Teachers who have been working with students who have disabilities may have come across the terms sensory processing or sensory integration, or may have been asked to try certain strategies in the classroom to provide or reduce sensory input for students. The teacher may not have been provided with a solid understanding of the rationale behind the request. In order to fully use the C-SEA and benefit from the information it provides, some background knowledge might be helpful.
For teachers: The C-SEA was developed with the goal of helping teachers examine their classrooms carefully to understand the multiple sensory inputs that their students are being exposed to throughout the day. Armed with this information, the teacher can then consider particular students in the classroom who might have difficulty tolerating or managing sensory information, and can then make classroom modifications to assist that student in learning and attending. The C-SEA is not meant to grade or judge your classroom, which is why you do not get a classroom score. It is meant to be a tool for you to use to make informed decisions about the sensory experiences you provide. The classroom map you receive from its completion can guide you to make those modifications. You may then compare your classroom map before and after the modifications to see how it has changed over time.
For occupational therapists: The C-SEA may be used in collaboration with teachers to modify the educational environment for a specific student on your caseload. The C-SEA maps may be used as a pre- and post-measure to examine the impact of your consultation with a teacher regarding sensory features of the classroom.
The proposed outcome of using the C-SEA is environmental modification.
The term sensory integration can take on various meanings. To both neuroscientists and occupational therapists, it means a process that occurs in the brain. Sensations come together in the brain to allow us to make sense of the world. To occupational therapists, it is also a theory of practice and an intervention developed originally by A. Jean Ayres, PhD, an occupational therapy researcher and scholar.
Sensation allows us to understand the world we live in and to function in it. Appropriate sensory integration allows infants and children to explore, learn, and develop. Appropriate sensory integration lets us move efficiently, behave appropriately, and respond effectively to environmental challenges. It is well understood that human beings need sensation and, if deprived of it completely, can actually experience hallucinations. But ill effects can also occur from lack of sensation at important periods of development.
This trademarked term refers to the theory, methods, and intervention developed by A. Jean Ayres. The approach has been clearly described and specifically defined. In ASI, there must be a comprehensive evaluation of the child’s sensory functioning prior to treatment. The intervention is child directed, play based, and provided in a specific environment with structures and equipment to provide activities with multiple sensory inputs. These activities are developed collaboratively between child and therapist to provide appropriate sensations through movement, with the “just-right challenge” that will lead to improvement and mastery. The child’s engagement, motivation, and active involvement are key. The expected outcomes of this approach are improved sensory integration, which is demonstrated by gaining new skills, reacting with better coping behaviors, and for many, a greater willingness to try. Therapists who use ASI believe that the activities provide environmental enrichment that promotes brain plasticity and generates changes to sensory integration over time. For occupational therapists, the trademark helps differentiate this approach from the multitude of techniques now also using the term sensory processing or sensory integration. ASI is an evidence-based practice for children with autism.
Specific sensory techniques are strategies that provide sensory input for a child, with the intention that the input will help behavior or attention. Many of these techniques developed over time out of the original theory of A. Jean Ayres. However, a number of these techniques are provided passively to the child (i.e., they are done to the child, not with the child). Some of these techniques are provided on a specific schedule, rather than based on the child’s behavior in the moment and the child’s apparent needs. Many of these techniques do not promote the child’s mastery or skill in any fashion. As a whole, specific sensory techniques do not meet the guidelines established for ASI intervention. They are related but not the same as ASI. Examples of specific sensory techniques include the Wilbarger brushing program, weighted vests, and the Astronaut Program. A sensory diet is often created out of a combination of specific sensory techniques and is typically provided on a schedule, rather than based on a student’s needs in the moment.
For occupational therapists: Specific sensory techniques are not evidence-based practices and therefore are not typically supported by the OT practice guidelines. However, there could be some individuals who would, in fact, benefit from some of the techniques. Therefore, there are times when they are appropriate to trial with individual students. In those cases, best practice suggests the technique(s) should be trialed one at a time, using data-based decision-making practices, and single-subject research methods to ensure behavior change.
