theoretical Framework
The theoretical framework underlying our current understanding of ADHD
remains rather nebulous. Various theories have been put forth, most revolving
around defects in behavioral inhibition, deficits in sensitivity to reinforcement,
deficits in inattention, arousal, and inhibition in the absence of immediate reward,
and neurological explanations for the observed behavior. It is obvious that poor
behavioral inhibition is the most important behavioral factor in ADHD.

In light of this, one researcher, Dr. Russell A. Barkley, has developed a hybrid
model that includes many of the features of previous ADHD models. His theory
explains how behavioral inhibition (self-control) and motor control systems (such
as persistence, sensitivity to feedback, and execution of responses) are interrelated
to and regulated by four executive functions: working nonverbal memory, working
verbal memory, self-regulation of effect/motivation/arousal, and reconstitution
(internalization of play). He concludes that ADHD is a disorder of performance,
not skill; that is, in their behavior ADHD sufferers are unable to apply previously
learned knowledge (especially in the social behavior realm) to new situations, even
though, at some level, they may realize exactly what they should do in such
situation.

He suggests various ways to treat ADHD patients, both pharmaceutically and

otherwise, especially in regards to making actions and their consequences more
temporally contiguous. For the ADHD sufferer, punishment or reward must be
immediate to be effective, since those with serious ADHD suffer from what
Barkley calls a ―myopia or blindness to time.‖ They do not see or understand
distances that lie ahead in time.

The key to his theory is the concept of temporal blindness or myopia. Those of us
without symptoms of ADHD can see ahead to the future; we not only see what we
need to do to reach our goals or maintain the status quo, but have also internalize
d the concept of personal accountability. We understand the consequences of our
actions, both good and bad. People with ADHD often do not, or are unable to
apply the rules they have learned, and so may be blindsided by future events that
others, with a minimum of personal inhibition, might have avoided. This theory
 seems make imminent sense, though of course the true test of Barkley‘s theory is
how well it fits the clinical reality of ADHD, and how well it stands the tests of
time.

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

What are some signs or symptoms of ADHD?

ADHD is a chronic disorder , meaning that it affects an individual throughout life.
The symptoms are also pervasive , meaning they occur in multiple settings, rather
than just one.

Current research supports the idea of two distinct characteristics of ADHD,

inattention and/or hyperactivity-impulsivity. A child with these characteristics
typically demonstrates the following signs:

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

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

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

How is ADHD diagnosed?

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

 Speech-language pathologists (slps)

 Regular, special education, and resource teachers
 Nurses
 Psychologists
 Employers (when applicable)

Assessments by the SLP may include some or all of the

following:
 Observing the interactions with peers and authority figures in the
classroom/work setting and during formal testing
 Observing conversation with parents and other family members
 Interviewing parents/caregivers about speech and language development
 Interviewing the child to evaluate self-awareness of needs and difficulties, as age
appropriate
 Formally evaluating speech and language skills, such as fluency (whether or not
child stutters), speech articulation (pronunciation and clarity of speech),
understanding and use of grammar (syntax), understanding and use of
vocabulary (semantics ), awareness of speech sounds (phonemic awareness)
 Evaluating the ability to explain or retell a story, centering on a topic and
chaining a sequence of events together
 Assessing social communication skills (pragmatic language)
 Discussing stories and the points of view of various characters
 Assessing the ability to plan, organize, and attend to details

What speech and language treatments are available for

people with ADHD?
Specific speech and language patterns vary from child to child with ADHD. For
example, some children with ADHD also have learning disabilities that affect their
speech and language. Evaluation of each child's individual speech and language
ability is critical to developing an appropriate treatment plan.

Speech and language intervention for the person with ADHD is always
individualized, as each person has different needs.

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

ADHD in Preschool
Preschool age children are often easily distracted and do not have long attention
spans, however, symptoms of ADHD often become more pronounced at this age.
For example, children without ADHD may stay with an activity for between 10
and 15 minutes, while children with ADHD may change activities every few
minutes. However, when interest level is higher, children may be able to stay with
a task for a longer time. For example, a child may find reading or drawing,
activities that require a child to sit still, may not hold attention but more active
tasks, such as playing with cars may keep a child‘s attention for longer periods

Impulsiveness and hyperactivity also become more apparent during the preschool
years. Children with ADHD may be in constant motion, they are always rushing or
hurrying from one activity to another, resenting having to take time to eat or even
use the bathroom. At this age, children with ADHD may jump from playsets, fall
out of windows or run out into the street without thinking.

While children without ADHD may be able to sit and play for 10-15 minutes,
allowing parents a small break, children with ADHD often must be supervised
every moment.

According to an article, ―What is ADHD?‖ [―What is ADHD?‖, 2002, Jim

Chandler, M.D., Attention Deficit Disorder Resources], states that preschool
children with ADHD:

 Have poor social skills

 Are more aggressive than peers without ADHD
 Disobey twice as often
 Display inappropriate behavior 5 times as often

ADHD is difficult to diagnose in preschool children. This is because children

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

 Inability to sit still

 Lack of interest in quiet activities or in listening to stories
 Changes activities every few minutes
 Inconsistency in attention skills, may be able to hold attention when an
activity is interesting, but not able to keep attention for other activities
 Always in motion, sometimes running without looking, may run into
street or fall often
 Can be very talkative
 Poor social skills
 Behavioral problems, not listening, disobeying or consistent unsafe
behaviors
 Can be clumsy or have underdeveloped coordination
 May grab toys from classmates, siblings or friends
 Difficulty waiting for their turn
 May be aggressive, causing fights or hitting other children
What is occupational Therapy?
The fundamental concern of Occupational Therapy is the development and
maintenance of capacity throughout one‘s lifespan to perform with satisfaction to
both oneself and others, those tasks and roles essential to productive living, and to
the mastery of both self and the environment.

Definition of Occupational Therapy

Occupational therapy is a health and rehabilitation profession, the goal of which is,
―To achieve functional outcomes that promote health, prevent injury or disability
and develop, improve, sustain, or restore the highest possible level of
independence (to) any individual who has an injury, illness, cognitive impairment,
psycho–social dysfunction, mental illness, developmental or learning disability,
physical disability, or other disorder or condition‖ (American Journal of
Occupational Therapy, 48, 1072–1073).

It is the art and science of directing man‘s participation in select tasks to restore,
reinforce and enhance performance, facilitate learning of those skills and functions
essential for adaptation and productivity, diminish or correct pathology and
promote and maintain health.
Occupational therapy became established as a profession when services were
needed to rehabilitate wounded and disabled soldiers after World War I, which
lasted from 1914 to 1918. Occupational therapists evaluate, adapt, and teach daily
living skills to help people attain maximum functional independence. People who
are limited by physical injury or illness, psycho–social dysfunction, developmental
delays, or the aging process, can benefit from occupational therapy.

What is Occupational Therapy?

Ten-year-old Jason was in an accident while riding on his bicycle. Although he
survived the accident, it left him with a brain injury. To improve some of his
cognitive (thinking) skills, comprehension skills, and coordination, Jason's doctors
recommended that he receive occupational therapy (OT).

