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Evidence-based Interventions for the Underlying Components of Academic Success: Sensory, Work Habits, Processing and Behavior - featured December 27, 2011

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Evidence-based Interventions for the Underlying Components of Academic Success: Sensory, Work Habits, Processing and Behavior

By: Toni M. Schulken, MS, OTR/L

What are Evidence-Based Interventions?

Evidence based interventions are those strategies, teaching practices, and programs that have been shown empirically, or by research, to be effective. The reformed Individuals with Disabilities Education Improvement Act of 2004 (IDEA 2004) changed the way we identify a specific learning disability. We may now use “alternative research-based procedures” (aka, evidence-based) rather than just an IQ discrepancy.

Tips for Success
When deciding on an intervention, there are several factors to keep in mind to ensure success.
  • Use a proactive approach – the priority of intervention selection should be on activities which help the teacher create a learning environment which is conducive to learning for all types of learners (i.e., universal design for learning – In other words, beginning a school year with certain organizational strategies, color coding, transition lessons, etc. can be the best interventions to “prevent” struggles before they happen.
  • Positive presentation of intervention strategies
      School-wide protocol of all teachers directly and specifically taking time to talk about, survey students and provide activities relating to various learning styles (visual, auditory, kinesthetic). This will include an explanation that various learning styles use different learning tools for each student to be successful. Therefore, at any time, students may see a child using a different type of paper, a pencil grip, wearing glasses, standing at the board while learning, etc. These are tools that match that student’s learning style and are chosen by the experts in learning, their teachers. Any teasing, commenting, bullying, fighting over these tools (because most of them will be pretty exciting and different) will not be tolerated. A student will only be given a tool if his/her learning style requires that tool.
    • Everyone is made special and needs to be treated in the way they will learn best.
    • Interventions that serve to separate a child from the whole class can be presented as a “by invitation only” access, allowing for use with various children in the class, as well as the targeted student
        A desk top carrel can be an “office” in which children are invited to use the office during independent work times or test taking situations.
      • A personal space mat during floor time activities can be the “example setter” square. Whoever is chosen to sit in the two or three squares get to set a good example for the class of sitting properly and keeping hands and feet in his/her personal space
      • A “quick walk” (walk to the front office, give a note to the office manager, come back) can be by invitation only when a child is getting restless
  • Student Involvement – research shows that involving children in student charting increases successful response to intervention
  • Parent Involvement – research show that parent involvement in directly correlated with academic success
  • Progress Monitoring and Documentation Protocol is necessary to increase accountability, consistency of intervention implementation, and increase ability decision-making. See the CATT Intervention System for research-based interventions and an easy-to-use documentation protocol.

When evaluating a child’s work habits and or skill performance and selecting an intervention, the following four components should be considered:
  • Curriculum (are the objectives, teaching methods and materials provided appropriate for the student)
  • Environment (visual and auditory environment in the classroom, transitions, desk and chair height, lighting, etc.)
  • Instruction (presentation style, rate of speech, direction giving, expectations)
  • Learner (student skills, perquisite skills, problem solving, learning style, learning barriers)

Sensory Processing
Sensory processing affects every aspect of a child’s life. It is the ability to take in, sort out and make sense of information from our environment, or the organization of sensation for use.
  • Sensory integration occurs automatically and on an unconscious level during normal development as children interact with their environment through their senses (taste, touch, smell, vision, hearing and movement)
  • Sensory input helps the central nervous system develop and mature
  • Sensory systems continue to develop through sensory experiences
  • Early childhood sensory experiences of touch and movement prepare the central nervous system to be able to later be able to learn through their eyes and ears (as needed in Kindergarten and up)
  • Children’s individual needs for sensory input vary, however, if sensory experiences are provided daily, they will seek out how much input they need to be able to feel organized, be able to attend to learning tasks, modulate their behavior and overall participate more fully in home, play and classroom activities.

Sensory Systems

Tactile System (touch): The tactile system has two branches: protective and discriminative. Receptors within the skin send information about light touch, pain, temperature and pressure. Typical response to information from the tactile system is important for social emotional development, body scheme (awareness of individual body parts and how they move in relationship to one another), discrimination skills in the hands for fine motor development and motor planning.

