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Journal of Occupational Therapy, Schools, & Early Intervention, 2:58–63, 2009Copyright © Taylor & Francis Group, LLCISSN: 1941-1243 print / 1941-1251 onlineDOI: 10.1080/19411240902720288

WJOT1941-12431941-1251Journal of Occupational Therapy, Schools, & Early Intervention, Vol. 2, No. 1, January 2009: pp. 1–10Journal of Occupational Therapy, Schools, & Early Intervention

The Sensory Processing Measure (SPM): Meeting the Needs of School-Based Practitioners

Part Two: Case Example and Practical Applications

Sensory Processing Measure, Part TwoD. A. Henry and H. M. Kuhaneck DIANA A. HENRY, MS, OTR/L, FAOTA1 AND HEATHER MILLER KUHANECK, MS, OTR/L2

1Henry OT Services, Inc., www.ateachabout.com2Occupational Therapy Department, Sacred Heart University, Fairfield, CT

As a follow-up to The Sensory Processing Measure (SPM), Part One: Description andBackground, this case illustrates how a student with poor peer interactions can behelped by the entire school and home team using the Sensory Processing Measure afteridentifying that sensory processing (praxis and sensory modulation) issues are contrib-uting to difficulties with social participation.

Keywords Sensory processing, modulation, praxis, ideation, motor planning, socialparticipation, collaboration

In the schools, focus on students with sensory issues has been primarily on modulation(over- and under-responsivity and sensory-seeking behaviors). The contribution of praxison behavior has often not been addressed because of difficulty assessing the componentsof praxis with available sensory questionnaires. The Sensory Processing Measure (SPM)is the first to address not only praxis (including ideation and motor planning) but the rela-tionship of sensory processing to social participation. The reader will learn how social par-ticipation can be impacted by praxis and by poor sensory modulation. This case study alsoshows how the entire team, including the bus driver, contributed to enhancing the child’ssocial participation and sensory processing needs.

Opatia is a 7-year-old Arabic second-grader with above average intelligence. She isbeing seen by an outside psychiatrist for aggressive behaviors and was referred for anoccupational therapy evaluation in school because of poor social participation with peers.The SPM team who participated in completing all the SPM forms consisted of Opatia’smother, the second grade teacher, the teacher assistant (TA) for the cafeteria and play-ground, the physical education (PE) teacher, the art teacher, the music teacher, and theschool occupational therapist (OT). The bus driver was also part of the SPM team,although he was not able to meet with the team. When the team met to discuss the resultsof the SPM, many noted that Opatia often “looks sad.” Opatia’s mother exclaimed thatdespite her daughter’s intellectual abilities, her daughter had recently arrived home afterschool saying, “All the kids say I’m retarded”.

Received 26 September 2007; accepted 5 November 2008.Address correspondence to Diana A. Henry, President, Henry OT Services, 7942 W. Bell Road,

# C5–429, Glendale, AZ 85308. E-mail: ateachabout@aol.com

Sensory Processing Measure, Part Two 59

On the Home Form, Opatia scored in the some problem range in social participation,vision, body awareness (proprioception), balance (vestibular). In the total sensory scale(TOT), she scored in the definite dysfunction range in hearing, touch, and planning(praxis). See completed Home Form Profile Sheet (Figure 1).

Many items were related to over-responsivity (VISION: Seems bothered by light,especially bright lights; has trouble finding an object when it is part of a group. HEARING:

Figure 1. Completed Home Form Profile Sheet. SPM material copyright © 2007 by Western Psychological Services. Reprinted by permission of thepublisher, WPS, 12031 Wilshire Boulevard, Los Angeles, California, 90025, U.S.A., www.wpspub-lish.com. Not to be reprinted in whole or in part for any additional purpose without the expressed,written permission of the publisher. All rights reserved.

60 D. A. Henry and H. M. Kuhaneck

Seem bothered by ordinary household sounds such as the vacuum cleaner, hair dryer;seem easily distracted by background noises such as the lawn mower; shows distress atshrill brassy sounds such as whistle, party noise makers. TOUCH: Becomes distressed bythe feel of new clothes; prefers to touch rather than be touched.) and praxis (IDEATION:Has trouble coming up with ideas for new games and activities; tends to play the sameactivities over and over, rather than shift to new activities when given the chance.MOTOR PLANNING: Performs inconsistently in daily tasks; has trouble figuring outhow to carry multiple objects at the same time; has difficulty imitating demonstratedactions such as movement games).

Opatia’s mother reported that, as a baby Opatia, struggled against being held, pulledaway from being touched, and did not like wearing short sleeves. When Opatia is upset,“she goes to her room and hides under a pile of blankets.” At home and in the community,Opatia is easily distracted, becomes overwhelmed, is disorganized, and does not seem toknow how to play with other children. When she is encouraged to develop friendships byplaying with some of her peers on the playground, Opatia frequently replies, “I can’t findthem.” Opatia’s mother’s main goal for her daughter is that she have “at least one goodfriend.”

