Providing an Equal Opportunity

By: Katie Koomar

When I tell people that I want to become an occupational therapist, I often get responses like, “What is that, therapy for the workplace?” While it is true that many occupational therapists (OTs) help adults recover from injuries so that they can go back to work, OTs can also help people of any age gain or regain the ability to do the activities that make life meaningful to them. One population that OTs can work with is children and adults on the autism spectrum. For individuals with Autism Spectrum Disorder (ASD), motor skills and sensory integration can be difficult. Sensory processing, modulation, or discrimination problems can lead to struggles in school, at work, in social situations, and in their ability to live a fulfilling life. Occupational therapy with a sensory integration frame of reference (OT/SI) can help improve their quality and enjoyment of life.

When interacting with or treating those with ASD, it is helpful to remember that “persons with ASD are integral members of their families and communities and have the right to fully participate in the educational, social, cultural, political, and economic life of society” (AOTA, 2009). While typical OT treatment can improve motor skills in a person with ASD, OT/SI increases their ability to participate in classroom/workplace and leisure activities. For example, if a child with ASD is invited to a birthday party, they might not be able to handle the auditory stimuli and begin to exhibit inappropriate behaviors. This can result in the child not being invited to other social events, which may lead to more social difficulty in the future than a child with ASD already has. But if individuals with ASD have effective treatment, a supportive environment, and work hard, they can be very successful.

One of many success stories is that of Paul Morris. Paul Morris is on the autism spectrum and was non-verbal until the age of 5. He had many typical ASD issues, including sensory integrative issues. But Paul did not let these struggles stop him. Through treatment and hard work, Paul went through a College Internship Program and served as a member of his Student Government. After this program, he learned how to cook, clean, live on his own, use public transportation, and work. He also volunteers and speaks publicly to advocate for himself and others with ASD. Paul explains that “it is not only autism people who need to learn, but people who don’t have autism need to learn to understand us and be tolerant” (2015). He recognized how far he has come, but that he still struggles with some social skills and sensory problems, skills with which OT/SI can help.

The effects of OT/SI on children and adults with ASD help them thrive in typical environments, making their lives (and the lives of their caregivers) easier. This is important because children with ASD and SI issues have a “significantly lower overall level of competence in activities, social, and school performance (Child Behavior Checklist)” (Reynolds, Bendixen, Lawrence, & Lane, 2011). OT/SI can help children and adults with ASD cope with the sensory under or over stimulations they experience in everyday life. The better they can cope with sensory stimuli, the better they can function in school or at work, which can help them become successful and lead to a more fulfilling life. Why is paying attention to and researching OT/SI for people with ASD so important? ASD prevalence rates have increased in the past few years. According to the Autism Science Foundation, 1 out of every 68 children born in 2016 is on the autism spectrum. The population of children and adults with ASD is not small, and OTs should be prepared to give the best possible treatment so that people with ASD have an equal opportunity to participate in what makes life meaningful to them.


American Occupational Therapy Association. (2009a). AOTA’s societal statement on autism spectrum disorder. American Jounral of Occupational Therapy, 63(6), 843-844.

Autism Science Foundation (2017). How common is autism? Retrieved from

Morris, Paul (2015). My story of growing up with autism. Autism Speaks. Retrieved from

Reynolds, S., Bendixen, R.M., Lawrence, T., & Lane, S.J. (2011). A Pilot Study Examining   Activity Participation, Sensory Responsiveness, and Competence in Children with         Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 41, 1496-    1506. DOI 10.1007/s10803-010-1173-x.

Essential Questions for a Prospective Sensory Integration Therapist

If your child has been diagnosed with a sensory integration (SI) problem, finding the perfect therapist to suit his or her needs is not an easy process. Sensory processing disorder (SPD) is a complex and challenging field of therapy, and requires a professional who knows what he or she is doing. When meeting a prospective therapist for the first time, it can be very helpful to come prepared with a list of questions for him or her, including the following:

What is your training in SI?