Vestibular (movement, especially change in head position): input from the vestibular system is received through receptors within the inner ear and interacts with higher centers in the brain to help us develop and maintain posture, muscle tone, joint stability, balance, movement, motor control and coordination, spatial awareness and a stable visual field. In addition, the vestibular system sends information to the part of the brain that regulates attention, speech and language and level of arousal.

Proprioceptive System (information from the large muscles and joints regarding body awareness): Proprioception is the unconscious perception of joint position and movement. Receptors in the muscle, joints and tendons send information to the brain about body position. Proprioception allows the child to execute gross and fine motor activities that require variations in strength, force and dexterity. It also allows a child to skillfully guide arm or leg movements without having to visually observe every action. When proprioception is functioning properly, a person’s body position is automatically adjusted to adapt to the needs of the situation.

Gustatory (taste) System: The receptors for the gustatory system are in the mouth. The gustatory system allows us to tolerate various textures of food for a well rounded diet and tolerate tooth brushing for oral hygiene. In addition, oral input (sucking, chewing) is often very organizing, especially when young.

Olfactory (smell) System: Smell has a powerful effect on our emotions. While flowers, perfume and cookies may have a pleasant smell and even be nostalgic; poison, gas or smoke may have an alarming, unpleasant or harmful smell.

Auditory System: Auditory is the sense of hearing and processing of auditory information. It helps us to hear sounds, localize to sounds, interpret sound, discriminate sounds for speech, remember auditory information and focus on auditory stimuli even with background noise present.

Visual System: The visual system allows us to comprehend and understand what we see in order to interact with people and objects in our world. Even if we have 20/20 visual acuity, our eye muscles may not work well together which causes stress and strain on the eyes, fatigue, difficulty with reading/writing, inattention, double vision at times, etc. We also need appropriate eye contact for social interactions.

Sensory Processing Relationship to School Performance
  • Filtering out background visual and auditory information
  • Regulation of arousal and attention level
  • Seeking out excessive movement
  • Avoiding tactile activities
  • Over reaction to incoming sensory input in areas of visual, auditory, touch, movement, smell, taste
  • Fine motor coordination
  • Gross motor coordination (clumsiness)
  • Motor planning (praxis)
  • Poor body awareness in space (standing in line, transitions, cafeteria, etc.)
  • Overall academic performance
  • Overall work habits
  • Gag reflex to smell, taste and texture.

Evidence-Based Interventions

  1. Use of proprioceptive input and movement in the classroom
    • Passive –
      • Weighted Hall Pass – hold with two hands while walking in line, transitioning or sitting and paying attention
      • Weighted Vest –wear for maximum of 20 minutes with at least an hour in between
      • Ribbed Lap Pad – use for 20 minutes at a time with at least an hour in between
    • Active – physical activity involving the large muscles and joints (Theraband, chair push-ups, exercise routines, etc.)
  2. Use of alternative seating in the classroom
      • Sit Ball – keep feet flat on floor at all times, use during any seated activity
      • Howda Hug Chair – great for floor time activities, allows child to get movement in an appropriate manner
      • Concentration Cushion – place on chair and allow child to sit on the cushion, can also be placed on the child’s lap and used as a weighted lap pad
  3. Use of Aromatherapy for Cognition, Memory, Attention and Mood
  4. Use of fidgets in the classroom - Fidgets are tools not toys!
      • Allow child to hold/manipulate fidget in lap or in desk
      • Fidget needs to stay close to the child’s body or in desk
      • Eyes need to be on teacher and child needs to be alert while fidgeting
  5. Maintaining a healthy noise level in the classroom for children who respond negatively to noise
      • Yacker Tracker to altert children when noises get to loud
      • Ear plugs or muffs
      • Hands over ears cue – have a child put their hands over their ears when it gets too loud. When the teacher or another child spots “hands over ears”, the class is alerted and began to use a more quiet voice.
      • Voice amplification system
  6. Use of background music in classroom (Mozart Effect) – this is often misinterpreted as ANY music. Only specially selected music has research supporting it’s positive effects to help to organize, focus and calm. Two examples are:
      • Mozart Effect CDs
      • Sound Health Series
  7. Use of Chewing Devices and Chewing Gum for Attention and Alertness, Increase Focus, Decrease Stress, Decrease Excessive Mouthing of Objects, Increase Biting and Chewing Skills
      • Chewing gum
      • Chew Ease Pencil Topper
      • Chewy Ps and Qs
  8. Use of cognitive approach to sensory and behavior (alert program)
      • Social Stories
      • Sensory Stories
      • Alert Program
  9. Engagement in 30-45 minutes of physical activity 3-5 days per week positively affects fitness, health and behavior
      • Exercise routines or Focus2Learn

Work Habits/Behavior

Work Habits are the skills and behaviors needed to fully participate and access the information and activities provided by instructors/teachers to be successful students.

