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Early Identification and Intervention of Sensory Issues in the Birth to 3 Years Population
Stacey Szklut
Executive Director
South Shore Therapies
Weymouth, Massachusetts
This CE Article was developed in collaboration with AOTA’s Sensory Integration Special
Interest Section. It was published in OT Practice Magazine October 27, 2014. It is copyrighted
through AOTA and cannot be reproduced in any way. This is for personal use only.
ABSTRACT
Occupational therapy practitioners in early intervention settings work with families to improve
infant and toddler abilities to participate in daily routines within natural environments.
Occupational therapy practitioners using a sensory integration frame of reference can promote
early identification and intervention of sensory issues in these children to enhance self-
regulation, social-emotional connections, motor development, play, and activities of daily living.
This article will identify early markers of sensory processing dysfunction and present assessment
and intervention strategies to support infants and their families in successful participation in
meaningful occupations.
LEARNING OBJECTIVES
After reading this article, you should be able to:
1. Identify five developmental areas for early intervention by occupational therapy
2. Recognize four early markers of sensory processing issues in the birth to 3 year population
3. Identify appropriate assessment tools to use with infants and toddlers
4. Recognize three components of collaborative consultation
INTRODUCTION
Early sensory experiences that occur during daily activities are essential in facilitating young
children’s ability to connect emotionally with and learn about the world. Through the comfort of
early touch and the security of positive eating and sleeping experiences, babies and their
caregivers develop successful daily routines. Over time, sensory exploration contributes to the
development of body awareness and motor skills, perception and planning, social engagement,
and play. When the young child has difficulty effectively processing these early sensory
experiences, regulatory, behavioral, and motoric concerns may manifest that impede successful
participation in daily occupations. Early recognition and intervention for these difficulties are
important. An occupational therapy practitioner using a sensory integration frame of reference
can be integral to promoting the child’s ability to interact successfully and participate in daily
experiences with caregivers in varied contexts.
Under the Individuals with Disabilities Education Act (IDEA) Part C, occupational therapy
services are provided for infants and toddlers at risk for or with developmental delays or a
diagnosed physical or mental condition, in order to enhance the families’ ability to care for the
child (American Occupational Therapy Association, [AOTA], 2011). Practitioners are
encouraged to use a variety of frameworks, including a sensory integrative approach. The
occupational therapy practitioner’s role in early intervention is to support and facilitate five
developmental domains:
Social-emotional areas, such as self-regulation, social participation, and play
Adaptive functions, including eating and self-care
Physical development to promote movement for exploration, positioning, and hand use
Cognitive abilities to notice and attend to objects, sequence daily routines, and generalize
skills
Communication through facilitation of social interactions, play, and assistive devices, as
needed (AOTA, 2011).
Early intervention for sensory processing difficulties can support growth and development in
each of these foundations and enhance the family’s ability to care for the child. In addition, a
sensory integration frame of reference can help caregivers frame unusual responses and
behaviors, prevent secondary problems from occurring for the child, and improve family life
(Miller & Fuller, 2006).
PREVALENCE AND CAUSAL RELATIONSHIPS
Approximately 16% of typically developing infants and toddlers in the United States
demonstrated scores in the extreme range in the normative data sample for the Infant and
Toddler Sensory Profile (Dunn, 2002). There is evidence to suggest that the prevalence of
sensory issues is greater for children diagnosed with autism spectrum disorders (ASDs) or
attention deficit hyperactivity disorder (ADHD). In a comparative study of children ages 3 to 6
years old using the Short Sensory Profile, Tomchek and Dunn (2007) found that 95% of children
with ASDs exhibited some degree of sensory processing dysfunction and performed significantly
differently from typical peers on 92% of the items. Parush, Sohmer, Steinberg, and Kaitz (2007)
identified 65% of their sample of school-aged boys with ADHD as demonstrating tactile
defensiveness.