At first, his parents were slightly skeptical about whether occupational therapy
could benefit their son. They had never heard of OT and wondered if it was more
appropriate for adults. But after watching the activities and Jason's improvements,
his parents felt hopeful that Jason was on the road to recovery.

Occupational therapy — a treatment that focuses on helping people achieve

independence in all areas of their lives — can offer kids with various needs
positive, fun activities to improve their cognitive, physical, and motor skills and
enhance their self-esteem and sense of accomplishment.

Some people may think that occupational therapy is only for adults; children, after
all, do not have occupations. But a child's main job is playing and learning, and an
occupational therapist can evaluate a child's skills for play activities, school
performance, and activities of daily living and compare them with what is
developmentally appropriate for that age group.

According to the American Occupational Therapy Association (AOTA), in

addition to dealing with an individual's physical well-being, OT practitioners
address psychological, social, and environmental factors that may hinder an
individual's functioning in different ways. This unique approach makes
occupational therapy a vital part of health care for some kids.
Who Might Need Occupational Therapy?
So who might use an occupational therapy practitioner? According to AOTA, kids
with the following medical problems may benefit from OT:

 Birth injuries or birth defects

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

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

An occupational therapist can also:

help kids with severe developmental delays learn some basic tasks, such as
bathing, getting dressed, brushing their teeth, and feeding themselves
help kids with behavioral disorders learn anger-management techniques (i.e.,
instead of hitting others or acting out, the children would learn positive ways to
deal with anger, such as writing about feelings or participating in a physical
activity)
teach kids with physical disabilities the coordination skills required to feed
themselves, use a computer, or increase the speed and legibility of their
handwriting
evaluate each child's needs for specialized equipment, such as wheelchairs, splints,
bathing equipment, dressing devices, or communication aids
work with kids who have sensory and intentional issues to improve focus and
social skill

How Physical Therapy and Occupational Therapy Differ

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

Occupational Therapy Practitioners

There are two professional levels of occupational practice — occupational
therapist (OT) and occupational therapist assistant (OTA).

Since 2007, an occupational therapist (OT) is required to complete a master's

degree program. Before 2007, only a bachelor's degree was required.

An occupational therapist assistant is only required to complete an associate's

degree program. OTAs are able to carry out treatment plans developed by the
occupational therapist but can't complete evaluations.

All occupational therapy practitioners must complete supervised fieldwork

programs and pass a national certification examination. Most states also require a
license to practice and require occupational therapy practitioners to take continuing
education classes throughout their careers to maintain that licensure.

Occupational therapists work in a variety of settings, including:

 hospitals
 schools
 rehabilitation centers
  mental health facilities
 private practices
 children's clinics
 nursing home

2. What is the role of occupational therapy in

autism?

People with autism can benefit from occupational therapy, both at home and at
school. Autism is a complex developmental disorder. A person who has autism
often has trouble communicating and interacting with other people. The person‘s
interests, activities, and play skills may be very limited.
What‟s the role of occupational therapy (OT) in treating
autism?
Occupational therapists study human growth and development. They are experts in
social, emotional, and physiological effects of illness and injury. This knowledge
helps them promote skills for independent living in people with autism.
Occupational therapists work as part of a team that includes parents, teachers, and
other professionals. They help set specific goals for the person with autism. These
goals often involve social interaction, behavior, and classroom performance.
Occupational therapists can help in two main ways: with evaluation and therapy.
How is occupational therapy useful for evaluation with
autism?
The therapist observes children to see if they can do tasks they are expected to do
at their ages. These might relate to certain self-help skills, such as getting dressed.
Or they might involve knowing how to play a game. Sometimes, it helps to
videotape a child during the normal course of the day. This will help the
occupational therapist better assess what is needed for care. With the tape, the
 therapist might learn about the child‘s reactions to the environment. For example
the therapist might note any of the following:

 Attention span and stamina

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

How does occupational therapy help a person with autism?

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

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

What are the benefits of occupational therapy for autism?

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

 daily living skills, such as toilet training, dressing, brushing teeth, and other
grooming skills
 fine motor skills required for holding objects while handwriting or cutting with
scissors
 gross motor skills used for walking or riding a bike
 sitting, posture, or perceptual skills, such as telling the differences between colors,
shapes, and sizes
 visual skills for reading and writing
 play, coping, self-help, problem solving, communication, and social skills

By working on these skills during occupational therapy, a child with autism may
also do the following:

 develop peer and adult relationships

 learn how to focus on tasks
 learn how to delay gratification
 express feelings in more appropriate ways
 engage in play with peers
 learn how to self-regulate

Why Would a Person With Autism Need to See an

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

What Does an Occupational Therapist Do for People with

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

 Provide interventions to help a child appropriately respond to information

coming through the senses. Intervention may include swinging, brushing,
playing in a ball pit and a whole gamut of other activities aimed at helping a
child better manage his body in space.
 Facilitate play activities that instruct as well as aid a child in interacting and
communicating with others. For the OT specializing in autism, this can translate
specifically into structured play therapies, such as Floortime, which were
developed to build intellectual and emotional skills as well as physical skills.
 Devise strategies to help the individual transition from one setting to another,
from one person to another, and from one life phase to another. For a child with
autism, this may involve soothing strategies for managing transition from home
to school; for adults with autism it may involve vocational skills, cooking skills
and more.
 Develop adaptive techniques and strategies to get around apparent disabilities
(for example, teaching keyboarding when handwriting is simply impossible;
selecting a weighted vest to enhance focus; etc.)

Why Would a Person With Autism Need to See an Occupational Therapist?

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

What Does an Occupational Therapist Do for People with

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

 Provide interventions to help a child appropriately respond to information

coming through the senses. Intervention may include swinging, brushing,
playing in a ball pit and a whole gamut of other activities aimed at helping a
child better manage his body in space.
 Facilitate play activities that instruct as well as aid a child in interacting and
communicating with others. For the OT specializing in autism, this can translate
specifically into structured play therapies, such as Floortime, which were
developed to build intellectual and emotional skills as well as physical skills.
 Devise strategies to help the individual transition from one setting to another,
from one person to another, and from one life phase to another. For a child with
autism, this may involve soothing strategies for managing transition from home
to school; for adults with autism it may involve vocational skills, cooking skills
and more.
 Develop adaptive techniques and strategies to get around apparent disabilities
(for example, teaching keyboarding when handwriting is simply impossible;
selecting a weighted vest to enhance focus; etc.)

Sensory Integration Dysfunction?

SI Dysfunction vs. Attention Deficit Disorder:

A brief comparison of two "look-alike" disabilities

By Carol S. Kranowitz, M.A.

In my book, The Out-of-Sync Child, I define Sensory Integration Dysfunction

(DSI) as the "inefficient neurological processing of information received through
the senses, causing problems with learning, development, and behavior." Picture a
child who has trouble processing and interpreting sensory messages about how
things feel and what it feels like to be touched. Touch stimulation overwhelms this
oversensitive child.

How does his problem play out? He is bothered by the label in his tee-shirt, the
approach of a classmate, the lumps in his mashed potatoes, the stickiness of the
play dough. Fidgeting and squirming, he pays a lot of attention to avoiding these
ordinary sensations. Meanwhile, he is unable to pay much attention at all to the
teacher's words or to playground rules.