Work Habits/Behavior Relationship to School Performance
    • Following routines
    • Transitions
    • Following directions
    • Attention to task and on task behavior
    • Initiation and completion of task
    • Sense of personal space while standing in line, during floor time, etc.
    • Class participation
    • Management of classroom materials and homework
    • Organization of workspace and desk
    • Test taking skills
    • Note taking skills

Evidence Based Interventions
  1. Universal Design for Learning (increase access to education for all types of learners)
    • Visual Schedules for following routines, transitions, direction following, task completion, managing the lunchroom, managing the bus, etc.
    • PBIS – Positive Behavior Interventions and Support – see
    • Classroom Organization (decrease transition time, decrease disruptive behavior, and increase on-task behavior and overall instruction time)
      • 2 parallel rows of desks in a semi-circle to allow for greater classroom participation and less off task behavior
      • Easy access to classroom materials
      • Clear and free high traffic areas of classroom
    • Longer orientation to classroom routines at beginning of year and periodic review throughout the year using a model-guide-practice approach.
    • Teach classroom rules in a lesson format with quick daily recap, along with parent signed list of classroom rules significantly increased rule following in the classroom
    • Transitions
    • With 8-15 transitions daily, it is important to teach transition rules, a transition signal, model, practice and time it with periodic recaps. Transition rules may be – put your things away, get the materials you need next, move quietly, keep your hands and feet to yourself. A transition may be lights off, a clapping pattern, or music plays. Classroom incentives to beat the timer are effective and fun with this plan.
    • Color-coding book covers and folders by subject, assignment on board by subject, sequence of steps, etc. Color increases retention by 60%.
    • Use of background music in classroom (Mozart Effect)
      • Mozart Effect CDs
      • Sound Health Series
    • Engagement in 30-45 minutes of physical activity 3-5 days per week positively affects fitness, health and behavior
      • Exercise routines
    • Use of Delivering effective praise, reprimands and commands
      • Process praise vs. ability praise yield very different results in research regarding confidence and persistence with challenging tasks, perception of one’s own intelligence and classroom participation. With older elementary and middle/high school students, private praise is often preferred.
        • Examples of Process Praise:
          • “You did a great job on that math paper.”
          • “Wow! You wrote so neatly today.”
        • Examples of Ability Praise:
          • “You are so smart in math!”
          • “You are a great kid for writing neatly”
        • Which is significantly more effective? Process or Ability