Potential risk or causal factors that may contribute to sensory processing disorder (SPD) are
beginning to be investigated. A retrospective chart review completed by May-Benson, Koomar,
and Teasdale (2009) examined the incidence of pre-, peri-, and postnatal birth and developmental
problems in 1,000 children with SPD. An average of seven events, including pre-natal/pregnancy
problems, delivery complications, assisted delivery, gestational or birth-related injuries or
illnesses, early childhood illnesses or injuries, infancy or early childhood developmental
problems, and delayed early developmental milestones were associated with later identification
of SPD. The incidence of jaundice in the SPD group was three to four times higher than the
national sample and was found to be linked with delayed motor skills. Other complications
higher than the national sample included breech presentation, cord wrap/prolapse, deliveries
requiring forceps or suction, and high birth weight. Among high-risk infants, sensory issues are
closely related to temperament, coping, behavior, and activity levels. Case-Smith, Butcher, &
Reed (1998) found that infants born prematurely had more frequent tactile defensiveness as well
as higher sensory-seeking behaviors and activity levels. Caregiver report significantly linked
sensory responsiveness to temperament. Similarly, DeSantis, Coster, Bigsby, and Lester (2004)
found that infants who demonstrated more hours of fussing showed less efficient sensory
processing, poorer coping with the environment, and more attention/hyperactivity problems at
ages 3 to 8 years. In their infant sample of 28 babies with colic, 75% of had atypical behavioral
responses to sensory events. Cermak and Daunhauer (1997) found that a sample of 3-to-6 year
old children adopted from Romanian orphanages scored significantly poorer on sensory domains
and behavioral measures, including activity level, feeding, organization, and social-emotional
responses. This data supports the importance of early intervention using a sensory integration
frame of reference to ameliorate the detrimental impact of SPD on temperament, coping, and
behavior.
EARLY IDENTIFICATION OF SENSORY ISSUES
There are many factors that can affect the early recognition of sensory-based issues inyoung
children. Because of the relationship between sensory issues and medical, regulatory, and
behavioral concerns, it can be challenging to isolate sensory processing dysfunction. It is
common for well-meaning relatives and doctors to play off issues as “he’s just a boy,” or “he’ll
grow out of it.” Sensory issues can be identified medically as colic, poor eating, or challenging
temperament.
Sensory and Motor Foundations
Participation difficulties in infants and children may have foundation in sensory modulation
difficulties, poor sensory discrimination, or a combination of both. In addition, praxis issues may
affect development of functional skills.
Sensory modulation is the ability to quickly evaluate an incoming sensation for relevance and
respond appropriately. It underlies the ability to respond to threatening events, regulate in varied
situations, and maintain functional arousal for successful participation. Individuals with sensory
modulation difficulties who are over responsive frequently misperceive daily sensory events as
threatening. They experience sensory defensiveness. Those who are under responsive display
poor registration and awareness of potentially threatening events, such as touching a hot stove or
mouthing a sharp object.
Sensory discrimination is the ability to discern the salient sensory qualities of sensory input. .
Accurate discrimination and labelling of sensation provides clarity about what is happening to
our body and underlies the understanding of prepositional and directional concepts. It is also the
foundation for developing body awareness, motor coordination and motor planning.
Praxis connects the ability to generate ideas with formulating and executing an action plan. A
key component of praxis is the adaptation of ideas or plans when an action plan is not effective.
Praxis allows the child to explore and adaptively interact with the world as well as learn new
motor skills. (Watling, Koenig, Davies, & Schaaf, 2011)
Participation
Difficulties effectively integrating incoming sensations manifest in the birth to 3 years
population in a variety of ways and affect foundational areas that influence successful
participation. Sensory modulation issues can significantly impact early bonding, regulation,
sleep, and eating. This can be extremely challenging for new parents who cannot find ways to
provide basic care to their inconsolable baby. Over time, sensory discrimination and praxis
issues may become more apparent in the toddler’s inability to successfully participate in age-
appropriate activities of daily living (ADLs), motor, and play skills. In addition, behavior, that
reflects a mismatch between capabilities and environmental demands may become more notable
and challenging over time.
Regulation
The first signs of SPD are often due to poor sensory modulation that affects the infant’s ability to
regulate outside the womb. Babies with poor regulation exhibit frequent-to-constant crying and
can be inconsolable. The baby is often described as “colicky,” and it can be difficult to
distinguish gastrointestinal distress from sensory overload. Over responsiveness to sights and
sounds manifests in strong startle responses and distress with bright lights and unexpected
noises. These babies can become upset by head movement, such as being laid down for diaper
changes. Toddlers with sensory defensiveness often appear uncomfortable; they may look, as
described by one parent, like they want to “crawl out of [their] skin.”