On the Main Classroom Form, Opatia scored in the some problems range in socialparticipation, hearing, and body awareness. She scored in the definite dysfunction range invision, touch, balance, and planning and on the total sensory scale (TOT). See completedMain Classroom Form Profile Sheet (Figure 2).

As on the Home Form, many items were related to over-responsivity (VISION:Becomes easily distracted by nearby visual stimuli. HEARING: Shows distress at loudsounds; shows distress at the sounds of singing or musical instruments. TOUCH: Isdistressed by the accidental touch of peers) and praxis (IDEATION: Is unable to solveproblems effectively; demonstrates limited imagination and creativity in play and freetime; plays repetitively during free time; shows poor organization of materials in, on, andaround desk area. MOTOR PLANNING: Does not perform consistently in daily tasks;quality of work varies; does not perform tasks in proper sequence; has difficulty complet-ing tasks from a presented model.)

Opatia’s second grade classroom teacher noted that Opatia looks sad, never saying,“I am good at that.” Opatia pulls away when offered a hug and insists on wearing herheavy jacket, even indoors when it is warm. She is not able to “get started” independently.When she returns to class from her specials, she seems lost and does not take the initiativeto do what she is told to do, despite having been told to look at the board for instructions.Although she wants to have friends, she does not interact on the playground, appearing tobe overwhelmed by the noise and the movement of others. Instead, she chooses to playalone, the same “wall ball” game every day.

All the other six school environments rating sheets were completed by the personresponsible for that specific environment. There was some initial resistance from both thebus driver and playground/cafeteria TA, as the SPM was the first questionnaire they hadever been asked to complete. Yet by the time they each had finished completing their SPMrating sheet, they were both very enthusiastic to learn more and understand how theycould help Opatia as part of the SPM team.

On the Bus Rating Sheet, Opatia scored within normal limits. The bus driver stated,“Although she is a bit more wiggly than the others, she follows all the rules.” He alsostated, “But she is not too happy. So when she gets on the bus I tell her ‘Smile! It is a greatday. She seems to enjoy my suggestions as her face changes to a smile and now when shegets on the bus, she often looks at me with a big smile” As everyone had noted that Opatia

Sensory Processing Measure, Part Two 61

frequently did look sad, one of the recommendations discussed at the SPM team meetingwas to take the bus driver’s suggestion and encourage Opatia to smile whenever appropri-ate in each home and school environment. The OT also agreed to provide the bus driverwith some sensory strategies such as weighted lap pads and head phones that Opatia’smother had indicated helped Opatia when they traveled.

The rater for the Cafeteria and Recess/Playground was the same person. Initiallyhesitant to share with the group (as this was her first time being part of a SPM team), given

Figure 2. Completed Main Classroom Form Profile Sheet.SPM material copyright © 2007 by Western Psychological Services. Reprinted by permission of thepublisher, WPS, 12031 Wilshire Boulevard, Los Angeles, California, 90025, U.S.A., www.wpspub-lish.com. Not to be reprinted in whole or in part for any additional purpose without the expressed,written permission of the publisher. All rights reserved.

62 D. A. Henry and H. M. Kuhaneck

the opportunity the TA indicated that she and Opatia had a good relationship. Althoughthe TA reported that Opatia was often alone, she also noted that they were able to joketogether and that she could make Opatia smile.

All members of the SPM team agreed that the items on the recess/playground ratingsheet reflecting Opatia’s difficulty with ideation (Demonstrates limited imagination andcreativity in play and free time) appeared to prevent her from knowing how to interactwith peers. Items reflecting over-responsivity (Is distressed by accidental touch of peers:may lash out or withdraw; plays by self away from others) were contributing to her feelingoverwhelmed and uncomfortable with the large numbers of students on the playground.The SPM team agreed that the TA could initially work with the OT to organize a “smallcircle of friends” for Opatia to play with during recess. This would give the TA the skillsto continue to encourage Opatia (on a daily basis when the OT could not be there), to useplayground equipment (climbing, hanging, pushing, and swinging) with her circle offriends. This would provide Opatia with some of the proprioceptive and vestibular sensoryinput her body needed to decrease sensory over-responsivity. Providing Opatia with safeopportunities to engage in appropriate social participation could increase Opatia’s self-esteem and reduce the inappropriate name calling by her peers.

On the PE rating sheet, Opatia’s total score fell within normal limits. The PE teacherexplained that he did not have a problem with Opatia’s behavior. Although she was not themost coordinated of his students, as noted in the BODY AWARENESS/PERCEPTIONitems (Occasionally shows poor timing of motion: misses ball when kicking or swingingbat; brings hands together too slowly or too quickly to catch ball), she was always willingto be corrected. He was also seeing her in gymnastics after school, which he felt was help-ing her seem “more grounded, more coordinated and organized.” He noted she especiallyenjoyed the “crashing” activities. As he gave many examples of Opatia’s willingness towork with him, the SPM team agreed he could play a vital role in helping to support a cir-cle of friends. Opatia could also help him (and the recess TA) as a “star helper” put heavyequipment away, to feed her sensory needs for proprioception.

