The Electronic Scoring for The SPMs with The SPM Quick Tips 4/12/2013
Henry, Olson, Herzberg and Kartik 1
The Electronic Scoring for The Sensory The Electronic Scoring for The Sensory Processing Measures (SPMs) with Their Processing Measures (SPMs) with Their
New SPM Quick TipsNew SPM Quick TipsGuides Us Towards Answering: Guides Us Towards Answering:
“What do I do next?”“What do I do next?”93rd Annual AOTA ConferenceApril 26 2013: San Diego CA
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April 26, 2013: San Diego, CASC 234 _3:30 PM – 5:00 PM
Room #: CC 25 CDiana A. Henry, MS, OTR/L, FAOTADiana A. Henry, MS, OTR/L, FAOTA
Henry OT Services Inc. Henry OT Services Inc. [email protected]@aol.com
Carol H. Olson, PhD, OTR/LCarol H. Olson, PhD, OTR/LUniversity of MaryUniversity of [email protected]@umary.edu
David S. Herzberg, PhD and Kartik Chandar David S. Herzberg, PhD and Kartik Chandar Western Psychological Services Western Psychological Services
References are attached
Sensory Songs for Tots Sensory Songs for Tots ChorusChorus
Here they are, these parts of meHere they are, these parts of meAll together, on my bodyAll together, on my bodyI’ll know them all soon you will seeI’ll know them all soon you will see
Challenging your praxisChallenging your praxis
I ll know them all, soon you will seeI ll know them all, soon you will seeStanzasStanzas
Nose, toes, knee caps, and tummyNose, toes, knee caps, and tummyChin, shin, shoulders, and my feetChin, shin, shoulders, and my feetEyes, thighs, elbows, and my earsEyes, thighs, elbows, and my ears
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‘‘here’s my nose’here’s my nose’Knee cap, toes, tummy, noseKnee cap, toes, tummy, nose
Nose, toes, knee caps, and tummyNose, toes, knee caps, and tummy
Sh ld hi f t hiSh ld hi f t hiShoulders, chin, feet, shinShoulders, chin, feet, shinChin, shin, shoulders, and my feetChin, shin, shoulders, and my feet
Elbows , thighs, ears, eyesElbows , thighs, ears, eyesEyes, thighs, elbows, and my earsEyes, thighs, elbows, and my ears 33
ObjectivesObjectivesFacilitate clinical reasoning and team collaboration using the SPM Quick Tips
View a customized set of SPM and SPM-P Quick Tips via 2 case studies
Use the electronic online administration and scoring of the Sensory Processing Measures
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My colleagues and coMy colleagues and co--authors of the SPMsauthors of the SPMs
Tara J. Glennon, EdD, OTR/L, FAOTAHeather Miller-Kuhaneck, PhD, OTR/L, FAOTA
Cheryl Ecker, MA, OTR/L, BCPL. Diane Parham, PhD, OTR/L, FAOTA
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The Sensory Processing MeasuresThe Sensory Processing Measures
SPM (5-12 yrs) SPM-Preschool (2-5yrs)
Additional School Environments: Music, Art, PE,
Recess/ playground, Cafeteria and Bus 66
For more info: visit booths:# 511 WPS
# 430 Henry OT
The Electronic Scoring for The SPMs with The SPM Quick Tips 4/12/2013
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Development of Development of SPM Quick TipsSPM Quick Tips
"The invariable mark of wisdom is to see the miraculous in the common.”
Ralph Waldo Emerson
Q pQ pWhile working on the ‘The SASI’ (pre SPM)
School Assessment of Sensory Integration
Collaborated with Danette Rowley, OT in Canada 77
Early Quick Tips in 2004Early Quick Tips in 2004
88
When SASI became SPM in 2007 When SASI became SPM in 2007
Obtained permission from WPS, the publisher of the SPMs, to be able to relate the Quick Tips to actual SPM items
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Held focus groups at workshops worldwide during optional
‘Lunch with Diana’ to obtain ideas/feedback regarding Quick Tips
Katie Allgood, Kathy Barrett, Colleen Basaraba, Rena Baxter, Danielle Bell, Cheryl Domino, Dave Herzberg, Debbie Hinerfeld, Jennifer Brady- Johnson, Sarah Johnson, Heather Miller-Kuhaneck, Cristy Mendoza, Victoria Nackle, Amy Niezrecki, Carol Olson and her graduate students, Diane Parham,
It does take a village!It does take a village!