Bonding and Connection
Social-emotional skills begin to develop in early life, starting with parent bonding, and expand
over time, allowing the child to participate in a variety of social environments (Case-Smith,
2013). Over responsive babies resist being held or cuddled, and they may cry, pull away, or arch
their backs to show their distress. Avoidance of eye contact, also indicative of sensory overload,
makes it harder to engage the young child. This affects the natural give and take of joyful smiles
and interactions. Toddlers with SPD are late to develop gestures and don’t enjoy the typical
interactive games, such as peek-a-boo (Sensory-Processing-Disorder.com, n.d.). Some children
exhibit extreme preferences for specific adults, which can be based on sensory characteristics,
such as tone and tempo of voice, smell, and touch (handling). Others exhibit severe separation
anxiety when left with a less familiar person.
Behavior
When infants, toddlers, and young children struggle with appropriately modulating incoming
sensations, it manifests in a wide range of behaviors, from appearing oblivious to people
andsurroundings, to overreacting to small changes (e.g., having a different cup at lunch). Young
children with over responsivity frequently exhibit strong reactions to small problems, inability to
switch moods or activities effectively, and extended tantrums. Delayed discrimination manifests
in a poor sense of personal space, with increased force in interactions. Sensory-seeking behaviors
can indicate the child’s effort to regulate through pursuing organizing inputs such as mouthing,
rocking, jumping, running, and crashing. In severe cases, children may engage in significant
aggressive behaviors or self-injury. Children with deficit body awareness may also seek intense
input to help them “find their bodies.” These behaviors can affect participation in daycare,
playgroups, and recreational activities.
Sleep
Poor sleep can exacerbate regulation and behavior issues as well as affect health. As described in
the literature, sleep involves a disengagement from the environment that is characterized by
selective “arousability” to meaningful stimuli (Carskadon & Dement, 1994). Young children
with sensory modulation issues have difficulty responding appropriately to meaningful stimuli.
This can affect their ability to fall asleep, stay asleep, and soothe themselves back to sleep,
impairing the establishment of predictable sleep-and-wake patterns. These children may require
excessive help and time to fall asleep. Specific routines and sensory stimulation may be needed,
such as particular sounds, lighting, pajamas, comfort items, or needing the caregiver to lay with
them. Young children may seek out organizing sensations through rhythmical activities, such as
sucking, rocking, or head banging. Caregivers may report a continuum of sleep length, from
babies who sleep only 30 minutes at a time to those who sleep all the time.
Eating
Early signs of feeding difficulty are quickly observed when babies have poor regulation and
cannot calm to eat. Babies may arch, pull away, and demonstrate gagging or choking if they are
not able to coordinate sucking and swallowing with breathing. Over time, the child with feeding
issues may not tolerate food transitions (e.g., cereals, purees, soft cubes, mixed textures). They
may refuse new foods and gag or vomit when they do try something. Muscle weakness and poor
sensory discrimination can also influence feeding skills. The child with delayed discrimination
may have trouble gauging an appropriate bite size, pocket food, and exhibit a weak suck and
chew.
It is common for children to go through phases of picky eating, generally of short duration.
Research indicates that the onset is typically in early childhood, declining to much lower levels
by age 6 years (Mascola, Bryson, & Agras, 2010). A problem eater, who will require
intervention, is one who eats fewer than 20 foods, with little variation in type, color, and texture
of preferred foods (Toomey, 2008). New foods are not easily added to the child’s repertoire,
despite persistent tries, and the presentation of new foods often evokes dramatic behavioral
reactions. Additionally, the child may go through “food jags,” in which he or she will only eat
the same food prepared the same way every day. A problem eater may suddenly refuse this food
and not add it back into his or her diet , thereby decreasing the food repertoire. These children
typically do not take in enough calories or nutrition, resulting in poor weight gain, growth, and
energy levels, which can significantly affect participation.
ADLs
White, Mulligan, Merrill, and Wright (2007) found that school-age children with atypical scores
on the Sensory Profile had significantly more functional difficulties in ADLs. Young children
who exhibit poor sensory modulation with over responsiveness strongly resist daily hygiene
tasks, such as diaper changes, bathing, nail clipping, hair washing, and tooth brushing. Clothing
textures can be an issue. Some children will have very strong predilections for clothes they can
tolerate, choosing either loose- or tight-fitting clothes. Others may prefer to be without clothing
at all. Children with under responsiveness or poor discrimination present an opposite profile of
not noticing soiled diapers, dirty faces, or crooked clothes . Because of poor body awareness and
motor planning, they may be slow to develop independence in dressing and other self-care skills.