Say a child with another form of SI dysfunction has trouble processing movement
and balance sensations. Say this under-responsive child needs to move around --
much more than her peers -- in order to rev up and get going. What is the fallout of
her problem? This impulsive "bumper and crasher" craves intense, vigorous
movement. She often rocks, sways, twirls, jumps, climbs, leaps, gyrates and gets
into upside-down positions. She pays a lot of attention to satisfying her need for
movement, and not much attention to her mother's instructions or to where she left
her shoes.

Inattention . . . impulsivity….fidgety movement . . . these are definitely symptoms

of SI Dysfunction.
Now consider my definition for Attention Deficit Disorder (ADD): "a neurological
syndrome characterized by serious and persistent inattention and impulsivity.
When constant, fidgety movement (hyperactivity) is an additional characteristic,
the syndrome is called Attention Deficit Disorder with Hyperactivity (ADHD)."

 Inattention
 impulsivity
 fidgety movement

These are definitely symptoms of ADD/ADHD -- and of many other

difficulties, as well.

In my book, I discuss other "look-alike" conditions which share symptoms with

sensory integration dysfunction (pp. 17-20). SI Dysfunction may look like ADHD,
and some symptoms may overlap. However, optimum treatment for the two
problems is different. Before jumping to conclusions and leaping to drug therapy,
parents and professionals need to look at the whole child. Then, we can
thoughtfully determine what will help the most.

If the child is frequently -- but not always -- inattentive, it is useful to ask some
questions: Where, when, and how often does this inattention occur? What is the
stimulus? What does the child do as self-therapy? What is happening -- or not
happening -- when the child concentrates well? What does the child need, and what
helps?

An overloaded child needs less stimulation. So, dim the lights and turn down the
radio. Comfort him with "deep pressure" bear hugs. Help him fix up a retreat, with
pillows and blankets, under the dining room table.

An under-responsive child needs more sensory stimulation. So, take her to the
playground each day, jog together around the block, engage her in gentle
roughhousing, and provide her with a chinning bar, a punching bag, and a
trampoline.

SI Dysfunction is a neurological problem, which affects behavior and learning.

Medicine doesn't fix it. One needs a therapeutic sensory program that addresses the
child's underlying difficulties processing sensations rather than just the symptoms
of inattention, not psycho stimulants. A therapeutic sensory program may be a
major component in treating the child with an attention problem. Taking a
 conservative approach can't hurt and often helps the inattentive child whose
problem is not ADD, but developmentally delayed sensory processing.

Sensory Integration Dysfunction - Topic Overview

What is sensory integration dysfunction?
Children with sensory integration dysfunction have difficulty processing
information from the senses (touch, movement, smell, taste, vision, and hearing)
and responding appropriately to that information. These children typically have
one or more senses that either over- or underreact to stimulation. Sensory
integration dysfunction can cause problems with a child's development and
behavior.
Who has sensory integration dysfunction?
Children with autism and other developmental disabilities often have sensory
integration dysfunction. But sensory integration dysfunction can also be associated
with premature birth, brain injury, learning disorders, and other conditions.
What causes sensory integration dysfunction?
The exact cause of sensory integration dysfunction is not known. It is commonly
seen in people with autism, Asperser‘s syndrome, and other developmental
disabilities. Most research suggests that people with autism have irregular brain
function. More study is needed to determine the cause of these irregularities, but
current research indicates they can be inherited.
What are the symptoms?
Children with sensory integration dysfunction cannot properly process sensory
stimulation from the outside world. Your child may:

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

How is sensory integration dysfunction diagnosed?

A health professional, often an occupational or physical therapist, will evaluate
your child by observing his or her responses to sensory stimulation, posture,
balance, coordination, and eye movements. While many children have a few of the
symptoms described above, your health professional will look for a pattern of
behavior when diagnosing sensory integration dysfunction.
How is it treated?
Sensory integration therapy, usually conducted by an occupational or physical
therapist, is often recommended for children with sensory integration dysfunction.
It focuses on activities that challenge the child with sensory input. The therapist
then helps the child respond appropriately to this sensory stimulus.
Therapy might include applying deep touch pressure to a child's skin with the goal
of allowing him or her to become more used to and process being touched. Also,
play such as tug-of-war or with heavy objects, such as a medicine ball, can help
increase a child's awareness of her or his own body in space and how it relates to
other people.
Although it has not been widely studied, many therapists have found that sensory
integration therapy improves problem behaviors.
What is sensory integration dysfunction?
Children with sensory integration dysfunction have difficulty processing
information from the senses (touch, movement, smell, taste, vision, and hearing)
and responding appropriately to that information. These children typically have
one or more senses that either over- or under react to stimulation. Sensory
integration dysfunction can cause problems with a child's development and
behaviour.

Who has sensory integration dysfunction?

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

What causes sensory integration dysfunction?

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

What are the symptoms?

Children with sensory integration dysfunction cannot properly

process sensory stimulation from the outside world. Your child
may:
 Either be in constant motion or fatigue easily or go back and forth between
the two.
 Withdraw when being touched.
 Refuse to eat certain foods because of how the foods feel when chewed.
 Be over-sensitive to odours.
  Be hypersensitive to certain fabrics and only wear clothes that are soft or
that they find pleasing.
 Dislike getting his or her hands dirty.
 Be uncomfortable with some movements, such as swinging, sliding, or
going down ramps or other inclines. Your young child may have trouble
learning to climb, go down stairs, or ride an escalator.
 Have difficulty calming himself or herself after exercise or after becoming
upset.
 Jump, swing, and spin excessively.
 Appear clumsy, trip easily, or have poor balance.
 Have odd posture.
 Have difficulty handling small objects such as buttons or snaps.
 Be overly sensitive to sound. Vacuum cleaners, lawn mowers, hair dryers,
leaf blowers, or sirens may upset your child.
 Lack creativity and variety in play. For instance, your child may play with
the same toys in the same manner over and over or prefer only to watch TV
or videos.

How is sensory integration dysfunction diagnosed?

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

How is it treated?
Sensory integration therapy, usually conducted by an occupational or
physiotherapist, is often recommended for children with sensory integration
dysfunction. It focuses on activities that challenge the child with sensory input.
The therapist then helps the child respond appropriately to this sensory stimulus.

Therapy might include applying deep touch pressure to a child's skin with the goal
of allowing him or her to become more used to and process being touched. Also,
play such as tug-of-war or with heavy objects, such as a medicine ball, can help
increase a child's awareness of her or his own body in space and how it relates to
other people.
Although it has not been widely studied, many therapists have found that sensory
integration therapy improves problem behaviors.

Definition of Sensory integration

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

The field of Sensory Integration exists as both a theory of neurological

function and the process of the human body and mind interacting with the
environment.

Sensory Integration was first identified by Dr. A. Jean Ayres, an Occupational

Therapist who noticed children struggling with functional tasks who did not fit into
specific categories of disability commonly used in the 1960 - 1970'.