Sometimes the simplest questions are the most helpful. A great first step in gauging whether a given therapist is right for your child is to get a sense of their knowledge of SPD, and training is a great indicator. There are several SI certification programs out there that your prospective therapist may have taken – one of the best-known is the Sensory Integration and Praxis Test (SIPT) which has been offered by Sensory Integration International in the past and in recent years by Western Psychological Services (WPS).  If the therapist is not certified in the SIPT, then asking what other coursework they have taken related to sensory integration can be helpful.

What practical experience in SI do you have?

So your child’s prospective therapist has degrees from all Ivy-League schools and a slew of professional memberships to boot? That’s all good and dandy, but there is no substitute for practical, hands-on experience treating children with sensory problems. This doesn’t necessarily have to limit your choices to veteran therapists with decades of experience – there are many fantastic mentorship programs for starting therapists that provide invaluable experience for use in a clinical setting. If your child’s prospective therapist is a bit behind in the clinical-experience department, ask if he or she has gone through any training or mentorship programs that included practical study (this might include fieldwork at a sensory integration clinic or an intensive mentorship program such as those offered by the Spiral Foundation) – the experience a new therapist can gain from these can certainly be enough to make up for a shortage of years in the clinic.

What other types of SI coursework have you taken?

Believe it or not, the best therapist for your sensory-impaired child may not be certified in SI at all! SPD can affect any of the seven human senses, and if your child is severely impaired in one sense more than another, a specialist who has taken SI-related coursework in your child’s area of sensory difficulty may be your best bet. For example, a child with extreme sensitivity to noise may make great progress while under the care of a therapist with heavy coursework on vestibular problems and sound therapy programs.

If you know a therapist who is looking for more experience and training in SI, be sure to refer them to the Sensory Integration Essentials Program here at the Spiral Foundation. This all-new course series for 2014 provides a solid and complete understanding of the ins and outs of SI and sensory problems, and includes hands-on clinical experience working with children with sensory difficulties. Our next course in the series, Essentials of SI Assessment, is coming up fast, so tell them to register today! As always, feel free to reach out to us any time at 617-969-4410 ext. 231 or

Sensory Tips for Parents and Teachers #2: Connecting with Children with Autism Spectrum Disorders Through Play

“All work and no play makes Jack a dull boy,” the old saying goes. If your child happens to have an autism spectrum disorder (ASD), that saying goes double for him or her. Playtime is crucial to stimulating the social, physical and mental development of children with ASD. Connecting in such a way with a child with ASD may seem challenging, but it doesn’t have to be! There are many deceptively easy tricks you can use to help stimulate your child’s development through play, including the following:

Limit Familiar Toys and Props

When parents see their children with ASD playing obsessively with certain toys, their first instinct is often to try to play along with them using said toys. However, this can be a challenge at times. Children with ASD tend to have very specific routines and habits when it comes to using their toys, and unless you can tap into their thoughts (scientifically impossible as of the posting of this blog) you may find it difficult to play with their toys the “right” way, as the child sees it. To avoid conflicts, use novel toys or games – such as Chase, tickle games (assuming your child likes these), or Hide and Seek – can be a great way to help your child build his or her play skills and connect with them in a way that is fun for both of you.

Maintaining Eye Level

This tip does not necessarily have to include eye contact, as most children with ASD tend not make direct eye contact anyway. What this tip does require is for your face to be clearly visible to your child at all times. This may require you to kneel, squat or even lie down, but your devotion to this can help your child pick up on certain facial expressions and start to associate them with corresponding emotions.

Make Mistakes and Be Absurd

Lack of attention is often a major concern in children with ASD, but this unlikely trick is a great step in the right direction! Being absurd and using things in unusual ways at unpredictable times can greatly help catch your child’s attention and hone his or her ability to notice what’s happening around him or her. This is an invaluable skill with countless applications in life. Try putting on a bowl instead of a hat when you are getting ready to go out and wait to see your child’s reaction when he or she notices. You could also put your socks on your hands and gloves on your feet, put your jacket on backwards or anything else you think your child may notice. As an added bonus, laugh at the mistake with your child when he or she notices, and correct it with him or her watching – this will exemplify that mistakes happen, and they can be fixed when they do.