Motor Development
Occupational therapy practitioners frequently focus on the development of motor skills to
promote functional outcomes, such as play and social interactions (Case-Smith, Frolek Clark, &
Schlabach, 2013). Although delayed motor milestones or neuro-motor dysfunction may be very
noticeable, sensory-motor signs in early childhood may be subtle. Young children exhibiting
touch sensitivity may keep hands fisted and resist exploring textured toys. Avoidance of crawling
and toe walking can be influenced by tactile sensitivity in the hands and feet. Babies with
vestibular sensitivity often resist head movement through space. They may prefer to stay in one
position, limiting the development of trunk rotation and smooth transitional movement patterns
needed for environmental exploration. May-Benson et al. (2009) found differences in both the
length and pattern of crawling in young children with SPDs. It is not unusual to observe poor
midline orientation (eyes, mouth, and hands) and decreased ability to use hands well together for
tasks such as holding a bottle, banging objects, and switching them from hand to hand. Children
with decreased sensory discrimination appear uncoordinated and clumsy, falling frequently and
bumping into things. The development of utensil use is typically delayed. Poor motor control and
planning also affect play skills, as the child may have difficulty engaging with toys or
playground equipment.
Daily Occupations
Daily occupations for young children often involve exploring new and familiar environments,
such as accompanying caregivers on errands and participating in family gatherings. Those
experiencing over responsivity are frequently distressed in public places and may exhibit flight,
fright, and fight behaviors, such as hiding under tables; running from the room; and pushing,
hitting, or biting. In chaotic situations, the child may demonstrate behavior that is frenetic and
out of control. When the young child has trouble self regulating , the caregiver has to be vigilant
at all times, trying to control the environment and instructing others on how to interact.
ASSESSMENT OF SENSORY ISSUES IN CHILDREN BIRTH to 3 YEARS
A comprehensive assessment should include parent interview and questionnaires, structured
testing, and observations of the child participating in daily occupations. All data gathered should
be considered in relationship to the referral concerns, background information, and parents’
hopes and goals.
Parent Information
Parent interview can provide essential information for assessment and intervention planning.
Gathering background information about pre-, peri-, and postnatal experience will highlight
medical and developmental concerns. By asking leading questions about daily routines, patterns
of sensory reactions, motor development, behavioral responses, and participation difficulties, a
complete profile will begin to emerge. The interview process allows parents to share their
perspectives and concerns and begin to develop a working relationship with the occupational
therapist. Listening carefully and asking questions that connect to the parents’ observations are
more successful than having a pre-set list of questions.
Parent questionnaires are considered an efficient means of gathering information, as the parents
can complete them in their own time frame and gather additional observations regarding daily
functioning across varied contexts (Eeles et al., 2012). Eeles et al. (2012) recommended the
Infant/Toddler Sensory Profile (ITSP) (Dunn,2002). for children birth to 2 years because of its
psychometric testing and theoretical principles based in neuroscience, sensory processing, and
occupation. The ITPS covers children birth to 36 months, designed to guide intervention
planning through determining the effect of sensory processing on the young child’s ability to
participate in play, learning, and social opportunities. Dunn is in the process of revising this tool
and separating it into two checklists—for infant, ages birth to 15 months, and toddlers, 15 to 36
months.
The Sensory Processing Measure (SPM) for Preschoolers was developed for young children 2 to
5 years old to support the identification and treatment of sensory processing difficulties
(Kuhaneck, Ecker, Parham, Henry, & Glennon,2010). Normative data was completed separately
for 2 year olds and 3- 5 year olds. Initial research verifies the assessment’s capability to
differentiate typical peers from those with SPD. In addition to using a sensory systems model
(e.g., vision, hearing, touch, body awareness, and balance and motion), the SPM also has
sections for planning and ideas (praxis) and social participation. There are separate forms for the
home caregiver and preschool teacher The SPM allows for three dimensions of interpretation:
individual item responses, scaled scores, and comparison of home and school environments.
Neither of these tools should be used in isolation to make diagnostic and treatment decisions.
Structured Testing
Using structured developmental assessments allows occupational therapists to observe how
children respond when specific demands are placed on them, and provides information
regarding the children’s direction following and learning styles. There are limited choices for
assessments that specifically assess sensory processing in the birth to 3 years age range. Eeles et
al.(2012) identified the Test of Sensory Functions in Infants (TSFI; DeGangi & Greenspan,
1989) as the strongest assessment to measure sensory processing in infants 4 to 18 months old.
