# Appendix

## Common classroom modifications for sensory modulation disorder (SMD): Rationale and effect on adaptive response

| Strategy | Rationale | Benefit and effect on adaptive response |
| --- | --- | --- |
| Dynamic cushion | Wedge-shaped: allows child-generated minor movement in linear front to back plane(some bounce) | Increases proprioception and thus arousal; suits degree of movement to child; enhances attention; extends work endurance; outlet for sensory-seeking behavior; use on floor to delineate child's space, increasing comfort in group(placing child at periphery can be more tolerable to overresponsive child); increases intensity of sensation |
| Dynamic cushion | Disc-shaped: allows child-generated variable movement in all planes; heavy work to postural core; can be used on chair or floor |  |
| Rocking chair; glider | Child-generated, rhythmic, linear movement | Child adjusts movement intensity to calm or alert; enhances attention; extends work endurance during quiet times(silent reading); delineates space; provides respite when child needs a break |
| Cube chair; booster seat; armchair | Provides tactile boundaries around child's body | Provides constant, predictable pressure touch for calming(especially if padded); delineates space on floor; increases duration of sensation |
| Small inner tube | "Cradles"child when seated on floor | Provides constant, predictable pressure touch for calming; child-generated movement as tolerated; delineates space on floor; provides respite |
| Therapy ball | Can be used as alternative to desk chair; provides child-generated movement in multiple planes; can be used for universal support to whole class.Variations for floor: inflated"animal seat,"inflated stool,bolster,peanut-shaped ball | Rock for calming;bounce for alerting;extends work endurance and attention to task;outlet for sensory-seeking behavior;adjusts intensity,frequency,duration |

| Strategy | Rationale | Benefit and effect on adaptive response |
| --- | --- | --- |
| "Uneven" chair | One shorter leg on chair provides for minor rocking | Can be alerting or calming; outlet for sensory-seeking behavior |
| Beanbag chair; large pillows | Envelops child when seated or provides "crash" pad; child can "burrow" under pillows | Deep pressure touch to multiple body surfaces; calms; burrowing allows "escape" and/or respite. Crash pad increases proprioception for organization of behavior; outlet for sensory-seeking behavior; increases intensity |
| T-stool; rolling chair | Child-generated movement in variable planes and directions | Proprioception from postural core; alerts and/or organizes; extends work endurance and attention to task; outlet for sensory-seeking behavior; adjusts intensity, frequency, duration |

| Strategy | Rationale | Benefit and effect on adaptive response |
| --- | --- | --- |
| Modify walls | Limit decorations and/or hangings to include at least one"neutral"wall; paint with calming colors(blues and/or greens) | Calms visual environment; removes distraction; enhances attention; prevents gradual escalation of arousal |
| Modify lighting | Turn fluorescent lights down on sunny day;include lamplight;use"daylight"bulbs or full spectrum lighting | Reduces harsh light;calms visual environment;enhances attention;may increase work duration;prevents gradual escalation of arousal;flashing lights may be intolerable to overresponsive child |
| Modify sound | Provide background music to suit needs of student;provide movement break;provide rhythm;provide warnings of loud sound(fire drill) | Provides calming or alerting auditory sensation. Calming:quiet,nature sounds;beat-per-second rhythms;predictable;moderation of teacher voice;"silent clapping". Alerting:loud,variable rhythms;unanticipated sound(clapping or burst of laughter) |

| Strategy | Rationale | Benefit and effect on adaptive response |
| --- | --- | --- |
| Consider furniture | Are children too close? Is there enough space at table? Do chairs fit child? Do chairs make noise when moved on floor? Does furniture leave enough floor space to allow for variable body positions during floor play? | More space "protects" tactile or movement-sensitive child and reduces likelihood of unwanted touching by sensory-seeking child; well-fit chairs provide contact with feet on floor for movement-sensitive child; alternative floor play enhances tactile encounters, pressure to body, natural movement |
| Designated sensory room | Designed by the OT to include specialized equipment for maximal benefit to children with SPD | Individualized therapy; supervised movement or respite breaks; restores self-regulation and enables ability to reengage in occupational tasks with optimal adaptive response |
| Seat assignment | Provide placement at periphery; experiment with back or front of classroom; change positions regularly for novelty | Distracted or visually overresponsive child at front; underresponsive child in front to receive instructional cues; novelty for under-responsive child; sensory-seeking child in back to allow for standing, stretching, or movement without disturbing others; experiment for movement-sensitive or touch-sensitive child; slightly separate desk to prevent unanticipated touch or reduce proximity of peers |
| Study carrel | Modifies child's immediate visual (some sound) environment; limits distraction | Increases focus on immediate task; some respite (Note: consider impact on constructivist learning methods. OT and teacher should negotiate regarding other options for supported group encounters.) |
| Room arrangement | Open space; carpeted space; respite corner; reading "loft"; space for mini-trampoline or rocking board; higher counter for standing work | Room for movement breaks; space for alternative positions to encourage postural and antigravity adjustment for baseline arousal; social engagement; separation when necessary; respite breaks |
| Modify storage | Cover or enclose extraneous materials (book shelves, dress-up clothing; blocks); unify storage containers; consider height of storage to encourage stooping, reaching, stretching | Covering materials removes distraction; unifies visual environment; calms; prevents gradual escalation of arousal. Height of storage facilitates proprioception via movement opportunity |