Thomas Passerino, Jocelyn Reynolds, Pat Rose, Rick Ruess, Kathy Sanders’ team, Deanna Sava, Jim Spear, Sue Swindeman, Monique Taylor, Kris Tuma, Renee Watling, Deb Wilson, Maureen Kane-Wineland, Janet Wright, workshop attendees throughout North America, England, Scotland, N. Ireland, Ireland, Australia….and many more! Thank You ! 1010
SPM & SPMSPM & SPM--P Quick Tips User GuideP Quick Tips User Guide
GUIDED BY CLINICAL REASONINGConsidering the ‘Big Picture’
INTERPRETATIONSorting
CASE EXAMPLESCase A: ModulationCase B: Psycho-socialCase C: Postural (VBI)Case D: Praxis Sorting
PROCEDURES TO CONSIDER When suggesting SPM QTs
TEAM EDUCATION
RECORDING DATATracking the
implemented strategies
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PROCEDURES TO CONSIDER WHEN PROCEDURES TO CONSIDER WHEN SUGGESTING SPM Quick TipsSUGGESTING SPM Quick Tips
Addressing the underlying deficits Providing family/staff/peer training to increase awareness change attitude and interaction skills
Each Quick Tip focuses on either: Each Quick Tip focuses on either:
awareness, change attitude and interaction skills, provide support and share resourcesTeaching self advocacyAdapting task / materials / equipment / environment Using cognitive and/or behavioral strategies to teach social skills and support social participation
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The Electronic Scoring for The SPMs with The SPM Quick Tips 4/12/2013
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Quick Tips addresses cafeteria aide’s Quick Tips addresses cafeteria aide’s concerns too!concerns too! Put applesauce in a cup
with a lid and use a straw, so it is not apparent that it is applesauce
Give him thick yogurt drink and drink that with a straw
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Use gum etc as a transition tool on the way to lunch.
Have the student explain his sensory seeking and oral motor needs
Have the student take responsibility in cleaning up his mess
Lane, S. J., & Lynn, J. Z. (2011).Sensory Integration Research:
A look at past, present, and future.
Sensory Integration Special Interest Section Quarterly, 34(3), 1-4.
Intervention researchIntervention research Examine effectiveness of therapeutic techniques with ASI™
Outcomes Focused ResearchClear identification of intervention outcomes
These charges can an also be appliedto sensory–based strategies
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Spiral Foundation Research ForumSpiral Foundation Research Forum
March 24, 2013 (left to right)Diana HenryDiana HenryDiane ParhamDiane ParhamAyelet Ben SassonAyelet Ben SassonTina ChampagneTina ChampagneBrian MullenBrian MullenDavid Lewkowicz David Lewkowicz
Teresa MayTeresa May--BensonBensonKaren AdolphKaren AdolphSimone GillSimone GillEllen CohnEllen CohnRosanne SchaafRosanne SchaafJanice Burke (moderator)Janice Burke (moderator)
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, ( g )
How do school based therapists How do school based therapists choose what strategies to use? choose what strategies to use?
Collins, A., & Dworkin, R. J. (2011)Pilot study of the effectiveness of weighted vests
Conclusion: Conclusion:
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Results indicated that weighted vests were noteffective in increasing time on task.The lack of an established treatment protocol strengthens the need to use intervention with systematic data collection.