The TSFI is a performance-based measure containing five domains of sensory reactivity and
processing (touch pressure and vestibular reactivity, visual-tactile integration, ocular-motor
control, and adaptive motor functions).
Miller has designed two standardized tests to assess toddlers and pre-schoolers. The Miller
Assessment for Pre-Schoolers (MAP) is a thorough developmental assessment for children 2.9 to
5.8 years that is divided into five performance indexes (sensory foundations, motor coordination,
verbal and nonverbal reasoning, and complex tasks) (Miller, 1998). The FirstSTEP (Miller,
1993) was designed as a screening tool for developmental delays in the five areas defined by
IDEA for children 2.9 to 6.2 years. It consists of three domains (cognition, communication, and
motor) and three optional checklists (social-emotional scale, adaptive behavior checklist, and
parent/teacher scale).
For children between the ages of 19 and 28 months, structured assessments of sensory processing
are not currently available. Observations of responsivity and integration of sensation can be
gathered while performing developmental motor assessments, such as the Peabody
Developmental Motor Scales (Fewell & Folio, 2000) orBatelle Developmental Inventory
(Newborg, 2005),
Qualitative Observations
Skilled occupational therapists using a sensory integration frame of reference can gather a wealth
of information about sensory processing and adaptive responses by observing the child engaged
in daily occupations. Providing enriched opportunities for sensory exploration, such as tactile
play with food, water, or sand, and movement through jumping, climbing, or swinging, enhance
sensory-based observations. Observations of tactile reactivity should include response to
sustained touch (e.g., clothing, seat belt), imposed touch, and unexpected touch. Incorporating
varied movement patterns (i.e., vertical, horizontal, angular, orbital, and rotational) will fully
evaluate vestibular processing. Therapists should also note how the child uses his or her eyes to
direct hand skill and movement through space as well as observe his or her ability to navigate
around static and moving obstacles, a skill that is essential for safe participation.
Qualitative assessment of praxis should include observations of ideation, motor planning, and
execution. Occupational therapists should observe if the child can anticipate what can be done
with an object. Can they spontaneously engage and vary play with novel items? Young children
with poor ideation often struggle with initiation and may repeat simple actions repeatedly, but
may be able to imitate actions (Parham, 1987). Children with poor motor planning may know
what they want to do (e.g., climb up onto the couch, take off socks), but they cannot figure out
how to move their body to be successful. They may accomplish a specific task in one context but
not generalize it to another. Because of this inefficiency, these children may have difficulty
participating in activities without a great deal of support from adults. Qualitative observations of
execution involve noting the precision and refinement with which a motor task is completed.
Execution can be affected by decreased sensory discrimination, muscle tone, strength, reflex
involvement, and other neuro-motor impairments.
INTERVENTION
Collaborative Consultation
Occupational therapy practitioners strive to facilitate participation of their young clients in
everyday life (AOTA, 2014). In the birth to 3 years population, successful participation is
enhanced when caregivers take a lead role in employing intervention strategies in the child’s
daily routines. To successfully help others administer therapeutic techniques, the occupational
therapy practitioner must understand the child’s functioning within the context of the typical
environments in which he or she participates (Szklut, 2012). Using a collaborative intervention
approach in the child’s natural environments can minimize developmental delays, maximize
successful participation, and support family functioning.
A collaborative model involves being mindful of the caregivers’ understanding of the baby’s
difficulties, family culture, beliefs, constraints, and interactional/learning style. During
collaborative consultation the occupational therapy practitioner engages the caregivers in an
interactive process, encouraging creative problem solving toward an achievable goal. It is
preferable to focus on building the parents’ capacity to design their own solutions to positively
affect their competence (Dunn, Cox, Foster, Mische-Lawson, & Tanquary, 2012). The intent is
to support key people in the child’s life to enable the child within the context of teachable
moments, such as a dressing task. The occupational therapy practitioner watches the child and
parent participating in a task and gathers information on what has been tried previously and how
successful it was. Through joint problem solving, the occupational therapy practitioner
encourages the caregiver to reflect on past experiences, building on successes and creating new
strategies. Dunn et al. (2012) used this model of reflective guidance to help parents understand
how sensory processing patterns were affecting participation and to develop strategies to meet
goals for specific activities. Results of the Dunn et al.] study also included lower levels of parent
distress, increased competence, and significant improvements in efficacy for helping their
children. The children’s ability to participate in everyday life events also increased significantly.