These children did not have clear cut diagnoses, but were obviously having
difficulty with work behavior, self-care and recreational activities. She saw the
challenges as neurologically based and developed the term "Sensory Integrative
Dysfunction" to describe the problems faced by children whose brains do not
consistently receive process or respond to sensory input with adaptive, functional
behaviors.
Traditionally, 3 types of sensory input comprise the cornerstone of the SI
approach. These are the tactile, proprioceptive and vestibular systems.

Tactile is our sense of touch, and is especially regulated through sensitive areas
such as the hands, feet and head.

Proprioception is an umbrella term for the sense of body position and is involved
in body awareness in space, planning and coordinating movements, emotional
security and confidence. Proprioceptive input is sent to the brain through receptors
in the muscles, joints, tendons and ligaments. The vestibular system is comprised
of sense receptors in the inner ear, as well as the fibers of Cranial Nerve VIII
(Vestibulocochlear) connected to internal brain structures.

Sensory Integration theory teaches that the ability of the vestibular system to
modulate sensory input has a powerful impact on the development of functional
skills.

The vestibular system is related to the regulation of muscle tone, balance, motor
control, postural stability, visual space perception, visual motor control, auditory
language skills and attention.

Sensory Integration is also known as Sensory Motor Integration, a global

understanding of how the human body and mind operate on a daily basis. We
receive and process sensory input constantly, and respond by producing desirable
"outcome" behaviors. For example: you are sitting near an open window reading as
the sun goes down. It begins to get both cool and dark in the room, and your brain
registers that visual and tactile/temperature information. The brain processing this
information then attaches meaning: I can't see, I am cold. We then identify
solutions: I need to close the window, turn on a light, get a sweater. The "adaptive
response" is the actual standing up, walking over to the window, reaching up,
pulling it down, locking it, etc.
In the big picture, Sensory Motor Integration is a continuous, fundamental constant
of human life at all ages. Seeing the children we work with as whole and complete
beings is a central aspect of the SMILY approach. Providing them with purposeful,
multi-sensory based activities that are both fun and effective is the overall
objective of the SMILY program. In this regard, SMILY is indeed a process of
Sensory Motor Integration. The SMILY book includes more detailed about how
yoga itself is an SI approach, including handy tables and lists that are easily
accessible and understood.

Person with sensory dysfunction?

Our bodies are intended to function as "well-oiled machines," which receive input
from the senses, and organize and process that information to be able to use it
appropriately, or to act on it. Our senses include hearing, seeing, touching, tasting,
and feeling, as well as the processes of movement and gravity. When these systems
are all working properly, and the brain is able to correctly interpret the information
they send, we refer to this process as sensory integration; the senses are working
together! However, when there are imperfections in this system, we call that
"sensory integration dysfunction." Although there are many variations in the ways
that sensory integration dysfunction (or sensory processing difficulties) can present
itself, there are two main underlying problems. The first is when a person receives
too much sensory input; in effect, their brain is overloaded. The second is when a
person does not receive enough sensory input, resulting in a "craving" of sensory
information. The following section will discuss how each of the senses affects
behaviors, as well as potential problems which arise when sensory integration
dysfunction is present.

Hearing. We use our ears to hear voices, music, alarms and sirens, as well as
"noise" around us generated by electronic equipment, nature, etc. When our brains
are able to properly receive and organize the data they receive through our ears, we
are able to sense danger, process information and instructions, and feel pleasure
through music or sounds of nature. A person whose senses are well-integrated can
sit in the middle of a noisy party with music, talking, glasses and silverware
clinking, and dogs barking, and still be able to carry on a conversation with the
person sitting across the table. This person‘s brain simply filters out the
unnecessary information, and focuses on the words the individual speaker is
saying.

In contrast, a person with sensory integration dysfunction may hear all of the above
sounds at the same level, in effect being bombarded by each of the sounds. This
person will be unlikely to follow the conversation directed at them by the person
across the table. Imagine a similar child in a classroom, surrounded by pencils
being sharpened, children talking, music playing, feet shuffling, and chairs being
scraped across the tile floor. This child may not be able to complete the math or
reading assignments correctly with all of the other stimuli overloading his brain. In
fact, this child may even exhibit behavioral problems resulting from his frustration
and inability to screen out unnecessary sensory input. The teacher may notice the
child "clowning around," staring into space, or flapping his hands. This child may
become terrified of the fire alarm, perceiving that sound as painful. Another child
may struggle when the room is quiet, because that child is not receiving enough
input through his hearing. This child may begin tapping his pencil, humming,
kicking his desk, or otherwise producing his own noise. All children are different
in their needs, but the teacher should be sensitive to the child with sensory
integration dysfunction, taking time to determine whether that child needs a quiet
area to study, a set of headphones to block out extra sounds, or perhaps a stereo
headset to provide quiet music.

Seeing. Our eyes provide us with input regarding such things as color, light,
movement, locations, body language, and facial expressions. This information,
when properly received and analyzed by our brains, allows us to find our way
around, read, interpret body language and facial expressions, anticipate movement,
and sense danger. A child who is under-reactive to sight stimuli might flick her
fingers in front of her face, or hold a book close to her eyes. On the other hand, a
child who is overly-sensitive or overly-reactive to visual input might be frightened
in a crowded mall, or become either withdrawn or hyperactive in a room with
bright lights and an abundance of color or movement. People with sensory
integration dysfunction may not respond appropriately to others‘ facial
expressions, due to their inability to properly organize visual input. A large
classroom which is visually stimulating, with colored posters, stacks of books,
bright lights and windows, rows of desks, and many children, can be very
distracting to the person with sensory integration disorder, and may require that
special accommodations be made for that person.

Smelling. We are often surrounded by fragrant scents from perfume and flowers,
and delicious smells of popcorn and freshly-baked bread or cookies. Other smells
we encounter in our environment include cleaning agents, newly mowed grass, car
exhaust, and smoke. Our sense of smell can bring us pleasure, enhance our ability
to taste our food, and warn us of danger. However, as with the other senses, the
sense of smell can cause frustration for a person whose brain is not able to properly
analyze, screen out, or respond to the information it receives. Some people are
overly sensitive to smells, and a whiff of perfume or cleansers can be very
distressing to them. Other people are under-reactive to smells, and may hold things
close to their nose to be able to smell them better. Whether they are overly- or
under-reactive to smells, students who are keenly aware of the smells around them
in the classroom may be unable to concentrate on the work they should be doing.

Taste. Taste often brings us pleasure. We tend to eat the things that taste good! But
taste can also warn us of danger. We know that milk may be sour or food may be
spoiled based on the way they taste. But a person with sensory integration
dysfunction may be either a very picky eater, avoiding certain (or many) tastes and
textures, or may be an indiscriminate eater, eating almost anything! Taste is an area
which will likely cause more distress and grief for the parents of children with
sensory problems, than for teachers and peers.

Touch. We only have two eyes, two ears, and one nose, but our bodies are covered
with very sensitive touch receptors. Through them we get information about hot
and cold, hard and soft, smooth and rough, and pain and pleasure. When a person‘s
brain is receiving and analyzing this information from the tactile system correctly,
he will quickly remove his hand from a hot stove, put mittens on when going out
into the snow, and smile when receiving a caress from a loved one. However, a
person who has sensory integration dysfunction may react violently to a warm
surface or a gentle pat on the back. He may not remember to wear mittens even on
an extremely cold day, or he may always wear long sleeves, even when it‘s warm,
because he dislikes having his skin exposed. If he is under-reactive to touch, he
may receive a serious wound, acting as though it is merely a scratch. He may hate
to get his hands dirty and to touch unfamiliar objects, or may have an intense need
to touch anything and everything.

