Gloria Frolek Clark, Renee Watling, L. Diane Parham, Roseann Schaaf; Occupational Therapy Interventions for Children and Youth With Challenges in Sensory Integration and Sensory Processing: A School-Based Practice Case Example. Am J Occup Ther 2019;73(3):7303390010. https://doi.org/10.5014/ajot.2019.733001
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© 2020 American Occupational Therapy Association
Evidence Connection articles provide case examples of how practice decisions may be informed by findings of systematic reviews sponsored by the American Occupational Therapy Association Evidence-Based Practice Project. This Evidence Connection article is the second article in a two-part series. The first article described a case report of occupational therapy provided to a child with a diagnosis of autism spectrum disorder and challenges in sensory integration in a clinic setting (Parham et al., 2019). This article describes the same child’s occupational therapy service delivery by the occupational therapist working in the school setting.
Alejandro struggles to complete handwriting and other tabletop activities at school because he has challenges using pencils, materials, and other tools. His fine motor control and dexterity are poor, and he has decreased awareness from the receptors in his joints and muscles (proprioceptive awareness) and touch (tactile hyporeactivity). Evaluation also indicates that he has difficulty with planning and carrying out movements (praxis) and using both sides of his body (bilateral motor coordination).
Alejandro often runs away from his seat during tabletop learning activities. He may be running away because of his challenges with postural control, which make it difficult for him to maintain a stable sitting position and sustain engagement, or it may be an attempt to escape from fine motor activities, which are difficult for him.
It is difficult for Alejandro to participate appropriately and safely in gross motor activities in the gym and on the playground. This may be related to his challenges in balance, bilateral coordination, and motor planning as well as poor body awareness related to difficulties processing input from various sensory systems (vestibular, proprioceptive, and tactile).
Alejandro has difficulty with self-regulation, leading to disruptive behaviors in the classroom and lunchroom. His challenges in self-regulation may be related to his problems with processing sensory information (hyperreactivity to some types of sensation and hyporeactivity to other types of sensation), which make it difficult for him to match the intensity of his responses to situational demands.
Strengths: academic skills, visual skills, enjoyment of computer games and music; responds well to redirection using a highly favored object (e.g., computer, games)
Needs: increased ability to complete fine motor work, to self-regulate when encountering challenging tasks or nonpreferred stimuli such as foods, and to play safely on the playground; improvement in social skills to make friends in the classroom and on the playground; expansion of options for healthy foods; and decrease in inappropriate behaviors in the lunchroom.
Conduct a comprehensive evaluation that includes screening of all areas of occupation, record review, interviews, observations during natural routines, and assessment tool use (when applicable).
Use evaluation findings to hypothesize why participation challenges occur.
Work with the team to identify the student’s needs and create collaborative student IEP goals to address these needs (not therapy-specific goals).
Provide occupational therapy services that reflect the distinct value of occupational therapy in school settings.
Gather frequent quantitative data to determine the effectiveness of the intervention.
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