Components to Successful Intervention
Young children learn many pertinent social rules and contexts through watching and imitating
adults. Case-Smith (2013) found that through educating parents using coaching and feedback,
occupational therapy practitioners could promote social competence in infants by increasing the
parents’ sensitivity and responsiveness to their baby’s cues. When the parents modeled
appropriate social behaviors, reinforced the child’s attempts, and designed positive natural
consequences, social skills were enhanced. Similarly, Frolek-Clark and Schlabach (2013) found
that helping parents become more sensitive to their preterm infant’s needs and responsive in
interactions improved joint attention and cognitive outcomes. Playing alongside the child and
allowing him or her to select and pace play activities also increased joint attention.
Crafting situations where the child is interested and actively engaged is an essential component
of effective intervention. In a study of preschoolers with ASDs, Dunst, Trivette, and Masiello
(2011) integrated high-interest activities into learning opportunities. The high-interest learning
group made considerably more developmental progress in social, cognitive, and language skills.
In a review of motor-based interventions for young children, Case-Smith et al. (2013) found that
interventions based exclusively on developmental theory had minimal effects on motor
outcomes. Motor interventions embedded into meaningful play activities resulted in significant
changes in performance . Other factors that encouraged active engagement and improved
therapeutic effectiveness included cueing, shaping, motivating, reinforcing, scaffolding, and
presenting the just-right challenge.
A key role of the occupational therapy practitioner using a sensory integration frame of reference
is to work with caregivers to adapt the child’s natural environments and activities to promote
successful participation. This involves combining a strong knowledge of sensory processing and
development. Using information gathered from the assessment, skilled observations, and
ongoing parent input, the occupational therapy practitioner can assist in adapting daily routines
based on the way the child processes incoming sensations. Guiding and using examples at a level
commensurate with caregiver understanding will help caregivers become more responsive to
their baby’s needs and, in turn, respond more effectively. AOTA’s Childhood Occupations
Toolkit has excellent information on developing successful routines (AOTA, 2013).
When an infant or toddler displays difficulties in modulating incoming sensations, resulting in
sensory defensiveness, the objective would be to decrease aversive stimuli and incorporate
organizing inputs to help regulate the child’s arousal for more successful interactions and
participation. This encourages more opportunities for bonding, interaction, and early learning
throughout the day.
Examples of bath time strategies for a child with sensory sensitivities include:
Make sure the bedroom and bathroom are warm before undressing the baby.
Incorporate the use of a soft, rhythmical voice.
Keep overhead lights off.
Wash the baby with a soft washcloth using slow, consistent pressure.
Avoid splashing water on the baby.
Swaddle the baby in a soft towel, drying off one body part at a time.
When the infant or toddler exhibits modulation difficulties that cause him or her to be under
reactive to daily sensory events, the general intervention concept is to increase the intensity,
frequency, and variety of sensory input over the day during all daily routines. Enhanced sensory
experiences can encourage improved engagement and functional arousal for greater
participation.
Examples of daytime strategies for the baby who is under responsive to sensory events include:
Interact with the baby by changing voice intonation, singing, and playing music.
Move the baby frequently during the day.
Brisk massage and gentle vibration to arms and legs.
Change toys that hang on play chair, crib, etc. Try textured toys with bright colors and
sounds.
Provide mouthing objects with textures or vibration.
Vary food textures and tastes (within an appropriate diet).
When a toddler is demonstrating decreased body awareness and motor planning related to
decreased sensory discrimination, the intervention should focus on enhanced sensory experiences
and developmentally appropriate motor challenges that are graded to encourage a greater range
of adaptive responses. A key objective is to make input meaningful and describe or label it to
help the child match the sensory event with the describing word (e.g. up, down, fast, slow, etc.) .
Examples of play strategies for the toddler who has poor sensory discrimination and planning
include:
Choose play activities that reflect the interests of the child and family.
Incorporate toys and household objects that have varied sensory qualities (e.g., textures,
sounds, colors, smells).
Allow time for sensory exploration before jumping in to “help.”
Label sensory events for the child; use enhanced voice intonations and body motions
(e.g., while bouncing the child, sing “up,” with ascending tone and body motion).
Grade the amount of assistance you give the child to be successful, fading assistance as
the child can do more independently; always try to end with success.
Choose toys that are at an appropriate developmental (not age) level.