A child with sensory integration dysfunction is going to present unique challenges

to the science teacher leading a lab dissecting frogs. This child is either going to
resent having to be involved in such a messy endeavor, or is going to be attacking
the frog to find and to handle every slimy bit of the innards. Similar problems may
arise in art class and in the cafeteria. This child may have difficulty standing in
line, because either he will be touching everyone, or he will be complaining that
everyone is touching him. Often he may perceive a light touch from a classmate as
a hit, and he may strike out at the other child. Parents may have difficulty choosing
a wardrobe for this child, because there are certain fabrics or articles of clothing
that he refuses to wear, or the tags in the back are bothersome to him.

A child with tactile defensiveness or a need to touch things, may benefit from
carrying a stimulating object in his pocket. This may be a small textured ball, a key
ring, or something that vibrates. When the child needs help concentrating, or needs
to be able to touch something, he can reach into his pocket for that item. Many
children with sensory integration dysfunction twirl their hair, rub their fingers
together, or even chew their fingernails.

Vestibular System. Although most people are familiar with the above senses,
there are actually two other systems that play a very large role in our brains‘ ability
to receive information and to respond to it. The first is the vestibular system, which
has to do with movement and balance. A person with sensory integration
dysfunction may be hyper-responsive (over-reactive) to movement, or hypo-
responsive (under-reactive) to movement. Hyper-responsiveness to movement may
cause a person to experience motion sickness in the car or on an amusement park
ride. This person may be afraid of heights or dislike being upside down, which is
referred to as gravitational insecurity. This person may seem stiff, and even hold
his head upright, to avoid excessive movement. (Problems with their vestibular
system may have caused the strange crawl that both of my sons developed; they
did not like to put their heads down, so crawled in a way that allowed them to keep
their heads upright.) A child with these difficulties may struggle on the playground
or in physical education classes, where they may be expected to swing, go on a
merry-go-round, hang upside down, or run.

Hypo-responsiveness to movement may result in a child who is always moving:

spinning, swinging, rocking, flapping her hands, and fidgeting. Many children with
sensory integration dysfunction appear as though they have Attention Deficit with
Hyperactivity Disorder (ADHD) simply because they rarely stop moving. These
children often exhibit poor balance, and may have difficulty navigating around
objects, bumping into walls and tripping over chairs. They might enjoy hanging
upside down, and appear able to spin without becoming dizzy. While a child with
sensitivity to movement is going to be presented with many frustrations outdoors,
hyperactive children are likely to be more challenged indoors, especially during
times when they are expected to be quiet, focused and attentive.

Proprioceptive System. The last system deals with body position, and is known
as the proprioceptive system. This system is often referred to as "awareness of
body in space." When this system functions properly, it allows us to sit down onto
a chair without falling, walk up and down stairs without watching our feet, close a
door with just the right amount of effort, squeeze a glue bottle just hard enough to
squirt out a small dot of glue, and walk down a crowded sidewalk without bumping
into anyone. Disturbances in this system can obviously lead to problems. A person
who does not know how far her arm extends may end up hitting someone as she
reaches for an object. This person may step on someone‘s foot as she walks, not
realizing that a foot was in her way. She may slam doors, or close them so lightly
that they do not latch. She may be clumsy, and may be unable to climb a piece of
playground equipment or walk up stairs without difficulty, perhaps needing to
watch her feet to see where to place them. Problems with the proprioceptive
system can be the main contributor to difficulties with motor planning, which is
the ability to figure out how to use one‘s body. For example, when walking under a
low doorway, most people know just how far to bend down to avoid hitting their
head. A person with motor planning difficulties may bend over too far, or not far
enough. This person may not know how to climb up the monkey bars on the
playground, or may not be able to get down once she is up there! Routine tasks
such as dressing, tying shoes, eating with utensils, and writing can be challenges
for people with motor planning difficulties.

Remember that not all individual preferences or behavioral problems are caused by
sensory integration dysfunction. Some people prefer to work with the radio on.
Some people like "dirty work" more than others. Generally, a person who has
sensory processing difficulties will manifest this in several different areas.
However, if you recognize your child in the preceding descriptions, do not despair!
Many things can be done to enable a person‘s brain to properly receive and
respond to sensory stimuli.

First, provide your child with an environment that is full of a variety of sensory
input: colors, light and dark, sounds, music, things to climb on, different textures,
and opportunities for movement and exploration, exposing all of the senses to
various types of input. This varied exposure to sensory input (targeting specific
needs) is often referred to as a sensory diet. It is important to learn what excites
your child, what calms him, and what frightens him. Allow your child to choose
activities that fit his needs and interests. Providing different experiences, along
with support and encouragement, will be a good foundation for helping your child
with sensory problems.

Second, knowing that your child may encounter things that are disturbing or
overwhelming, help her to adapt the activity, or even avoid it when necessary. If
your child does not like light touch (many people with sensory integration
dysfunction do not), make a point of using a firm, calming, deep pressure touch. If
your child cannot study in an environment with a high level of noise and other
stimuli, help him to find a quiet place to complete assignments and prepare for
tests.

Remember that your child may not be able to process a lot of sensory input
simultaneously. For example, she may not be able to talk while she is walking on a
balance beam. She may not be able to look at you when you are giving her verbal
instructions. Although you might encourage a child to make eye contact with
people when greeting them, asking a question, or beginning or ending an
interaction, he or she might not be able to look at you when you are giving
instructions or discipline. Instead, when we finished, we ask the child to rephrase
what was said in order to monitor his or her comprehension.
Many children benefit from Sensory Integration (SI) Therapy, either through their
schools (if their sensory integration dysfunction is interfering with their ability to
learn or to participate in the school environment), or through private therapy.
Usually, SI therapy focuses on the tactile, vestibular, and proprioceptive systems.
This therapy does not teach specific skills; rather, it provides exposure to sensory
input in a controlled environment. Once children are able to tolerate and
subsequently process the sensory input, they are able to catch up on skills that they
may have been missing. Sensory Integration Therapy can be a wonderful way for
parents to learn activities to do with their children at home! Once you learn about
SI from occupational therapists, you can begin incorporating many different
activities into your daily routine, including trips to the playground, "messy" play
with paint, modeling clay, and sand, and a variety of exercises. Trained therapists
can also provide an evaluation of a child to better determine what that child‘s
needs are.

Some children need deep pressure in order to calm themselves and to help their
brains organize and process sensory input. Children who crave deep pressure may
benefit from using a weighted vest, blanket, or wrist or ankle weights. I
recommend talking with an occupational therapist for specific suggestions
regarding your child‘s needs.