      Research shows us that ability praise can actually decrease the child’s confidence in trying a similar task again or persevering on a task in the hopes to avoid NOT being smart or a great kid.
      • Characteristics of effective reprimands
        • Although used often and with some success, reprimands are often over-used, misused, can be very disruptive to ongoing instruction and are often habituated to fairly quickly.
        • Research has identified six pieces of the intervention of reprimanding that increases effectiveness.
          • Promptness- with peer attention as a strong reinforcer for misbehavior, even a 2 minute delay can make the reprimand ineffective
          • Briefness – use the child’s name and 2-3 other words “John, stop talking”, “Sally, hands off Suzie” (this elicits less attention to the inappropriate task and there is less room for argument)
          • Softness – quiet and private reprimands have been shown to have dramatic positive effect on behavior, while loud and public reprimands are ineffective and can exacerbate the disruptive behavior
          • Proximity – studies show that reprimands over a large distance are NOT effective, however, reprimands given within one yard of the child that also have the above characteristics are highly effective
          • Calmness – calm and consistent tone of voice
          • Eye contact- effectiveness of verbal commands are enhanced by eye contact
      • Characteristics of effective commands
        • Avoid rhetorical questions when looking for an action (i.e., What are you doing?, Why are you sitting on the floor?, Where are your math materials?) as research shows us often leads to unproductive teacher-student interactions.
        • Allow wait time for the child to process the command. Research shows that 5 full seconds should be waited before repeating the command.
        • Six pieces that need to be in place for effective teacher-student and parent-child compliance with commands per research include:
          • Specificity – child must understand exactly what is expected – “Take your math book out of your desk” versus “It’s time for math”
          • Positive statement commands – “Do” instead of “Don’t” commands
          • A firm, calm and unemotional voice
          • Proximity
          • Eye contact
          • Praise for compliance (process praise)
  2. Targeted Interventions
    • Visual schedule on desk, cubby, locker, keychain for following routines, transitions, direction following, task completion, managing the lunchroom, managing the bus, etc.
    • Pre-teaching/pre-practicing skills for routines, academic skills, physical education, music, art, transitions, etc.
    • Social Stories: A Social Story™ describes a situation, skill, or concept in terms of relevant social cues, perspectives, and common responses in a specifically defined style and format. Effective for most social situations.
    • Use of visual and tactile cues for time management, on-task behavior, transitions, task completion, homework completion, class participation
      • Time Timer™
      • Teacher’s Hands™ Personal Pager
      • Line Leader™ – helps preschool-2nd grade stand in line
      • Duo Reading Rulers™ and Highlighter Strips alert child to area of focus
      • Write Klip™ Clipboard help with materials management and tactile feedback when writing
      • Personal Space Mat provides visual cue for personal space
      • Desktop Carrel provides an “office” workspace for increased focus
    • Desk-a-doo, Slant board and Over the Chair Storage Buddy for increased materials management and organization

Processing Skills

Processing Skills are the sequence of steps that information takes as it flows from one’s sensors (eyes, ears, hands, etc.) to cognitive processing.

Interventions at the level of processing skills are aimed at enhancing each child’s ability to process the information given to them so they can use it in everyday learning and social tasks. There has been much research on different learning styles in both children and adults, which rely heavily on each individual’s strengths and weaknesses in the areas of visual, auditory and tactile/kinesthetic processing.
When the learning style of the student mismatches the teaching style of the instructor, students may become bored, inattentive, discouraged, do poorly on tests, behave inappropriately and have poor academic achievement.
The best way to combat this issue is to teach to all learners, or find a balance between different instructional methods, avoiding teaching only in their learning preference. Make sure to:
  1. Pair auditory and visual information when giving directions and teaching concepts whenever possible
  2. Allow reflection and acting out material
  3. Give project-based assignments to demonstrate learning
  4. Use visualization, motor activities and fun auditory memory strategies (singing, acronyms, etc.)
  5. Teach early skills in a multi-sensory manner – see it, say it, hear it, touch it, act it out, find it, teach it, feel it
  6. Use manipulatives whenever possible

When the discrepancy is more pronounced than a preference, these evidence-based interventions may be useful.
  1. Metronome use for rhythm and time
    • Rhythm is an important input into the brain! It increases retention like the way we can remember words to a song.
    • Time: Inputting information into the brain is like inputting information into a computer. But, where did I put it???
      For information to be useful, it must be accessible. With metronome practice, information must be accessible by the next
    • Read on beat, practice math facts, spelling a word with one letter on the beat, practice motor patterns to the beat
    • In general, the goal is have the metronome at 54-60 beats per minute
  2. Visual Aids
    • Color Overlays – research shows that there is not one color that works best for every child, therefore, all colors need to be presented with the decision made by child report and teacher observation (reading sample should be at or below the child’s reading level)
    • Duo Reading Ruler – same benefits as color overlays with added benefit of aiding in visual tracking
    • Magna Typoscope – enlarges print and aids in visual tracking
    • Highlighter Strips, highlighters
    • Highlighter paper
    • Enlarge print
  3. Voice Amplification and auditory feedback devices
    • Toobaloo – auditory feedback for the child who demonstrates poor visual memory and comprehension is provided without disruption to the classroom with reading aloud
    • Talking Calculator
    • Talking Dictionary
    • Voice Saver
  4. Tactile Reminders
    • Grotto Grip for pencil grasp
    • Raised-lined paper for tactile feedback
    • Wikki Stix for raised boundaries or kinesthetic approach to teaching/learning


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Tags: Article OT Newsletter 30 December 2011