Johnson, A. (2013). Johnson, A. (2013). Growing Pains or Growing Pains or
Cause for Concern? Cause for Concern? Wall Street Journal Wall Street Journal
Teacher referred child
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to pediatrician for ‘licking his
shirt’
Mulligan and TrolleyMulligan and Trolley--Hanson Hanson (AOTA, 2012)*(AOTA, 2012)*
Naturalistic interventions in context of daily living at school, home and in the community Change from us being the expert, to team
b b i h i h imembers being the experts in their environmentsImportant to include data to see if what we are doing is working
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**Early Intervention for Young Children with ASD
The Electronic Scoring for The SPMs with The SPM Quick Tips 4/12/2013
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SPM Quick Tips processSPM Quick Tips processClinical reasoning following use of the SPMsHypothesis generationItem analysis and sorting of QTTeam empowerment & brainstorming ideas for i di id l i t i h l & hindividual environments in school & homeIntervention, including sensory-based strategiesRecording what was doneRe-testing using SPM and other toolsCharting outcomes
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SPM Quick Tips are SPM Quick Tips are
Color coded and easy to useDigital and fast Able to be sorted by
Sensory systems across environmentsVulnerabilities (OR, UR, postural control etc)Praxis (ideation, motor planning)EnvironmentsSocial participation
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vestibular
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“Sensory challenges may also impact the child’s thought processes and
fallback action choices when dealing with frustrations” (Orloff, 2012)
2222
SPM Quick Tips are SPM Quick Tips are NOTNOTPrescriptive
A ‘cliff note’ for OT/SI (ASI™)
A cookbook of activities based on problematic behavior and diagnosis
A pre-designed plan to provide to teachers and parents
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** 2006 (Opatia) Dx: ED: social participation…praxis2006 (Opatia) Dx: ED: social participation…praxis* 2007 (Dustin) Dx: ADHD… Also sensory issues?* 2007 (Dustin) Dx: ADHD… Also sensory issues?* 2008 (CCNS) Dx: Autism…severe (self contained)* 2008 (CCNS) Dx: Autism…severe (self contained)* 2009 (A) Dx: Autism…preschooler…praxis* 2009 (A) Dx: Autism…preschooler…praxis* 2010 (Declan): Expelled from Montessori * 2010 (Declan): Expelled from Montessori * 2011 (QT) Kg: Vestibular* 2011 (QT) Kg: Vestibular--posturalpostural-- bilateral bilateral
* 2012 (Mason) Dx: Severe LD…Praxis* 2012 (Mason) Dx: Severe LD…Praxis* 2012 (National and international case studies)* 2012 (National and international case studies)
* 2013 (John): Behavior prob... OR to sound/touch* 2013 (John): Behavior prob... OR to sound/touch* 2013 (Bismarck ND preschool study): Prevention* 2013 (Bismarck ND preschool study): Prevention
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The Electronic Scoring for The SPMs with The SPM Quick Tips 4/12/2013
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John, John, his his
wonderful wonderful
SPM Quick Tips: JohnSPM Quick Tips: JohnJanuary January ––March 2013March 2013
11stst gradegradeteacher,teacher,
and some and some classmates classmates
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Main ClassroomMain Classroom
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Struggles in MusicStruggles in MusicStrategies used: 1.Take
away recess
2 Send to
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Tired?Seeking touch pressure?
Are the sounds disorganizing?
2.Send to principal’s office
HomeHome
ClimbingClimbingand and
LegosLegos
Happy at homeHappy at home
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But sounds But sounds are too loudare too loud
Initial Initial SPM test scoresSPM test scores
JohnJohnMain ClassroomMain Classroom
TOT Raw = 95SD 72
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SD = 72% =
98 to 99 % do better:1to 2 percentile
Material from the SPM copyright © 2007 by Western Psychological Services. Reprinted for
scholarly and professional presentation by permission of the publisher, WPS. All rights
reserved ([email protected])
Social participation
Team Meeting: Jan 11, 2013Team Meeting: Jan 11, 2013
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Student teachers for main classroom and music, 1st grade teacher, private OT, RtI, Diana,
parent, art and PE teacher
The Electronic Scoring for The SPMs with The SPM Quick Tips 4/12/2013
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Difficulty discriminating what is important when presented verbally or by light touchProtects self by:
Team education re Team education re Over responsivity to touch & to sound Over responsivity to touch & to sound
3131
Tuning out /Turning away Choosing to be last Isolating & avoiding crowded situations
Being defiant Sensory seeking: muscle and movement input
Sorted: OR across sensory systemsSorted: OR across sensory systems
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Using a Using a divider…divider…for othersfor othersfor others for others
too too ☺☺
3333
Team education re Team education re Sensory SeekingSensory Seeking
When a child is over responsive to touch and to sounds, he may seek movement and muscle input to regulate his state of arousal
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Adding muscle input to an activity adds feedback from the body and provides a calming influence