There are many deep pressure activities you can do with children. Swinging in a
blanket, being rolled in a blanket like a "hot dog," pulling each other across the
room in a laundry basket, and carrying heavy milk cartons are all excellent
activities. The Wilbarger Brushing Method, developed by Patricia and Julia
Wilbarger, uses a surgical scrub brush to stimulate the touch receptors, followed by
deep pressure (proprioception) on the joints. A trained therapist could determine
whether a child might benefit from brushing, and could instruct parents on how to
use this method with their child.

Although adults are generally able to control their environment by making

decisions about the sights, smells, and sounds that surround them, as well as the
activities that they engage in, children rarely have the "luxury" of avoiding
uncomfortable sensory stimuli in this way. In a crowded, activity-filled classroom,
there is often no opportunity to escape the noise and confusion. Activities such as
finger painting, sculpting with clay, or dissecting a frog are planned for the entire
class to participate in, and frequently, the student‘s performance is rated based on
the successful completion of these tasks. It is important to talk with your child and
his teacher to determine what activities and situations may be presenting
challenges in the classroom and in other environments, and to help to provide a
solution. There is much that can be done to help a child with sensory integration
dysfunction!

What is Speech Therapy, Sensory Integration Therapy &

Occupational Therapy?
What is Speech Therapy?
Speech therapy is a corrective and or rehabilitative treatment for individuals with
difficulties in verbal communication and expression. It includes speech –
articulation, pronunciation, intonation and language training- receptive and
expressive language, syntax, semantics, pragmatics, phonology and morphology of
speech.
Who is an SLP?
‗Speech and Language pathologist‘, In India, also know as a „Speech therapist‘,
these professionals‘ asses, diagnose and remediate issues related to speech and
language of the individual.
Does my child need Speech therapy?
If you feel your child is not using age appropriate communication tools, is not
talking as much and with as much ease as kids of his/her age, has unclear speech
and his/her language is not developing as per his/her age, consult a Speech
Therapist.

Where can I find one?

• Your physician/pediatrician could refer you to one. • The diagnostic center would
have contacts of good SLPs in your area.
• Hospitals/ pediatric clinics • Special schools • Private practice

What is Sensory Integration Therapy (SI) and “Sensory Diet”?

Many children on the autism spectrum have difficulty managing the sensory input
(sights, sounds, touch, smells, heights, depths). They may over react (hyper
sensitivity) or under-react (hypo- sensitivity) to visual, tactile and aural input.
These imbalances in reactions are sometimes to the point where the child is unable
to participate in typical life activities.

These differences in sensory reactiveness are labeled "sensory processing disorder"

or "sensory processing dysfunction‖ and as a result of these differences, many
children with autism receive therapy for sensory issues, known as "sensory
integration therapy" or SI therapy

Sensory integration therapy is a form of occupational therapy, generally offered by

specially trained occupational therapists. The concept of sensory integration
therapy was first developed by Dr. Jean Ayres

It involves specific sensory activities that are intended to help the child regulate his
or her sensory responses.

A SI therapist focuses on the three main sensory systems of the body- tactile,
vetsibular and proprioceptive systems. In simpler terms, the therapist works on
normalizing the child‘s reactions to touch, odors, help children become better
aware of their body in space, and help their ability to manage their bodies more
appropriately- run and jump when it's time to run and jump, sit and focus when it's
time to sit and focus, etc.
Depending upon the child‟s needs, the SI therapist may use
various techniques such as:
• Swinging
• Deep pressure-squeezing, rolling in weighted blankets etc
• Jumping on trampolines
• Playing with toys that vibrates, are squeezable, etc.
• Gross motor play such as wall climbing, ladder climbing, balance beam, etc.
• Brushing extremities
• Small and big joint compression

The outcome of these activities may be better focus, improved behavior, child
being more in control of his/her body and even lowered anxiety. Just like a
balanced meal includes all the essential nutrients for the body, a ‗SI Diet‘ is a
combination of various motor activities and therapist provided interventions such
as deep pressure, brushing, compression etc that aim to balance the child‘s
sensorial system and its responses to the outside world. For more details on
Sensory Processing Disorder and sensory integration.

What is Occupational Therapy?

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

Does my Child need Occupational therapy (OT)?

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

Where can I find an OT?

• Your physician/pediatrician could refer you to one.
• The diagnostic center would have contacts of good OT‘s in your area.
• Hospitals/ pediatric clinics
• Special schools
Sensory Integration Therapy for Children with Autism
What is it?
Most of us unconsciously learn to combine our senses (sight, sound, smell, touch,
taste, balance, body in space) in order to make sense of our environment. Children
with autism have trouble learning to do this. Sensory integration therapy is a type
of occupational therapy (OT) that places a child in a room specifically designed to
stimulate and challenge all of the senses. During the session, the therapist works
closely with the child to encourage movement within the room.

Sensory integration therapy is driven by four key principles (1):

1. the child must be able to successfully meet the challenges that are presented
through playful activities (Just Right Challenge);
2. the child adapts her behavior with new and useful strategies in response to the
challenges presented (Adaptive Response);
3. the child will want to participate because the activities are fun (Active
Engagement); and
4. the child's preferences are used to initiate therapeutic experiences within the
session (Child Directed).

Sensory integration therapy is based on the assumption that the child is either over
stimulated or under stimulated by the environment (2). Therefore, the aim of
sensory integration therapy is to improve the ability of the brain to process sensory
information so that the child will function better in his daily activities (2).

Recently another sensory-related therapy has been reported called Sensory Stories .
Sensory Stories are similar to social stories (see Social Stories Therapy Fact Sheet
) in that they use individualized stories about sensory situations that an individual
 child may encounter, and then provides instructions on appropriate behaviors for
the child to use in response (3).

What's it like?

A sensory integration room is designed to make the child want to run into it and
play. During sensory integration therapy, the child interacts one-on-one with the
occupational therapist and performs an activity that combines sensory input with
motion. Examples of such activities include:

 Swinging in a hammock (movement through space);

 Dancing to music (sound);
 Playing in boxes filled with beans (touch);
 Crawling through tunnels (touch and movement through space);
 Hitting swinging balls (eye-hand coordination);
 Spinning on a chair (balance and vision); and
 Balancing on a beam (balance).

The child is guided through all of these activities in a way that is stimulating and
challenging. The focus of sensory integration therapy is helping children with
autism combine appropriate movements with input they get from the different
senses.

A parent can integrate sensory integration into the home by providing many
opportunities for a child to move in different ways and feel different things. For
example, a swing set can be a form of sensory integration therapy, as can a ball pit
or a lambskin rug.
What is the theory behind it?

On a daily basis, most people experience events that simultaneously stimulate

more than one sense. We use our multiple senses to take in this varied information,
and combine them to give us a clear understanding of the world around us. We
learn during childhood how to do this. Thus, through childhood experiences we
gain the ability to use all of our senses together to plan a response to anything we
notice in our environment. Children with autism are less capable of this kind of
synthesis and therefore they may have trouble responding appropriately to
differently stimuli.

Children with autism may also have a difficult time listening when they are
preoccupied with looking with at something. This is an example of their difficulty
in receiving information via more than one sense simultaneously. Physicians who
treat children with autism believe that these difficulties are the result of differences
between the brains of children with autism and other children.