If you would like to learn more about helping children with ASD through play, be sure to register for The Spiral Foundation’s next webinar, Promoting Play Skills in Children with Autism Spectrum Disorders, on Monday, February 10, 2014. Our very own Sarah Friel, MA, SLP-CCC will be sharing vital information on this timely topic, drawn from her 23 years of experience helping children with ASD. Plus, you can earn contact hours! For more information on our other course offerings, reach out to us at (617) 969-4410 ext 231 or

Ahhh…That Exciting Cerebellum!!

As we learn more about the way the brain works and how that functioning relates to movement, we are learning more about the incredible influence of the cerebellum on so many of our daily functions.  Historically the cerebellum has been relegated to the functions of balance and timing of movements.  Today, however, we now know that the cerebellum not only controls these functions but also influences motor skills in the timing in oculomotor control, timing and prediction of the  motor aspects of speech; ataxia of gait, visuo-kinesthetic interactions of limb movements; and prediction and anticipation of motor action.

Even more exciting is the growing body of evidence which supports the role of the cerebellum in cognitive functions. One function that is particularly of interest for occupational and physical therapists working in the area of sensory integration, is the cerebellum’s role in encoding internal models of action which support and influence the development of mental representations in the cerebral cortex.  This is the vital role of sensory integration intervention…to create those internal models.  In addition, these models and cognitive mental representations appear to be vital for the child’s ability to generate ideas for actions and motor planning.

New information is also emerging which supports the role of the cerebellum in sensory acquisition.  Schmahmann postulates a theory he calls “Dysmetria of Thought” which states that the cerebellum is critical for the modulation of sensorimotor, cognitive, and limbic functions through the integration of internal representations with external stimuli and self-generated actions.  Wow!!  What a powerful thought.  In addition to these functions, the cerebellum is also now believed to influence traditionally cortical executive functions such as working memory, mental flexibility, perseveration on task, problem solving, expressive language, verbal fluency, emotional control, attention, and mental representations of visual spatial relationships.  All of which rely on our ability to represent, hold and access information.

Numerous resources are available to therapists on this topic.  I recommend the following for basic introductions.  These can be highly technical resources but are worth the read.  The articles are available as open access via Google Scholar.  Enjoy!!

* Kandel, E., Schwartz, J., Jessell, T., Siegelbaum, S., Hudspeth, A.J. (2012). Principles of Neural Science, Fifth Edition.

* Fatemi, S. H., Aldinger, K. A., Ashwood, P., Bauman, M. L., Blaha, C. D., Blatt, G. J., … & Welsh, J. P. (2012). Consensus paper: pathological role of the cerebellum in autism. The Cerebellum, 11(3), 777-807.

* Manto, M., Bower, J. M., Conforto, A. B., Delgado-García, J. M., da Guarda, S. N. F., Gerwig, M., … & Timmann, D. (2012). Consensus paper: roles of the cerebellum in motor control—the diversity of ideas on cerebellar involvement in movement. The Cerebellum, 11(2), 457-487.

* Koziol, L. F., Budding, D., Andreasen, N., D’Arrigo, S., Bulgheroni, S., Imamizu, H., … & Yamazaki, T. (2013). Consensus Paper: The Cerebellum’s Role in Movement and Cognition. The Cerebellum, 1-27.

* Ito, Masao (2011-08-01). The Cerebellum: Brain for an Implicit Self (FT Press Science).

Dyspraxia or DCD? What’s in a name?

For many occupational therapists the question continues to arise regarding how to label the motor organization and coordination difficulties we treat in children.  Popular terms include developmental dyspraxia, dyspraxia, and developmental coordination disorder.  As previously noted in this blog, there can be strong feelings among different groups regarding terminology.  At this time there continues to be a lack of consensus on which term is most appropriate.