Loves PE as gets Loves PE as gets input he needsinput he needs
Presses body Presses body against wall to against wall to
regroundreground3535
Prop and vestib across environmentsProp and vestib across environments
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The Electronic Scoring for The SPMs with The SPM Quick Tips 4/12/2013
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TransitionsTransitions
3737Allowed to wear his coat
Team education reTeam education reSocial ParticipationSocial Participation
Answering: Are sensory issues driving the behavior?Sounds are painful, so he has also learned to ‘tune out’ verbal instructions
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tune out verbal instructions He responds best:
When provided with visual cuesWith headphones When engaged in heavy work and movement In quiet cozy spaces
Social Participation with sens Social Participation with sens strategies strategies
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Strategies recordedStrategies recorded
ParentsParents
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Homework on Homework on chair ballchair ball
Using Using ‘Sounds surrounds ‘Sounds surrounds
Us’Us’
4141
‘sounds surrounds us’‘sounds surrounds us’
Hug something heavy when you hear something loudChew something chewy when stuck in a crowdS i k i l h fl hStick in your ear plugs when you flush awayCrawl under something heavy while the vacuum is on Swing swing before the mowing’s begunFiddle with your hand fidget while the bell’s rung
4242
The Electronic Scoring for The SPMs with The SPM Quick Tips 4/12/2013
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ParentsParents
4343
Strategies recordedStrategies recorded
Main ClassroomMain Classroom
4444
HeadphonesHeadphonesCozy quiet spaceCozy quiet space
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Main classroom teacherMain classroom teacher
4646
Strategies recordedStrategies recorded
Day careDay care
4747
Day careDay care
Batman costume Batman costume Eating Eating snacksnack
during homeworkduring homework 4848
The Electronic Scoring for The SPMs with The SPM Quick Tips 4/12/2013
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Day careDay care
4949
After a month, stopped using the strategies. “Doing well”After a month, stopped using the strategies. “Doing well”
Strategies recordedStrategies recorded
ArtArt
5050
Art uses visuals! Art uses visuals!
5151
Can be by himself and in different positions
ArtArt
5252
1 month post initial test: 1 month post initial test: ReRe--sorted PE/Recesssorted PE/Recess
5353
Strategies recordedStrategies recorded
Recess/Fit Kids (same aide)Recess/Fit Kids (same aide)
5454
The Electronic Scoring for The SPMs with The SPM Quick Tips 4/12/2013
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Cool down areaCool down area
5555
Fit Kids & RecessFit Kids & Recess
5656
Strategies recordedStrategies recorded
Private OTPrivate OT( h d l d l 1( h d l d l 1(scheduled only 1 x (scheduled only 1 x every two weeks)every two weeks)
5757
Private OTPrivate OT ConsultationsConsultations
5858
Combining Combining all the all the
strategiesstrategies
Each chose Each chose what would what would
work in their work in their environment environment
5959 6060
The Electronic Scoring for The SPMs with The SPM Quick Tips 4/12/2013
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January initial test (red) March re-test
(black)
SPM Main ClassroomSPM Main Classroom
Progress in many Progress in many i l di t &i l di t &
6161
Material from the Material from the SPMSPM copyright © copyright © 2007 by Western Psychological Services. 2007 by Western Psychological Services. Reprinted for scholarly and professional Reprinted for scholarly and professional
presentation by permission of the presentation by permission of the publisher, WPS. All rights reserved publisher, WPS. All rights reserved
(([email protected]@wpspublish.com))
including art & including art & cafeteriacafeteria
hearing & praxishearing & praxis
Progress in other environmentsProgress in other environmentsPE: Doing better when time to line upArt: Follows clean up directions Cafeteria: Not isolating as much
6262Isolates: Jan 2013Isolates: Jan 2013 With buddy: March 2013With buddy: March 2013
January initial test (red) March re-test
(black)
SPM HomeSPM Home
Scores reflectScores reflect
6363
Material from the SPMcopyright © 2007 by Western
Psychological Services. Reprinted for scholarly and professional presentation by permission of the publisher,
WPS. All rights reserved ([email protected])
Scores reflectScores reflectlearning curve!learning curve!
Team mtg March 15, 2013Team mtg March 15, 2013‘take home points’ ‘take home points’
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Strategies recorded (home, art, daycare, recess, cafeteria, classrooms) pointed to areas of progress on retest
School OT and counselor now joined the team to develop a 504 accommodation plan
Summer 2013 Summer 2013 ☺☺
Participate in an intensive OT/SI program with iLs
via private clinic based OT 6565
504 Accommodation team 504 Accommodation team follow up: School OT (4follow up: School OT (4--1212--13)13)
“Hi! I'd been meaning to email you. I was REALLY impressed with how informed the teachers (Janelle-1st grade, Andrea- recess, Marge-day care and Jamie-counselor) and Mom were about John's needsJamie-counselor) and Mom were about John s needs, sensory strategies, and what works for John.
