Pediatric Therapeutic Services


By Pamela Girvin Hackett, MPT, with Lesley Austin Geyer, MA, OTR/LMy nephew is an intelligent, talented, 4-year-old boy who plays the piano, writes music and has the energy ofthree typical children. He also hammered more than 200 dents in our entertainment center, cannot sit for morethan two minutes in a restaurant, needs a pacifier to sleep, and struggles with potty training. His parents lovehim dearly, but his constant need for movement, stimulation and control makes each day a challenge.
“Why can’t you get him to behave?” people have asked. The answer is that these issues are the result of a sensory processing disorder (SPD), also called a sensory
integration disorder, which causes him to seek certain kinds of sensory input to feel organized or calm.
What is SPD and how does it affect children?With SPD, the body senses receive sensation normally, but those sensations are processed abnormally by the brain. As a result, these children are unable to respond in
an organized, appropriate way to sensory input. For example, a parent’s gentle, light touch to the child’s back can be perceived as extremely unpleasant by a child with SPD, as these children typically prefer a firmer touch or “deep pressure.” The child may go to extremes to control their environment in order to avoid stimuli that is perceived as noxious.
Many children with SPD have resulting delays in motor skills, social development and learning. The actual cause of SPD is not understood.
In addition to the five commonly known senses, there are two other sensory systems that are important in understanding SPD: the proprioceptive system and the vestibular system. Proprioception is the sense that tells us where our body parts are and what they are doing through sensory receptors in the muscles and joints. The proprioceptive system helps us to control the force of our movements and allows for the development of good motor skills. Input to this system tends to be calming and helps to “organize” the child with SPD.
The vestibular system provides our sense of movement and tells us where we are in relation to the ground. The receptors for this system are in the inner ear. This system impacts balance, eye movement, tolerance for movement and arousal level. These two systems work together to allow us to move safely in our environment. Some children with SPD will seek sensory input more than their typical peers. For example, my nephew liked hammering my entertainment system because banging provides input to the proprioceptive system that he finds very pleasant and calming. Other children seeking proprioceptive input may play roughly, bang into walls, kick their chair legs and jump or hop excessively.
Children who seek input to their vestibular system will often need to constantly be “on the move” and will have trouble sitting still. Conversely, other children with a different type of SPD will avoid sensory input more than their peers. Tags on clothing and seams on socks will irritate them immensely, they may become upset in settings with lots of noise and/or they will avoid movement activities. Many children show a combination of these two types of SDP and will excessively seek out certain types of sensory input while showing strong avoidance of others.
Often misdiagnosedWhile SPD is often associated with other disorders such as ADHD, developmental motor coordination disorder or autism, it can exist alone. Children with SPD are often misunderstood by teachers, parents and even their own peers. So often, the challenges these children experience with attention, learning, social interaction and
motor skills are attributed solely to other associated diagnoses. As a result, families and school staff often miss an opportunity to address a key underlying cause of these functional problems.
Children with SPD can benefit greatly from input from an occupational therapist (OT), who is trained in evaluating and treating sensory disorders. When an OT began consulting with my nephew’s preschool staff, issues such as jumping up and running off during circle time, refusal to participate in “messy” activities, and poor attention improved dramatically as the teachers were instructed on ways to help him get the sensory input he needed in ways that were less disruptive and more socially acceptable.
For school-age children, OTs can develop a “Sensory Diet” that gives children the access they need to regular sensory input in a classroom setting. This might involve
setting up a program of “heavy work activities” that provide lots of input to the proprioceptive system, such as erasing the blackboard, moving chairs and doing standing push-ups against a wall. It might also include providing an air-filled cushion to provide subtle movement (and thus provide input to the vestibular system), whilethe child is in a seated position.
While there may be need for actual direct therapy sessions to address the problems these children face, consultation with the family for carryover of the sensory program in the home and teacher training to develop and adapt the classroom-based sensory program are critical to the success of the intervention. When a program is implemented in the home and classroom, the benefits are carried through the child’s entire day, improving function and attention in places where it matters most.
Education and training from the OT helps teachers understand the difference between SPD and “bad behavior.” Pediatric Therapeutic Services, Inc. (PTS) is committed to empowering teachers to help these students, and provides regular in-service trainings to the staff in the school districts we serve at no cost. As a result, PTS has been able to foster a culture of support and tolerance where there had previously been years of misunderstanding.
What do you do if you suspect a Sensory Processing Disorder?If you suspect that your child may have a sensory processing disorder, you may request an evaluation through your county’s early intervention agency (for children who
are not yet school-age) or through your child’s school district.This evaluation generally includes a sensory questionnaire which allows both parents and teachers to provide
information on how the SPD is affecting the child’s functional abilities. To receive services from an OT, most schools will require that your child be eligible for special education services or have a diagnosed disability that significantly affects function. It is important to note that, once a child is school-aged, only SPDs that are interfering with a child’s ability to access his educational curriculum can be addressed by the school’s OT.
Pediatric OT clinics are also available, should your child be ineligible for school-based services.
When any professional works with a child with SPD, parent input is crucial. No one knows your child as well as you do, and the information you can provide regarding what calms and what overstimulates your child is critical to the development of a successful intervention plan. To view a symptoms checklist, visit
Today, my nephew is thriving at his preschool, thanks to the early intervention provided by occupational therapists experienced in managing SPD in an education setting. His teachers have been instructed in effective ways to meet his sensory needs and identify problems before they occur. Despite all the challenges children with SPD face, with understanding and the right supports, they can mature into well-adjusted, successful individuals.
Pamela Hackett, MPT is the co-owner and co-founder of Pediatric Therapeutic Services, a Conshohocken-based company providing therapy services in school districts, charter schools and intermediate units in the Delaware Valley. The company’s innovative approach to school-based therapy services has positively impacted the lives of students and teachers throughout the area. For more information, visit
Lesley Austin Geyer, MA, OTR/L is executive director with Pediatric Therapeutic Services. In addition, she is president of the board of directors for the Pennsylvania Tourette Syndrome Association and is active in working with families affected by this condition.
Parent Resources• “The Out-of-Sync Child: Recognizing and Coping with Sensory Processing Disorder, Revised Edition” by Carol Stock Kranowitz (1995)

• “Sensory Processing Disorder Answer Book” by Tara Delaney (2008)

• “Raising a Sensory Smart Child: The Definitive Handbook for Helping Your Child with Sensory Integration Issues” by Lindsey Biel, Nancy Peske (2005)
• “Too Loud, Too Bright, Too Fast, Too Tight: What to Do If You Are Sensory Defensive in an Overstimulating World” by Sharon Heller (2004)
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