I came across an article recently which may be useful.  While I don’t agree totally with all that is reported, it can provide a nice summary of the situation.  This article,Dyspraxia or developmental coordination disorder? Unraveling the enigma”  by Gibbs, Appelton and Appelton is open access and available for download.  These authors propose that functionally the terms DCD and dyspraxia be considered synonymous and that the best approach is to avoid labels at all and simply focus on describing the child’s motor difficulties.  This approach is probably the most useful for therapists and can allow more flexibility in perspectives.  Therapists who work from a sensory integration perspective can describe the perceived sensory foundations, while those working from other perspectives can concentrate on those skills most relevant to them.  Ultimately, the label is not important.  What is important is how we can treat the problem and improve the lives of our clients.

Sensory Tips for Parents and Teachers #1 – Those Winter Clothes

As we now head into fall with winter right around the corner, many parents of children with SPD are beginning their seasonal struggle to dress their child for the cold weather.  Many children with SPD experience sensory defensiveness, especially tactile defensiveness.  This tactile defensiveness manifests as an over-sensitivity to touch information.  These individuals often do not like light or unexpected touch, yet may crave deep touch pressure and heavy muscle work (proprioception).  Because of their sensitivity to light touch, clothing can be a problem.  We all know that friend that only dresses in soft, sloppy clothes because dress clothes are just too constricting.  The girlfriend that would not be caught dead in nylons or panty hose because she JUST CAN’T STAND THEM.  These friends probably have a bit of touch sensitivity.  In children with SPD this preference for certain kinds of clothing can be particularly strong.  The child may avoid wearing socks or underwear.  They may wear the same shirt or outfit over and over until it is way past too small or is worn thin from washing.  Seasonal clothing transitions from short pants to long pants and vice versa may be problematic.  In cold months, keeping hats, mittens, coats and scarfs on the child may be a challenge.  So what’s a parent to do?

Some Solutions:

1. Have your child be a part of the clothes finding process.  As adults we have total freedom in deciding what we wear and when we wear it.  This control allows us to feel more comfortable.  Don’t buy clothes for your child without them trying it on first.  Have them be an active participant in selecting items in their wardrobe.

2. Natural fibers tend to be easier to tolerate.  When selecting clothing, natural fibers, especially 100% cotton, tend to be easier for the defensive child to tolerate.  Avoid scratchy synthetics.  Go for soft knits and fleeces.

3. Avoid those tags and watch those seams. Try to get shirts that have printed tags rather than sewn in tags.  If you need to cut out a tag, be sure to get all of it and don’t leave sharp edges behind.  Also check seams for irritating tags and make sure that your child can tolerate the seams in any given garment.  Elastic waist pants can often be easier to tolerate than pants with zippers and waistbands.  Purchase socks that are seamless, these are much easier to find in stores like Walmart and Target these days or by Googling on the internet.

4. Prepare early for seasonal changes.  Weather changes can be unpredictable in fall and spring, but it behooves parents to start the clothing transitions earlier rather than later.  With the child select those long sleeved shirts and long pants in early September before the cold weather sets in.  If possible, on cooler days have the child wear the new clothes to get used to them, even if it is part of a day.

5. Pre-wash and soften new clothes.  Pre-wash and soften up any new clothes.  Take advantage of that early preparation and wash the new clothing several times before expecting your child to wear them.

6. Find a coat the child will tolerate.  OK, easier said than done, right?  Think about coat choices and have your child help select one.  Avoid wool coats.  Will your child handle a puffy fiber-fill jacket or would he or she do better with a thinner fiber?  Is a waist-length jacket better or does your child prefer a longer hip or knee length coat?  Is a double-breasted button-up too much fabric?  Is a zipper easier to manage?  Will your child wear a hood or is that too much irritation on their head or neck?  Also think about whether your child will or will not layer up on clothes.  A somewhat lighter coat may suffice if the child will wear a warm sweatshirt or sweater on a regular basis under it.