What a great team he has ... and a great Mom. I really have never seen anything like it! You have done a fantastic job of informing and coaching that team!
Gretchen Wilce, school based OTGretchen Wilce, school based OT6666
The Electronic Scoring for The SPMs with The SPM Quick Tips 4/12/2013
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504 Accommodation team 504 Accommodation team follow up: Schoo1 Counselorfollow up: Schoo1 Counselor
“Good morning Diana, The 504 Accommodation Plan meeting went well yesterday, and those present are definitely committed to helping support this little guy in thecommitted to helping support this little guy in the classroom and school community! It was apparent to me that he has come a long way since the beginning of the year due to many of the strategies put in place with your guidance.
Jamie Smith, school counselor Jamie Smith, school counselor 44--1212--1313 6767
Dr. Carol Olson & OT studentsDr. Carol Olson & OT students
6868
Jane Charley, Ashley Peck, Jessica Walworth,Jane Charley, Ashley Peck, Jessica Walworth,Carol, Meagan Chapman Carol, Meagan Chapman
IMPLEMENTATING THE IMPLEMENTATING THE SENSORY PROCESSING SENSORY PROCESSING
MEASURE (SPM) QUICK MEASURE (SPM) QUICK TIPS: TIPS: AN AN EARLY EARLY
CHILDHOOD CHILDHOOD CASE STUDYCASE STUDY
Carol H. Olson, PhD, OTR/LCarol H. Olson, PhD, OTR/LUniversity of MaryUniversity of Mary
Bismarck, NDBismarck, ND
MethodologyMethodologyIRB approvalParticipants/Setting
AJ3 years old
Developmental Center Preschool ProgramParents, Teachers, OTs
ResearchersOT studentsFaculty preceptor
MethodologyMethodologyChronology of Procedure
Initial Test – SPM-P (Sensory Processing Measure –Preschool)/Analysis of dataMeeting 1
Discuss results/choose Quick Tips strategies
Implementation of SPM Quick Tips TMImplementation of SPM Quick Tips Documentation Weekly e-mails
Meeting 2Re-test – SPM-P/AnalysisMeeting 3
Discuss results and perceptions
Initial Test Initial Test
SchoolDefinite Dysfunction
VisionHearing
HomeSome Problems
Social ParticipationHearing
Balance and MotionPlanning and Ideas
Some ProblemsSocial ParticipationTouchBody Awareness
TouchBody Awareness
TypicalVisionBalance and MotionPlanning and Ideas
The Electronic Scoring for The SPMs with The SPM Quick Tips 4/12/2013
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Quick Tips Focused on Sensory Quick Tips Focused on Sensory Systems and VulnerabilitiesSystems and Vulnerabilities
Proprioception
Tactile/Vision/Hearing
Vestibular/Proprioception
Quick Tips ImplementedQuick Tips ImplementedSensory System Number of times at
Home (Mom & Dad)Number of Times at School (Tchr, OT, Aide)
Vestibular 39 76
Proprioception 66 355
Hearing 9 4Hearing 9 4
Taste/oral 42 0
Touch 185 88
Motor Planning 39 0
Total 380 523
AJ Results AJ Results School School HomeHomeDiscussionDiscussion
Improvement in occupational performance at home and at school
Addi i l id f f Q i k iAdditional evidence for use of Quick Tips
Collaboration and communication key
Lessons Learned by Research Lessons Learned by Research TeamTeam
Improved clinical reasoning by research teamImproved understanding of team dynamics and importance of collaboration
i f i idDocumentation of strategies provides support for why changes may have occurredIncreased knowledge of sensory processing can change how people view and respond to behaviors
Thank you to: Diana Henry & WPS“AJ” and his familyExploring Minds Developmental Center staff (teachers, OTs, Aid )Aides)U of Mary OT students
Ashley PeckJessica WalworthJane Charley Meagan Chapman
AJ & family at Disneyland
The Electronic Scoring for The SPMs with The SPM Quick Tips 4/12/2013
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David Herzberg & Kartik ChandarDavid Herzberg & Kartik Chandar
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Digital Assessment Platforms: Digital Assessment Platforms: Competitive AnalysisCompetitive Analysis
Pearson Pearson Assessments: QAssessments: Q--Global, QGlobal, Q--InteractiveInteractivePAR: iConnect PAR: iConnect MHS: Online Assessment CenterMHS: Online Assessment Center