The underlying concepts of sensory integration therapy are based on research in

the areas of neuroscience, developmental psychology, occupational therapy, and
education. Research suggests that sensory information received from the
environment is critical; interactions between the child and the environment shape
the brain and influence learning. Furthermore, research suggests that the brain can
change in response to environmental input, and rich sensory experiences can
stimulate change in the brain.

Does it work?

The effectiveness of sensory integration therapy is controversial and there are very
few well-designed studies upon which to base a clear assessment of whether or not
it works. Approximately half of the reports in the scientific literature show some
type of effectiveness with sensory integration therapy, and half show no benefits at
all. Some researchers suggest that sensory integration therapy would be more
useful for younger children than for older children. It is also possible that it might
work for some children and not others. Some experts suggest that sensory
integration therapy be discontinued if effects are not apparent during a specified
time frame or if the child has a negative reaction.

Successful sensory integration therapy has been able to decrease sensitivities to

touch and other stimuli. The result is that the children are better able to play, learn,
and interact with people and surroundings.

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

Sensory Integration Program

Sensory Integration Program (SIP)

Sensory integrative dysfunction is a disorder in which sensory input is not fully
integrated or organized functionally in the brain, and may produce various degrees
of problems in development, information processing, and behavior. Sensory
integration focuses primarily on three basic senses: tactile, vestibular, and
proprioceptive.
Sensory Integration Therapy allows for controlled sensory input in a way that
allows the individual to make an adaptive response that integrates the senses and
helps enhance the organization of the brain.

The Sensory Integration Program provides Sensory Integration Toolkits filled with
many different types of therapeutic tools and technology to aid in this process.

The Toolkits are available for therapists to use for evaluation purposes, and to
assist them in making appropriate recommendations for sensory activities and
programs. Training is provided to therapists and others in the functional use and
application of the Toolkit.

Sensory Integration Toolkit

Sensory Integration Program

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

We are used to thinking of the five senses as sight, sound, taste, touch, and smell.
However, all but one of these is actually the secondary layer of senses, often called
the higher senses. Their full development depends on the development and
integration of our base senses. These base senses are the tactile or touch system,
the vestibular or balance system, and proprioceptive or muscle/joint system.

Unless the base senses are well nourished and integrated, the higher senses will
struggle with intake and processing, and remain unsure how to interpret the
incoming sensation. This will leave the nervous system on alarm and in ―survival‖

mode.
When a child – or any one else – cannot integrate the sensory information he is
receiving he is overwhelmed. Imagine we are standing in a subway with a train
approaching, smelling freshly baked chocolate chip cookies, while a mosquito
buzzes overhead and the poison ivy rash on our legs is itching – and then someone
asks us to write a job application. Sense your own reactions; then we may have
some glimpse of the child‘s experience. Of course he becomes agitated and shuts
down or becomes hyper-reactive. Any of us would react this way if this was our
moment to moment experience. It is our job as adults to help the child build a
healthy foundation through the integration of his base senses.

Each of the three base systems plays a central role in telling us what is happening
internally, where we are in space, and where the ―I‖ ends and ―other‖ begins.
Together they give us our fundamental security. Since we are, wisely, programmed
to put survival above all else, if these are not functioning well, both individually
and in an integrated manner, we are at the mercy of our most instinctual selves –
the reflexes. Like any automatic response, these are far more rigid and lack the
freedom of response we gain as more advanced systems develop and integrate – in
this case the base senses.

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

The nourishment and integration

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

Informed by the work of Jean Ayres, PhD – the founder of Sensory Integration
Therapy - our Sensory Integration Program works with specific and targeted
movement activities in the context of the developmental issues of the child. For
example, we can look at the younger children who are focused on leaving home for
adventure and returning safely. For them the specific movements would be
accompanied by a verse about Mama Swan or the Peepers hatching form the mud.
The imaginative world so alive in young children is nourished, as is their
connection to nature – all the while their base senses are being fed.
This kind of work weaves right through our days. It might be in the focused
physical activities of the morning, five minutes of targeted movement here and
there, or having a child who misbehaves run around a track rather than sit in his
seat or his room. In both the home school and classroom we work with specific
movement and handwork activities and with the very natural opportunities to n

ourish and integrate the senses.

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

The Sensory Belt is one of the best sensory aids for teens, and adults with sensory
disorders! Weighted belts promote self calming and increased body awareness by
enhancing proprioceptive feedback. Within seconds of wearing the Sensory Belt
you will feel more balanced, focused, and secure! The Sensory Belt benefits
children, teens, and adults diagnosed with Autism, ADD, ADHD, Angelman
syndrome, Aspergers syndrome, Ataxia, Cerebral Palsy, Down syndrome, Fetal
alcohol syndrome, PDD-NOS, Peripheral Neuropathy, Rett syndrome, Sensory
Integration Disorder, Sensory Processing Disorder, and any other balance related
diagnosis. Using the latest in foam technology we have created the most
comfortable, safe, and durable line of sensory aids for teens and adults with
sensory disorders.

The Sensory Belt is a weighted belt providing sensory integration benefits for
children, teens, and adults weighing more than 75 pounds. The Miracle Belt is a
pediatric weighted belt providing sensory integration benefits for infants and
children weighing less than 75 pounds. Sensory Warehouse is a sensory catalog for
weighted sensory integration aids.

Every sensory aid includes a 30 Day Money Back Guarantee.

Benefits of Sensory Aids

o Increases Body Awareness

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

Sensory Aids benefit teens & adults with

o Autism
o Attention Deficit Disorder (ADD)
o Attention Deficit Hyperactivity Disorder (ADHD)
o Angelman syndrome
o Aspergers syndrome
o Ataxia
o Cerebral Palsy
o Down syndrome
o Fetal alcohol syndrome
 o Pervasive Developmental Disorder (PDD-NOS)
o Peripheral Neuropathy
o Rett syndrome
o Sensory Integration Disorder (SID)
o Sensory Processing Disorder (SPD)

Sensory Aids are helpful in these therapies

o Behavior Therapy
o Occupational Therapy
o Physical Therapy
o Speech Therapy

Sensory Aids are Useful

o At Home
o At School
o At Work

Story from Autism ?

Hope for autistic children

BANGALORE Sept. 29. Every week, at Prathibha Karanth's consulting rooms, at

least two sets of frantic parents bring their toddlers, plying her with questions,
scared and mystified, as to why the children are violent, unresponsive, anti-social,
incapable of feeling emotions, and unable to take care of themselves. Or in less
alarming degrees, not displaying the normal social skills or responses appropriate
to their age.
Autism and related pervasive developmental disorders (PDD) affects at least 15 in
every 10,000 people, and research is advanced just enough to link them to
biological or neurological disorders.

The search has been on to find a cure since autism and PDD first became known,
and to help the affected people enter the mainstream.

The past couple of decades have seen if nothing else, a coming together of parents
and families of autistic children to make common cause, share the problems, and
work towards a solution.

But the eminent speech-language pathologist, Prathibha Karanth, is impatient, with

answers that elude research and experiment. Dr. Karanth, who trained at
NIMHANS and worked at the Mysore-based All-India Institute of Speech and
Hearing, pioneered the Communication DEALL (Developmental Eclectic
Approach to Language Learning).