| Strategy | Rationale | Benefit and effect on adaptive response |
| --- | --- | --- |
| Weighted vest, shoulder"snake"or lap pad; weighted backpack | Increases proprioception and deep pressure touch | Calms and/or organizes for self-regulation; increases attention and adaptive response; limits sensory-seeking behavior; weighted back-pack can be worn during transition times between classrooms to organize the overresponsive or sensory-seeking child; regulates intensity, duration |
| Spandex or Lycra clothing; bike shorts; pressure vests | Increases deep pressure touch | Calms and/or organizes for self-regulation; regulates intensity, duration |
| "Body sock"or Lycra wrap | Increases deep pressure touch;"heavy"(resistive) work | Calms and/or organizes for self-regulation; respite activity; can be incorporated into classroom movement games; social engagement |
| Hooded sweat-shirt; soft, worn, or all-cotton clothing; seamless socks; tags removed | Increases warm and/or tolerable touch; hood allows for occasional"escape" | Calms and/or organizes for self-regulation; eliminates sources of nonhabituating tactile sensation that can distract the overresponsive child and escalate behavior |
| Headphones | Provide soothing or alerting sound or no sound; filter or eliminate ambient sound via general noise reduction | Calms, alerts, or organizes for self-regulation; provides respite from multiple sound environments of classroom; increases attention to task; may improve test taking; eliminates source of nonhabituating auditory sensation |

| Strategy | Rationale | Benefit and effect on adaptive response |
| --- | --- | --- |
| Fidget toys | Any combination of sensory characteristics:squishy,soft,bumpy,vibrating,bendable,stretchy,smooth and/or hard,scratchy,weighted.Allow anytime access or during"listening"times or transitions | Tailored to sensory needs of child;self-regulation;outlet for sensory-seeking behavior;enables selective attention;prevents child from touching and/or pestering peers(note:to prevent distraction to peers,select quiet toys during listening times);regulates frequency,duration,some intensity |
| Chewables and other oral options | Chewable bracelets or necklaces,whistles,straws,harmonicas,age-appropriate choices for oral exploration | Allows for self-regulation,attention;provides outlet for oral sensory-seeking(especially for child who chews and/or sucks clothing);provides a source of"heavy work"to specific muscles and joints |
| Snacks | Flavors:Intense(cinnamon,citrus,salty)Bland(vanilla) | All for self-regulation:AlertingCalming |
| Snacks | Intense textures:crunchy,chewy | Alerting |
| Snacks | "Heavy work"to muscles of mouth:strong sucking through small straw;thickened liquids(yogurt,milkshake);lollipop;gum | Organizing |
| Snacks | Temperature | Cold for alerting;warm for calming |
| Olfactory options | Aroma kits | Assists with self-regulation(calming or alerting);promotes attention |
| Vibration | Teething toys;pillows;small massagers;stuffed animals | Initially alerting;calming over time |
| Tactile placemat | Needlepoint grid,sandpaper,tub decals | Place under coloring paper to increase sensory feedback:alerting;can sustain attention to task |
| Bright placemat | Orange,red,yellow under written work | Alerting;sustains attention |
| Roller or rocker board under feet;spandex wrap on chair legs | "Fidgets"for the feet | Provides outlet for sensory-seeking behavior;spandex offers heavy work or resistance for self-regulation;regulates frequency,intensity,duration |
| Velcro tabs | Place on or under edge of desktop:loops for soothing touch,hooks for alerting touch | Assists with self-regulation;provides outlet for sensory-seeking behavior;inconspicuous |

| Strategy | Rationale | Benefit and effect on adaptive response |
| --- | --- | --- |
| Small fans | Handheld as fidget toy; desktop as sound and/or tactile sensation | Assists with self-regulation; alerting; provides "white noise" for masking ambient sound |
| Sensory bins and tables | Fill with beans, cornmeal, sand, rice, water, bubbles | Assists with self-regulation; provides outlet for sensory-seeking behavior; can gradually desensitize child to touch, depending on material. (Note: slimy textures are often rejected by the overresponsive child; lightweight materials [rice] can overstimulate a child and create disorganized behavior) |

## ROUTINE

| Strategy | Rationale | Benefit and effect on adaptive response |
| --- | --- | --- |
| Early arrival or dismissal | Enables packing or unpacking before group arrives | Reduces likelihood of unwanted physical contact or"chaotic" movement; enables selective attention to arrival and/or dismissal routine; provides a better start and end to the day |
| Movement breaks | Embed regularly into daily routine and learning activities; allow extra as needed | Excellent for self-regulation of all children; enhances learning via the movement-learning link |
| Special assignments | Additional movement breaks(bring attendance to office; hand out or collect papers; stack books; erase board; carry materials bin while walking in line; be door holder, note taker, stopwatch manager) | Creates embedded proprioception and movement for self-regulation; provides respite; provides outlet for sensory-seeking behavior; provides protection from unwanted sensation; promotes self-esteem and confidence |
| Daily schedule | Predictable or novel, depending on child's needs | Predictable for overresponsive child; novelty for underresponsive or sensory-seeking child |
| Visual schedule | Aids predictability of daily events and transitions | Reduces anticipatory anxiety and hypervigilance; facilitates work duration when breaks are known |

| Timers | Aid predictability of work session or end of break | Reduces anticipatory anxiety; facilitates work duration |
| Timers | Aid predictability of work session or end of break | Visual timer for child who processes best through visual channel |