7. What about those hats, scarves and mittens?  The need for hats, scarves and mittens may depend on the jacket or coat preference of your child.  If he or she has a jacket with a snug collar and a hood, does he/ she really need a hat or scarf?  Again, think of the fabric of these items.  There are also options in the hat and scarf lines.  A cowl style may give warmth and be able to be pulled over the head without being constricting.  Ear muffs or head bands may provide sufficient warmth versus a full cap.  Will a ball cap be enough cover for most days?

For hand covering, consider mittens over gloves.  Can you attach mittens to the sleeves of the jacket.  Are the jacket sleeves long enough the child can pull their hands in the sleeves rather than wearing mittens?  Again check the tolerability of the fabrics of the mittens.  You may love Aunt Susie’s home made mittens but they may drive your child crazy.  Consider washing mittens as well to soften them up.

Clothing changes with the seasons can be hard on both parents and child but some preparation and respecting a child’s clothing preferences as much as we respect our own can go along way to making the transitions easier.

Spiral Foundation’s NEW!! Book Club

In our ever-growing attempts to provide resources and materials to professionals and parents, the Spiral Foundation has partnered with Amazon to bring you our NEW! A-Store.  In our A-store/ Book Club you will find recommended reading for parents, professionals and children.  By purchasing your books…paper or Kindle versions alike!…through our store, you not only get a great recommendation, but also help support research and education activities in sensory integration.  So make us your first stop for your sensory-related resources!

Today for professionals we would like to highlight two wonderful MUST HAVE resources by Dr. A. Jean Ayres.  If you want to know more about praxis pick these up today!  Click on the pictures to go to our store.


Ayres Dyspraxia Monograph, 25th Anniversary Edition

Ayres Dyspraxia Monograph

This monograph is THE resource on beginning to understand the complexities of praxis.  This updated version includes bonus information by praxis expert, occupational therapist, Dr. Sharon Cermak as well as a new extensive bibliography of praxis references.

The Adaptive Response

The Adaptive Response

This classic DVD is the only resource from Dr. Ayres fully explaining adaptive responses in sensory integration intervention and detailing the various levels of adaptive response.  This resource is a MUST HAVE for every therapist practicing in the area of sensory integration or mentoring other therapists or students in sensory integration.

Happy reading and viewing and watch this blog as well as our Facebook page for more great resources.

In Memorium – Jane A. Koomar, PhD, OTR/L, FAOTA

Jane KoomarMany people are already aware that our beloved friend and colleague, Dr. Jane A. Koomar, passed away this year on February 23, 2013 after a three year battle with breast cancer.  Jane was the heart and soul of her private occupational therapy clinic, OTA The Koomar Center (previously known as OTA-Watertown).  She was an icon in her field and changed for the better the lives of thousands of children, parents and therapists.  The Spiral Foundation deeply mourns her loss but endeavors to continue her work with our research and education activities.

To see  a lovely memorium written by OTA and Spiral Foundation staff please visit our website,, or by clicking here.

Donations in Jane’s honor may be made to the Spiral Foundation to support research in sensory integration.

Vayu vest, a Spiral partner, garners attention from medical device industry – good sign for sensory products

About three years ago, we were approached by a young engineer, Brian Mullen, who was working to create a deep pressure vest for adults with mental health concerns. Impressed by his work, we partnered with Mullen and his business partner Chris Leidel so they could access our research resources to develop and promote their Vayu vest as an FDA registered medical device.

“There is currently a large market for products that help with sensory-based interventions, such as weighted blankets and vests, massagers, sound therapy programs, etc.  However, at this time, most are not considered medical devices in the eyes of the FDA,” explained Brian and Chris.

Though numerous individuals have sought to develop weighted or pressure vests that can be mass produced and still meet the needs of those with sensory processing problems,  Therapeutic Systems, Mullen and Leidel’s company, set out to produce an evidence-based, insurance-reimbursable medical device.

“While many of these [sensory-based products on the market] are useful, moving sensory tools into the realm of medical devices could be advantageous by allowing for the development of higher quality technology solutions, facilitating increased clinical research, and ultimately resulting in insurance reimbursement. This could increase access of innovative and effective new products to many different populations,” they said.