On the Music Rating Sheet, behaviors related to MOTOR PLANNING (Has diffi-culty correctly imitating demonstrations: movement games, songs with motions; has diffi-culty using two hands to hold to play a musical instrument) and POSTURAL CONTROL(Has difficulty moving body to rhythm: clapping hands, tapping feet) were frequentlynoted. Yet, the music teacher was very positive about Opatia’s behavior overall. She hadalways thought that Opatia was very bright, yet had been baffled by her difficulty in get-ting organized and knowing how to start. The difficulty with IDEATION revealed in theSPM made sense. She felt she had intuitively been able to help Opatia by keeping herclose to her in the front row and initially giving her additional visual cues, verbal instruc-tions, and physical assistance. The team applauded her strategies, and other membersjoined in to discuss how they, too, could give Opatia additional cues to help with ideationand motor planning. She invited the OT to join her in co-teaching a module to further pro-vide strategies to address the postural control and motor planning issues.

As she, too, had noted that Opatia tended to be alone, the music teacher exclaimedhow easily it would be to support the SPM team’s idea of a circle of friends in her musicclassroom. As she sometimes also assists in the cafeteria, she stated she would be happy toorganize a “lunch bunch” with Opatia and her designated circle of friends.

On the Art Rating Sheet, Opatia scored 29 points, just on the cutoff indicating occa-sional difficulties on most items. The art teacher noted that Opatia was a little slow at get-ting going, took longer than others during transitions and, during “clean-up,” was not asefficient as the others. Overall, Opatia was “no big problem” and responded well to the

Sensory Processing Measure, Part Two 63

additional verbal and physical cuing that she was happy to provide. She always made sureOpatia sat in front, close to her. She noted that Opatia seemed to really enjoy working withmanipulatives, especially clay. The OT explained that the cuing was helping to address theideation and motor planning issues and that the clay was also a good medium to addressOpatia’s sensory modulation issues though the proprioception and touch pressure she wasreceiving from the clay. The music teacher also invited the OT to join in and bring morestrategies that could help other children too.

The only concern she had was that Opatia often made what seemed to be angry-lookingdrawings. Recently, the class was to copy an animal and color it on their own. Opatia hadchosen a cat, and then changed it to look very angry, adding sharp teeth and claws usingmainly black colors. Upon seeing the drawing, the SPM team agreed it did look angry.The SPM team suggested Opatia’s mother speak with her psychiatrist about art therapy, asOpatia appeared to have much to say through her art. Using manipulatives such as claycould also address some of her sensory modulation issues through providing tactile andproprioception.

After about 45 minutes, before closing the meeting, the OT turned to the SPM teamand asked, “What do you think of the SPM and of the process we have just gone throughdiscussing the results together? The classroom teacher said, “The SPM is of great value.Although we each have different curriculums, we have the same goals for Opatia. TheSPM has permitted us to see what works in each environment and hear what strategies wecan adapt to use in our own specific environments.” She went on to say that she nowunderstood that Opatia wanted to wear her coat indoors because it was giving her thetouch pressure she needed. She invited the OT to come to her room to explore differentstrategies she could use with Opatia (and other students) such as wearing a weighted vest.

The music teacher said, “This experience was refreshing. Being able to discuss notonly the challenges but all the positive strategies is very encouraging.”

Opatia’s mother thanked everyone for caring about her daughter. She said the SPMhad given her the possibility to get a bird’s eye look into each environment and to realizewhat a great job all were doing to support her daughter. She was eager to integrate thesame strategies at home and to share the SPM results with Opatia’s psychiatrist.

The SPM team decided to meet again in a month to review strategies and to updateOpatia’s program. Supporting the principles of response to intervention (Klotz, 2007), theSPM would be used as a post-test to measure change and to determine what worked andwhat did not.

Reference

Glennon, T. J., Henry, D. A., & Miller Kuhaneck, H. (2008, April). Response to intervention and thesensory processing measure. Paper presented at the 2008 Annual AOTA Conference and Expo,Long Beach, CA.

Glennon, T. J., Parham, L. D., Henry, D. A., Ecker, C., Herzberg, D., Miller Kuhaneck, H.(2007, April). Sensory processing measure: Practical applications for clinic and school basedtherapists. Paper presented at the 2007 Annual AOTA Conference and Expo, St. Louis, MO.

Henry, D. A. (2009). 10 ways to implement RtI with sensory strategies. School Specialty Abilita-tions Webinar Series. Greenville, WI: School Specialty.

Klotz, M. B. (2007). Response to intervention: A primer for parents [Electronic Version]. RetrievedJune 14, 2007, from www.nasponline.org/resources/factsheets/rtiprimer.aspx.