SI Frequently Asked Questions
Frequently Asked Questions
Based on the new terminology proposed in the November/December 2007 issue of AJOT, the term sensory processing rather than sensory integration is proposed for diagnostic descriptions. Why? Because other disciplines use the term sensory integration to describe sensory integration on a cellular level, which is very different from the meaning that occupational therapy attaches to this term.
Also, Sensory Processing Disorder (SPD) is the proposed overarching diagnostic category with three categories of SPD being Sensory Modulation Disorder (SMD), Sensory-Based Motor Disorder (SBMD) and Sensory Discrimination Disorder (SDD). Each of these categories has subtypes.
For the purpose of this website, the term sensory processing disorder is used to refer to the diagnostic description of a student who has problems with sensory processing.
There is sometimes confusion over what school occupational therapists do or do not do related to sensory integration. Some say school occupational therapists “don’t do SI” and others say they do. This comes down to a question of terminology and understanding the OT's role in the public schools. Until we are consistently able to define and use these terms across our profession (let alone outside of our profession) we will continue to encounter this confusion. The truth of the matter is that occupational therapists working in the public schools use “SI” quite frequently in many ways. School OTs address sensory processing in their evaluations and intervention to educate parents and other team members during a team meeting of a student who is ineligible for special education services; to consult with teachers in order to develop and implement a sensory diet in the classroom; to work with the student in context in order to develop sensory strategies for effective participation, to provide direct intervention with the student when other less restrictive options are determined to be ineffective in supporting school participation.
See Supporting Students with SPD in School for more information on how OTs use their unique knowledge of sensory processing in the schools.
School-based occupational therapists assess students in all areas of suspected disability including sensory processing. Occupational therapists are uniquely qualified to analyze how sensory processing influences learning and behavior. OTs can support the student by sharing this information with the team, whether or not the student is ultimately found eligible for special education and/or related (OT) services.
For eligible students, (see section on IEP Process for more information on eligibility) OT may address sensory processing needs if necessary in order for the student to participate in his or her educational program. Services are always provided with consideration for the least restrictive environment and are therefore on a continuum from least to most restrictive. See section on Supporting Students with SPD in School for more information.
The SIPT may be given by a school therapist certified in its administration for a student with a suspected disability in Sensory-Based Motor Disorder or Sensory Discrimination Disorder. However, the SIPT has several limitations and often may not the most appropriate, efficient or cost effective tool for use in the public school setting. The SIPT was designed for use with children from 4 years to 8 years, 11 months. The test is complex requiring two to two and half-hours to administer and is time consuming and expensive to score requiring purchase of a CD for scoring or sending the results in to Western Psychological Services (WPS), with the interpretation and scores returned in one to two weeks. The SIPT does not specifically assess Sensory Modulation Disorder.
The school therapist is interested in assessing a student’s school participation. When assessing a student with suspected sensory processing problems, record review, teacher and parent interview or questionnaire (ex. Sensory Profile, Sensory Profile School Companion, Sensory Processing Measure) and observation in the school environment in the specific context(s) where the student is having difficulty are all critical components of the assessment process. Functionally-based assessments are also used such as the School Function Assessment (SFA) and the Miller FUN Scales. Clinical observations as well as specific perceptual and motor assessments can also be useful in observing aspects of sensory processing.
A diagnosis of Sensory Processing Disorder (SPD) alone does not necessarily or typically qualify a student for special education. However, when considering eligibility, there may be situations where a student with SPD may meet the criteria for Developmental Delay, Other Health Impairment, or even Emotional Impairment (caused by the presence of SPD) depending on state disability definitions. Teams are encouraged to review their state disability definitions in relation to the individual student for whom they are considering eligibility. Sensory processing problems can also coexist with, or be a part of, other disabilities. For example, students on the PDD spectrum often have sensory processing issues and their ability to participate in school can be facilitated through the use of sensory strategies.
Section 504 of the Rehabilitation Act has a broader definition of a qualifying disability than does Special Education. To be eligible under Section 504 an individual must have a mental or physical impairment and while SPD could arguably qualify, the extent of the impairment is often the factor that is not met when looking at eligibility. The mental or physical impairment must be determined to substantially (not minimally or even moderately) limiting participation in one or more major life areas (learning is one area).
It is typically not necessary to have suspended equipment in order to effectively address participation-based issues related to sensory processing in the school setting. The role of the occupational therapist in the public schools is to provide eligible students with intervention in the least restrictive setting only as necessary for effective school participation. This most typically involves reframing the student’s behaviors using a sensory lens, consulting and collaborating with the teacher and other team members, and working in the educational context (e.g. classroom, gym, playground, cafeteria, etc.). The goal of the public school OT is to enable participation rather than remediation, making suspended equipment typically unnecessary and inappropriate for the school setting.
A student may receive direct OT-SI when all less restrictive intervention options have been unsuccessful and there are indicators, based on the occupational therapist’s clinical reasoning, that direct OT-SI would allow the student to achieve his or her identified school participation goal(s).
It is important for the occupational therapist working in the public schools to be able to clearly articulate his or her role, as well as the differences between the public school OT and the community OT. Developing a brochure or handout for parents to help them to better understand these differences can be an effective strategy and can reinforce what has been explained to them verbally.
Any explanation should include the role of OT as a related service provider in providing services (only) when necessary for the student to participate and progress in his or her educational setting. It can be effective to explain to the parent that their child is in school to get an education, not to get therapy. Given this, the educator (teacher) is the primary service provider and OT is a support (related) service that is only provided when necessary for the child to get an education. The school-based OT has a narrower role than an OT in another setting might have because the school OT only and specifically addresses school participation and does not necessarily remediate. Go to OT Role for a comparison of the roles and services of the public school and the community occupational therapist.
Information Sharing is often the first step in supporting the student with SPD in school. This may include:
- Reframing the team’s understanding of student behavior & explaining the just right fit for the student with SPD in the educational setting
- Educating the team about sensory diet
- Supporting the team in making adjustments to the activity demands or context
Start by sharing information and reframing the teacher’s understanding of why the student is behaving as they are. Once the teacher understands the student’s behavior from a sensory perspective, he or she will be more inclined to implement suggested sensory strategies. Address the most important thing first - the teacher’s biggest area of concern or difficulty related to the particular student. Try the easiest/simplest thing first - do everything you can to help the teacher and student right now. Individualize interventions – avoid generic lists of strategies or accommodations. Try one or two strategies at a time - assess the effectiveness and modify, change or add.
It is important to follow special education procedure which states that the team must ‘consider’ all information (including outside reports provided by the parents). All decisions for eligibility and services remain with the team regardless of any outside documentation. The only requirement is that the team review and consider all available information. The student’s medical condition, medical doctor, or any other specialist outside of the public school, does not determine which services a student requires in the public school setting. These determinations are the responsibility of the special education team.
No. “SI certification” refers to SIPT certification which is required to administer the SIPT (Sensory Integration and Praxis Tests)