CONCLUSION
The role of the occupational therapy practitioner working in early intervention is to minimize
developmental delays, maximize successful participation, and support family functioning. A
sensory integration frame of reference provides a framework to help parents understand and
support their young child to improve self-regulation, social interactions, and participation in
daily routines. Identifying specific sensory difficulties and consulting collaboratively with
caregivers are essential to developing an effective, individualized intervention plan that focuses
on participation goals.
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How to Apply for Continuing Education Credit
A. To get pricing information and to register to take the exam online for the article Early
Identification and Intervention of Sensory Issues in the Birth to 3 Years Population, go to
www.aota.org/cea, or call toll-free 877-404-2682.
B. Once registered, you will receive instant e-mail confirmation with password and access
information to take the exam online immediately or at a later time.
C. Answer the questions to the final exam found on page CE-8 by October 31, 2016.
D. On successful completion of the exam (a score of 75% or more), you will immediately receive
your printable certificate.
Final Exam CEA1014
Early Identification and Intervention of Sensory Issues in the Birth to Three Years
Population
October 27, 2014
To receive CE credit, exam must be completed by October 31, 2016.
Learning Level: Intermediate
Target Audience: Occupational therapists and occupational therapy assistants
Content Focus: Category 1: Domain of OT; Category 2: OT Process: Evaluation, Intervention
1. Which of the following is not one of the five developmental domains AOTA recommends
addressing during early intervention occupational therapy?
A. Adaptive functions
B. Behavior management
C. Social-emotional development
D. Physical skills
2. Among high-risk children, early sensory issues are closely related to temperament, coping,
behavior, and activity levels.
A. True
B. False
3. A component of effective sensory processing is the ability to discern the salient sensory
qualities of sensory input as a foundation for body awareness, motor coordination, and motor
planning. Which of the following terms best describes this process?
A. Sensory modulation
B. Orientation
C. Sensory discrimination
D. Registration
4. Many toddlers with sensory processing disorder exhibit sensory-seeking behaviors. Which of
the following explains this pattern of behavior?
A. Seeking intense input to positively impact body awareness
B. Seeking input that feels good and is pleasurable
C. Seeking organizing inputs as a way to help self-regulate
D. All of the above
5. Which of the following is not typically an early marker of sensory processing issues in the
infant?
A. Resists being held and cuddled, may pull away, arch back, or cry
B. Cries much of the day and appears inconsolable
C. Prefers to be held and rocked to fall asleep
D. Startles and cries when laid backward to change diaper
6. Which one of the following profiles best identifies a problem eater who will benefit from
intervention?
A. A toddler who has 25 foods in his or her repertoire, refuses to eat vegetables, and will only try
new foods if his or her brother eats them
B. A toddler who has 15 foods in his or her repertoire, wants the same foods prepared the same
way every meal, and has had no new foods added to his or her diet for 3 months, despite
persistent presentations
C. A toddler who has 20 foods in his or her repertoire, craves sugary foods, and will only eat at
the table if the television is on during the meal
D. A toddler who has 20 foods in his or her repertoire, will only eat one brand of chicken
nuggets, and requires multiple presentations of the same food before he or she will taste it
7. Identify the best combination of modalities that would constitute a thorough assessment of a
child in the birth-to-3-year-old age range from the following choices.
A. Parent questionnaire, discussion with parents before testing, structured testing
B. Parent interview, parent questionnaire, structured testing, observations of child at home
C. Observations of the child at daycare, discussion with daycare provider, structured testing
D. Parent interview, parent questionnaire, observations of the child at home
8. To assess sensory processing in a 17 month old, which structured test would be the most
appropriate?
A. Infant/Toddler Sensory Profile
B. Battelle Developmental Inventory
C. Test of Sensory Functions in Infants
D. FirstSTEP
9. Young children with poor ideation often struggle with initiating task and anticipating what
they can do with an object, but they may be able to imitate actions.
A. True
B. False
10. Collaborative consultation involves which of the following concepts?
A. Interactive process
B. Reflective guidance
C. Teachable moments
D. All of the above
11. Which of the following sensory accommodations would not be appropriate for an infant with
sensory defensiveness?
A. Dim lights
B. Quiet, rhythmical music
C. Swaddling
D. Brisk, light massage
12. Which of the following concepts is the most important to consider when working with a
young child with poor discrimination and body awareness using a sensory integration frame of
reference?
A. Decreasing aversive stimuli
B. Providing meaningful input
C. Changing inputs on a daily basis
D. All of the above