And less than two years since it was initiated, DEALL has proved to be the light at
the end of the tunnel for more than 50 children.

Five children on the DEALL programme are already in regular schools, and for Dr.
Karanth, they are the vindication of her conviction that earlier the intervention,
easier the integration of the child into the mainstream.

Parents of one child have relocated from the Middle East so that it can overcome
the debilitating disorder, and another mother brings her three-year-old from
Peenya, although there is another baby for her to look after.

Another child, who finished therapy with Dr. Karanth, is happily attending regular
school, and his mother is volunteering her time, and sharing her experience to
encourage parents who continue to be devastated on discovering their child's
condition.

Communication DEALL, says Dr. Karanth, a winner of the Young Scientists'

Award early in her career, was a response to the virtual absence of intensive early
intervention for alleviation of these disorders. DEALL aims to provide intensive
stimulation and training to small groups of pre-school children with developmental
disorders, in the areas of communication, cognition, behaviour, and socialisation,
enabling their integration into the normal school set-up.
Parents are wary of being candid about their child's disorder history, as they fear,
with justification, that it may mean a prejudice against the child. "I tell them to call
only if some problem develops, and there are indications of a regression, although
it is remote,'' she says.

There is nothing that sensitivity and understanding cannot handle, but school
managements and other parents are often short on those, when it comes to autism,
as any parent of an autistic child knows.

This has only made Dr. Karanth all the more determined to show that autism is
conquerable. She has put 15 toddlers on DEALL in a new Montessori school,
Creative Foundation, in Fraser town.

The school's Neelam Calla, who had no qualms about "mixing these
extraordinarily gifted children with others'', however, sent off letters to all parents,
and was touched to find that nearly every one of them welcomed the idea.

For Dr. Karanth, this means autism or PDD can be "erased'' and the child
integrated without the trauma or ignominy associated with the disorder.

“Autistic children need genuine friends, not sympathy”

Great show: Samuel Ashish Marcus, performing at a conference at the

Pondicherry University on Tuesday

PUDUCHERRY: ―I like music very much,‖ said 22-year-old Samuel Ashish

Marcus, a person with autism, who plays guitar and keyboard and has over 10
compositions to his credit. Thanks to early recognition and proper nurturing of his
skills, Marcus, who wants to achieve much more with music, comes as an example
of how autistic children should be reached at an early age.

Marcus, who lives in Hyderabad, was in Puducherry for a two-day international

conference on ‗Autism: Social Skills and Creativity‘ organised by the Pondicherry
University. He enthralled the audience with a music performance on Tuesday
evening.

For his mother, Annamma, the journey has been filled with a myriad of
experiences. ―Marcus was a premature, Caesarean child. A week after birth, he had
very high fever and was given high dose of drugs. He was a healthy baby and was
fond of music from a young age. Yet, we sensed that he never demanded anything
like other children and was aloof. By the age of four, we found he was a high-
functioning autistic child after medical assessment,‖ she recalled.

Filled with passion for music, Marcus started to learn to play instruments from
1995. ―He learned to play guitar using an advanced guitar learning book and is
now doing the sixth grade in keyboard with the Trinity College of Music. He is
part of the church choir and is good at special numbers. Marcus is more of a soloist
than a group performer. His compositions are more devotional, about beauty and
people,‖ she said.

Marcus studied up to Standard VII under ICSE board. Presently, he is studying

computer science at a centre for exceptional children in Hyderabad. He has passed
English and Computer Science through open school and has to clear three to four
subjects more. ―Music is his life. We have given him an own room with musical
instruments. In fact, Marcus wants to bring out an album of his compositions,‖ she
stated.

She exhorted parents of autistic children not to give up, to explore, let the child be
himself/herself and give all help. ―These children need genuine friends and not
sympathy,‖ she insisted. With plenty of love for music, Marcus said: ―I want to
learn violin.‖
Chennai: Most of us would help a blind person cross the road. But when it comes
to an autistic child, people turn indifferent.
In an age where communication is the most important of all skills, how does an
autistic child cope with a communication disorder?
Tamil actor Prithvi Raj‘s 11-year-old son Ahed was not allowed to board a plane in
Bangalore because airport security seemed to think that his disability made him
dangerous.
"Our struggle is to make my son acceptable in the main stream society. We don't
want special privileges, don‘t make his life miserable please," Prithvi Raj says.
Autistic children like Ahed face insensitivity and discrimination almost everyday.
When an autistic child does not make eye contact, or doesn't return a greeting,
people think he's either rude or indifferent.
While the truth is that autistic children find it difficult to communicate verbally or
even through gestures.
"For our children, just to look, to blow, to turn around when called. Each and
everything needs to be worked upon," 'We CAN' Resource center for autism
founder Hema Jairam says.
A popular misconception about autism is that it is a disability of the super
intelligent and that all autistic children have a special talent.
However, therapists say that such cases are extremely rare, and most autistic
children are like regular kids who could love music, hate math and be great
athletes.
The first rigorous study of behavior treatment in autistic children as young as 18
months found two years of therapy can vastly improve symptoms,

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

The study was small just 48 children evaluated at the University of Washington but
the results were so encouraging it has been expanded to several other sites, said
Geraldine Dawson, chief science officer of the advocacy group Autism Speaks.
Dawson, a former University of Washington professor, led the research team.

Early autism treatment has been getting more attention, but it remains controversial
because there's scant rigorous evidence showing it really works. The study is thus
``a landmark of great import,‘ said Tony Charman, an autism education specialist
at the Institute of Education in London.

There's also a growing emphasis on diagnosing autism at the earliest possible age,
and the study shows that can pay off with early, effective treatment, said Laura
Schreibman, an autism researcher at the University of California at San Diego.

The National Institute of Mental Health funded the study, which was published
online Monday in Pediatrics.
Children aged 18 months to 30 months were randomly assigned to receive
behavior treatment called the Early Start Denver model from therapists and
parents, or they were referred to others for less comprehensive care.

The therapy is similar to other types of autism behavior treatment. It focused on

social interaction and communication _ which are both difficult for many autistic
children. For example, therapists or parents would repeatedly hold a toy near a
child's face to encourage the child to have eye contact _ a common problem in
autism. Or they'd reward children when they used words to ask for toys.

Children in the specialized group had four hours of therapist-led treatment five
days a week, plus at least five hours weekly from parents.

After two years, IQ increased an average of almost 18 points in the specialized

group, versus seven points in the others. Language skills also improved more in the
specialized group.

Almost 30 percent in the specialized group were re-diagnosed with a less severe
form of autism after two years, versus 5 percent of the others. No children were
considered ``cured.‘
Ashton Faller of Everett, Washington, got specialized treatment, starting at age 2.

``He had no verbal speech whatsoever, no eye contact, he was very withdrawn,‘
recalled his mother, Lisa Faller. Within two years, Ashton had made ``amazing‘
gains, she said. Now almost 6, he's in a normal kindergarten class, and though he
still has mild delays in social skills, people have a hard time believing he is
autistic, Faller said.

The treatment is expensive; participants didn't pay, but it can cost $50,000 a year,
Dawson said. Some states require insurers to cover such costs, and Autism Speaks
is working to expand those laws.