Combining Sensory Integration and Integrated Playgroups at Developmental Pathways for Kids
Rebecca Berry, M.S., PT and Glenda Fuge, M.S., OTR/L

It wasn’t so long ago when Ben spent the bulk of a birthday party alone and unhappy. While other kids laughed, played, and gobbled up cake, he sat in a corner sucking his thumb, just waiting for the time when he could walk back out the door. Experiences at local playgrounds weren’t much better. Ben would reluctantly play on the monkey bars or slides. But he’d only do that when no one else was using them. In fact, his most successful moments at a park were when he had it all to himself. For Ben’s parents, the scenes were heartbreaking. “I remember wondering if I’d ever get the chance to watch my son happily playing with another child,” recalls Ben’s mother, Linda. “Would he ever dream up imaginary games or participate in a friendly game of kick ball?”

The answer to all those questions, thankfully turned out to be ‘yes’. Just before his third birthday, Ben began to participate in an innovative program at Developmental Pathways for Kids in Redwood City, California. The idea, launched in 1997 was to blend sensory integration therapy with facilitated peer play groups for children within the autism spectrum. The pioneering program was designed by directors, Rebecca Berry, MSPT and Glenda Fuge, MS, H. Ed, OTR to address the unique social, play and sensory needs of children with autism spectrum disorders (Wolfberg, 1999; Berry & Fuge, 2004). Drawing from current research and practice, this combined program provides a unique opportunity for development of sensory processing, self-regulation and social competence while participating in play with typically developing peers.

Experienced clinicians working with children within the autism spectrum note that greater than 75% of these children have difficulty sorting through information and stimulation that comes at them resulting in poor sensory processing, difficulty modulating behavior and limited ability to keep themselves in balance (self-regulation). These sensory “glitches” can result in a variety of anti-social behaviors (for example, a child with touch sensitivity may be overwhelmed by light touch involved in a messy art activity and may demonstrate emotional insecurity by running away, crying, or fighting with others when asked to participate). In Ben’s case, for instance, too much sound, motion or visual stimulation caused him to either retreat from a situation entirely or to become so wound up he was bouncing off the walls. For other kids, nothing but a constant barrage of activity and stimulation will engage them. The one thing that is true across the board, however, is that the inability to process sensory information properly restricts play skills and makes it virtually impossible for a child to interact appropriately with peers. Carol Karanowitz, author of the Out of Sync Child states, “The child whose sensory system is “out-of-sync” may not have the know-how to get started with play. Children need three-dimensional, hands-on, hard-work play that builds better brains and bodies.” (Kranowitz, 2003)

Sensory integration(SI) refers to the organization of sensation for adaptive use. When a person uses his or her body and the environment in a creative or useful way, the result is called an adaptive response. Although children are born with the capacity for sensory integration, they must develop it further by interacting with their environment and making adaptive responses (Ayres, 1979). Therapy based in sensory integration theory is directed at normalizing the child’s responses to sensory input and developing more adaptive and functional motor skills.

That’s why the approach at Developmental Pathways for Kids makes so much sense. The therapy offers children with a combination of social and sensory difficulties a natural and supportive environment in which to make friends and learn the fine art of play. The first 30 minutes of an hour-long session are spent addressing a child’s sensory needs. By using the SI teatment approach, therapists can determine how children are processing information and provide them with the sensory input that offers the “just right challenge” for organizing and regulating the sensory system. The treatment approach utilizes a variety of methods of stimulation (vestibular, tactile, proprioceptive, visual, auditory, gustatory and olfactory) and provides building blocks for functional skills. These sills are not taught, but are allowed to emerge spontaneously as foundations develop. Therapy is most effective when the atmosphere is relaxed, mutually supportive and playful. The SI therapy is designed to be intrinsically motivating and child-centered in order to capitalize on the child‘s attention and motivation as well as innate drive to move, explore, and learn through pleasurable experiences. For example:

The second half-hour of a therapy session pairs a kids like Ben, dubbed a novice player, with two typically developing peers, so-called experts in a fun play experience called an Integrated Play Group (IPG). The facilitated play program (IPG) is based on a model developed by Pamela Wolfberg, P.hD. The Integrated Play Model is designed to support children of diverse ages and abilities with ASD in mutually enjoyed play experiences with typical peers and siblings. Guided by theory, research and evidence practices, this multi-dimensional model incorporates parameters known to affect social interaction, communication, play and imagination in children with ASD (Wolfberg 1999, 2003). The peer play is facilitated by a therapist who acts as a guide” from a distance” during the play. The experts serve a son the spot guides for the novice players, engaging them in a wide variety of spontaneous, mutually enjoyable games. On a given day at DPK you may see three girls dressed up in the castle serving tea for the “queen” or a group of boys building a car race station with ramps, innertubes, cones and tires. Initially the adult scaffolds and supports the peer play with structure, design of play themes and assistance with communicating with peers. Eventually, the goal is that the group takes on it’s own life—each child is an independent participant in the group and most sessions can be driven exclusively by the kids. This flexibility allows for the most natural play scenarios and gives novice players consistent opportunities to build play repertoires and make successful social interactions. And it is fun! Laughter and smiles combined with determination and engagement in the play scenario are evidence that each child is participating in a worthwhile experience. Parent and principal, Judith Brown comments, “I know there is no ‘ magic’ in what happens at DPK, but the change in my daughter has been magically amazing. Strategies for developing social skills, self-regulation, and language are basic and easy for most children. For a child and parent who are lost, the author’s program, Developmental Pathways for Kids, has been pivotal in find the path to positive, pragmatic, and creative social interactions.”

Several recent research studies at San Jose University in California have provided preliminary data to support the efficacy of the SI-IPG model at Developmental Pathways for Kids. The studies found that following participation in the SI-IPG program at DPK, novice players made significant improvements in the social dimension of play, rate of social initiation-responsiveness, quality of social interaction-responsiveness, fine motor skills and gross motor skills. Parents of children involved in the studies completed an open-ended parent perception questionnaire. Changes in social and play behaviors observed by parents were reflected in six themes: sibling/peer friendships and relationships, increase in peer interaction, changes in overall well-being, diversity of play, and changes in skills and behaviors (Schaefer & Atwood, 2003). Two independent case studies were also designed to replicate DPK’s model at the pediatric clinic at San Jose State University and these studies found significant increase in the child’s duration of play engagement, self-regulation, symbolic and social dimension of play following participation in a 10-week program. The results of these studies support further investigation into the outcomes of this intervention, particularly how well children generalize play and social skills into home and school environments. “A widely accepted goal for children with special needs is that they be integrated into community institutions as fully as possible. For children, the major community institution is the school, whether it public, charter, or private. The problem is that until now, no one has provided the bricks and mortar, the actual methods of integrating the vital part of the child’s life-the relationships with other children-the social fabric of the child’s life. Fuge and Berry have taken the vague and fuzzy concepts of sensory integration and given them form and substance by providing guidelines and specific methods for melding children within the autism spectrum with typically developing children into happy and cohesive playgroups. The wonderful thing is that the activities that are vital to the children with ASD also enhance the capabilities of the typical children, Everyone benefits.” Lorna Jean King, OTR/L, FAOTA

By utilizing sensory integration strategies within the Integrated Play Groups format, a balanced partnership is created. Combining SI and IPG allows therapists to carefully craft ways in which to engage children in play experiences that are not only developmentally appropriate and theraputic in nature, but also reflect the natural play experiences of typically developing children. By blending practices, children are afforded opportunities to perform and master a host of necessary skills to acquire social competence, effective communication, adaptive behavior, functional motor skills, and flexible imagination. With specific structure and support they lean how to attend, observe, follow, imitate, share space and materials, coordinate actions, and carry out pretend play scripts with peers. Throughout this process, play is recognized not only as a vehicle to learning and development, but as a most meaningful part of childhood that enables children to simply have fun and make friends.

As for Ben, he is now six years old. He attends first grade at a mainstream public school in his community. He has several friends, plays on his local baseball team, and has graduated from local playgrounds to full-fledged amusement parks. As for birthday parties, Ben now looks forward to each and every one of them – especially his own.