In order to efficiently use sensation, it must be variously attended to and ignored when appropriate. Two processes are very important. A student should be able to notice when a sensory experience is new and be able to pay attention to it, for example, responding appropriately to a knock on the door, an object coming through the air toward them, a touch on the arm, a change in the surface one is walking on. But just as important, a student must be able to ignore sensory inputs that are not important, for example, the feel of a shirt on one’s back, the humming of a fan, the ticking of a clock, the movement of the flag blowing in the wind, seen out of the corner of one’s eye. Some students may have difficulty with either of these processes and may either appear inattentive or become overly distracted by sensations others are not bothered by. In addition, some students will seek out “extra” sensation because they don’t experience it strongly enough at typical levels, or because it is calming to them in some way. They may seek constant movement or may touch everything. They may seek sensation to help pay attention. The reality is that we all use sensation to help us pay attention and to calm ourselves when stressed. Think about a soothing hot bath or massage, or a leg shaking, a finger tapping, gum chewing, or pen clicking that you might do when having to listen to a lecture. Students may be trying to do the same things, although sometimes in unconventional ways.
There are many ways to approach these issues, but the primary ones are 1) trying to change the child’s sensory processing using ASI; 2) providing specific sensory techniques to try to alter the student’s behavior and attention in the moment; or 3) modifying the environment to remove the bothersome sensation and providing sensations that are helpful. Generally, in the school environment, the second and third approaches are most common. In relation to the C-SEA, we are going to focus on #3.
The proposed outcome of completion of the C-SEA is to make environmental modifications, which means that one thing or multiple things in the classroom or school environment are altered, with the specific intention to improve student behavior, focus, engagement, or attention.
Modifications generally either reduce exposure to certain sensory stimuli that are distracting or bothersome, or increase exposure to other sensory stimuli that are more calming.
Modifications can reduce stress and anxiety for students, improve their ability to pay attention, and in turn, improve behavior. Research is just beginning to examine these practices, but to date, results have been positive.
Bodison, S. C., & Parham, L. D. (2018). Specific sensory techniques and sensory environmental modifications for children and youth with sensory integration difficulties: A systematic review. American Journal of Occupational Therapy, 72(1), 1-11. doi: 10.5014/ajot.2018.029413
Kuhaneck, H., & Kelleher, J. (2018). The classroom sensory environment assessment as an educational tool for teachers. Journal of Occupational Therapy, Schools, & Early Intervention, 11(2), 161-171.
Parham, L.D., & Mailloux, Z. (2020). Sensory integration. In J. O’Brien & H. Kuhaneck (Eds), Case-Smith’s Occupational Therapy for Children and Adolescents. (pp. 516-549). Maryland Heights, MO: Mosby (Elsevier).
Parham, L. D., Roley, S. S., May-Benson, T. A., Koomar, J., Brett-Green, B., Burke, J. P., ... Schaaf, R. C. (2011). Development of a fidelity measure for research on the effectiveness of the Ayres Sensory Integration intervention. American Journal of Occupational Therapy, 65(2), 133-142.
Reynolds, S., Glennon, T. J., Ausderau, K., Bendixen, R. M., Kuhaneck, H. M., Pfeiffer, B., ... Bodison, S. C. (2017). Using a multifaceted approach to working with children who have differences in sensory processing and integration. American Journal of Occupational Therapy, 71(2), 1-10. doi: 10.5014/ajot.2017.019281
Smith Roley, S., Mailloux, Z., Kuhaneck, H., & Glennon, T. (2007). Understanding Ayres' sensory integration. AOTA Continuing Education article CEA0907. https://digitalcommons.sacredheart.edu/cgi/viewcontent.cgi?article=1017&context=ot_fac
Watling, R., Kuhaneck, H., Parham, L. D., & Schaaf, R. C. (2018). Occupational therapy practice guidelines for children and youth with challenges in sensory integration and sensory processing. Bethesda, MD: AOTA Press.