Creating An Optimal User Creating An Optimal User ExperienceExperience
Behavior Behavior rrating scales first, then other testsating scales first, then other testsW b b fi t thW b b fi t thWeb browser first, then apps Web browser first, then apps Easy to create an account, add assessmentsEasy to create an account, add assessmentsShare uses with your colleaguesShare uses with your colleaguesEmail templates: clear, efficient messagingEmail templates: clear, efficient messagingContextual help throughoutContextual help throughout
SPM Scoring/Quick Tips Online: SPM Scoring/Quick Tips Online: WorkflowWorkflow
Administer Online Score Select Quick Tips Report
SPM Scoring/Quick Tips SPM Scoring/Quick Tips Online: Online: Interface DesignInterface Design
SPM Scoring/Quick Tips Online: SPM Scoring/Quick Tips Online: Interface DesignInterface Design
The Electronic Scoring for The SPMs with The SPM Quick Tips 4/12/2013
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SPM Scoring/Quick Tips Online: SPM Scoring/Quick Tips Online: Interface DesignInterface Design
SPM Scoring/Quick Tips Online: SPM Scoring/Quick Tips Online: Interface DesignInterface Design
SPM Scoring/Quick Tips Online: SPM Scoring/Quick Tips Online: Interface DesignInterface Design Pricing and ValuePricing and Value
What problems does digital assessment solve What problems does digital assessment solve f th li i i ?f th li i i ?for the clinician? for the clinician? Pricing reflects the value of solving those Pricing reflects the value of solving those problemsproblemsInitial startup (“kit”) vs. ongoing usage Initial startup (“kit”) vs. ongoing usage (“forms”)(“forms”)
We must continue to connect!We must continue to connect!We must continue to connect!We must continue to connect!Thank You very much!
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Questions?Also visit us at our booths
Henry OT # 430 & WPS # 511
TheElectronicScoringforTheSensoryProcessingMeasures(SPMs)withTheirNewSPMQuickTips
DianaA.Henry,MS,OTR/L,FAOTAPresentedattheAOTAAnnualConference
April26,2013
References
Brown, T. (2010). Centennial Vision‐ Child and youth practice area publications in the American Journal of Occupational Therapy in 2008 2009: Content analysis, methodology review, &summary. American Journal of Occupational Therapy, 64, 814‐819.
Collins, A., & Dworkin, R. J. (2011). Pilot study of the effectiveness of weighted vests. American Journal of Occupational Therapy, 65, 688‐694.
Colyvas, J.L., Sawyer, L. B., & Campbell, P.H. (2010). Identifying strategies for early intervention that occupational therapists use to teach caregivers. American Journal of Occupational Therapy, 64, 776‐785.
Henry, D. A. (2009). Ten Ways to Implement RtI with Sensory Strategies. School Specialty Abilitations Webinar Series. School Specialty, Greenville, WI.
Henry, D. A., & McClary, M. (2011). The Sensory Processing Measure Preschool (SPM‐P)—Part two: Test–retest and collective collaborative empowerment, and a father’s perspective. Journal of Occupational Therapy, Schools, & Early Intervention, 4, 53–70.
Johnson, Avery. (2013) Separating Growing Pains from Warning Signs in Kids. Wall Street Journal online. February 25, 2013.
Lane, S. J., & Lynn, J. Z. (2011, September). Sensory Integration Research: A look at past, present, and future. Sensory Integration Special Interest Section Quarterly, 34(3), 1‐4.
Miller Kuhaneck, H., Ecker, C., Parham, L.D., Henry, D. A., & Glennon, T.J. (2010). Sensory Processing Measure‐Preschool (SPM‐P): Manual. Los Angeles: Western Psychological Services.
Parham, L.D., Ecker, C., Miller Kuhaneck, H., Henry, D. A., & Glennon, T.J. (2007). Sensory Processing Measure (SPM): Manual. Los Angeles: Western Psychological Services.
Watling, R., Koenig, K., Davies, P., & Schaaf, R. (2011). Occupational Therapy Practice Guidelines for Children and Adolescents with Challenges in Sensory Processing and Sensory Integration. Bethesda, MD: AOTA Press.