A primary goal of the company has always been to not only develop a great product, but to validate that product through research. Over the summer, the Vayu vest was launched as a Class 1 FDA medical device and Therapeutic Systems is currently planning clinical trials to establish its effectiveness as a therapeutic deep pressure product. Though their current focus has been providing the Vayu vest to children with autism, they are also exploring other deep pressure applications such as PTSD and trauma informed care.

If Vayu succeeds in becoming an FDA registered medical device that is insurance reimbursed, it may pave the way for other sensory-based interventions to also gain this recognition. 

Recently, the Vayu deep pressure device garnered some exciting attention from the medical device industry. A prominent medical device industry journal, MD+DI, ran a profile of Therapeutic Systems. This kind of press is a great sign for sensory interventions; it shows the traditional medical device industry is interested in products that address sensory needs. 

We were thrilled to work with Therapeutic Systems, and the company was actually one of our first research affiliates – one of the ways the SPIRAL Foundation promotes research in sensory integration and Sensory Processing Disorder is through our Research Affiliates Program.  This program facilitates individuals and organizations’ ability to develop, conduct and publish research related to sensory integration. 

Both Dr. Jane Koomar and Dr. Teresa May-Benson of SPIRAL serve as scientific advisors for Therapeutic Systems and are mentioned in the MD+DI article. Check out the article and we hope you follow Therapeutic Systems and the Vayu vest!

What’s the relationship between DCD and dyspraxia?

Many are understandably unsure of the relationship between Developmental Coordination Disorder (DCD) and dyspraxia. Though I’ll try to clear the issue here, I admit, it’s complicated.

First, the definition of “dyspraxia” is not always very clear and its current usage is not exactly synonymous with conceptualizations of praxis in general. I actually try to avoid the term dyspraxia altogether these days because it is not a terribly useful term due to its lack of clear definition. I prefer the term “praxis deficits,” which is more accurate. Praxis deficits may include problems with ideation or motor organization issues of motor planning, bilateral coordination, sequencing, or projected action sequences – all of which are aspects of praxis. Dyspraxia tends to refer only to motor planning problems and depending on the profession, can be even more restrictively defined as only problems with imitation of gestures. This is far more restrictive than our current understanding of praxis in general which can include problems with tactile-based motor planning, vestibular/prop-based bilateral coordination and sequencing problems, and ideational deficits.

The term was originally developed to try to standardize identification of motor performance problems (including praxis issues) in children so there was some uniform terminology and assessment for researchers. DCD was eventually included in the DSM as diagnosis. As a diagnosis, DCD is used very broadly and is usually perceived as an umbrella term that encompasses praxis deficits. The problem with the research and the hard core DCD people is that the gold standard assessment of DCD is the Movement ABC which, from a sensory standpoint, only taps into vestibular issues and does not address tactile-based motor planning. So, the majority of children identified in the DCD literature, if they only use the M-ABC, will be those with bilateral coordination and sequencing problems and not those with tactile-based motor planning. The hard core DCD people tend to make a distinction between “motor coordination” problems (which they usually identify as issues of balance, running, ball skills, etc. – what we identify as bilateral coordination and sequencing and projected action problems) and “motor planning” or “dyspraxia” problems (which they identify as problems of imitation of gestures).

So long answer to the question – the answer is not clear. DCD is generally perceived by OTs as a larger umbrella diagnosis with praxis deficits such as motor planning problems (dyspraxia) falling under the umbrella. However, your hardcore DCD people, including many in Canada and the UK, can be quite adamant that they are different issues. The DCD research literature will capture problems with praxis but they will largely focus on children with more vestibular/ bilateral coordination/ sequencing problems; though you have to read carefully as an OT will use the DCD term but may make a point of capturing kids with tactilebased issues as well.

There is amazingly little research specifically on praxis and even less recent research. Most current articles are in relation to imitation skills in children with autism. I think it is most important to realize DCD research will reflect mostly skill-based vestibular activity and, unless done by an OT, will not reflect specific problems in tactile-based motor planning.

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