Irvine Therapy Services

Using sensory integration to help children succeed since 1980

FREQUENTLY ASKED QUESTIONS

The first step in the process is to determine whether or not your child would benefit from receiving occupational therapy services at Irvine Therapy Services. Once we receive your inquiry, a member of our staff will contact you in order to gain a better understanding of your concerns. We ask that parent(s) and/or caregiver(s) complete the intake forms (which are downloadable from the Get Started page of our website) and return them to our office so that we can determine what would be the best assessment for your child. If you would prefer to speak in person with a member of our staff, we would be happy to schedule an appointment to meet with you for a complimentary consult and tour.

We believe that good services begin with an in-depth assessment. If your child has received an occupational therapy evaluation within the last year, we ask that you bring us a copy of the report for our review. We would be happy to take a look! Assessments performed at other facilities may or may not provide the information we need in order to initiate services.

Not all insurance plans cover occupational therapy services. Irvine Therapy Services is an “in-network” provider for some Blue Shield of California PPO insurance plans. We are not providers for Covered California plans. It has come to our attention over the past year that some insurance brokers or Blue Shield themselves have erroneously informed individuals that we accept their insurance plan. If you think that we might be an in-network provider for your insurance plan, we are happy to contact your insurance company for benefit verification. Please call our office; we would be happy to check for you!

At this time, we are an “in-network” provider for a select number of Blue Shield PPO plans only. Most medical insurance companies want us to provide the least amount of services for the shortest duration possible. This model compromises the quality of care we believe our clients need and deserve. Rather than giving in to keep insurance companies happy, we have chosen to stay true to our values and beliefs in providing high quality care. Clients with PPO insurance plans for whom we are “out-of-network” can be seen with payment due at the time of service. We are happy to provide you with the information needed to submit an invoice to your insurance company for possible reimbursement. We know that the process can be frustrating and difficult to navigate; so if you have questions, please do not hesitate to ask. We want to help!

Yes, absolutely. We recognize that the majority of a child’s time is not spent in the clinic, but at home, at school, and in the community. Once your child’s therapist has had an opportunity to get to know your child, she can collaborate with you to develop a home program of activities to complement what your child is doing in therapy.

No, not all pediatric occupational therapy is the same. Many health professions have general practitioners as well as specialists, and occupational therapy does too. There are occupational therapists who specialize in hand therapy, feeding and swallowing, etc. Sensory integration is a specialty area too. A pediatric occupational therapist may have been exposed to sensory integration principles while in school or even taken a continuing education class; however, applying sensory integration principles in occupational therapy practice is a specialty that requires post-graduate education and training. For an occupational therapist to effectively use a sensory integration approach, she or he requires additional education to understand its theoretical underpinnings and extensive mentorship training to integrate the theory into practice.

Children all grow and mature at different rates; however, sensory integration deficits and other sensory processing issues are not something that children grow out of. Early identification and treatment of concerns are important. The earlier that concerns are identified and treated, the better the outlook for the child’s well-being physically, emotionally, and psychologically.

From the American Occupational Therapy Association (AOTA):

In its simplest terms, occupational therapists and occupational therapy assistants help people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities (occupations). Common occupational therapy interventions include helping children with disabilities to participate fully in school and social situations, helping people recovering from injury to regain skills, and providing supports for older adults experiencing physical and cognitive changes. Occupational therapy services typically include

an individualized evaluation, during which the client/family and occupational therapist determine the person’s goals,
customized intervention to improve the person’s ability to perform daily activities and reach the goals, and
an outcomes evaluation to ensure that the goals are being met and/or make changes to the intervention plan.
Occupational therapy services may include comprehensive evaluations of the client’s home and other environments (e.g., workplace, school), recommendations for adaptive equipment and training in its use, and guidance and education for family members and caregivers. Occupational therapy practitioners have a holistic perspective, in which the focus is on adapting the environment to fit the person, and the person is an integral part of the therapy team.

No, not all pediatric occupational therapy is the same. Many health professions have general practitioners as well as specialists, and occupational therapy does too. There are occupational therapists who specialize in hand therapy, feeding and swallowing, etc. Sensory integration is a specialty area too. A pediatric occupational therapist may have been exposed to sensory integration principles while in school or even taken a continuing education class; however, applying sensory integration principles in occupational therapy practice is a specialty that requires post-graduate education and training. For an occupational therapist to effectively use a sensory integration approach, she or he requires additional education to understand its theoretical underpinnings and extensive mentorship training to integrate the theory into practice.

From Frequently Asked Questions About Ayres Sensory Integration®, AOTA, 2008

Sensory integration is the process by which people register, modulate, and discriminate sensations received through the sensory systems to produce purposeful, adaptive behaviors in response to the environment (Ayres, 1976/2005). The sensory systems we depend on for input include vision, auditory, gustatory (taste), olfactory (smell), tactile (touch), proprioceptive (joint position sense), and vestibular (balance and movement). Effective integration of these sensations enables development of the skills needed to successfully participate in the variety of occupational roles we value, such as care of self and others, engagement with people and objects, and participation in social contexts. The therapeutic approach of sensory integration was originally developed by A. Jean Ayres, PhD, OTR, and is formally know as Ayres Sensory Integration® (ASI; Ayres, 1989). ASI® includes the theory of sensory integration, assessment methods to measure sensory integration, and a core set of essential intervention constructs that can be utilized to intervene with clients who have difficulty processing sensory information.

As children grow, they typically develop the refined ability to appropriately register, modulate, and discriminate sensory information to support the development of effective emotion regulation, social skills, play skills, and fine motor and gross motor skills. Problems effectively integrating sensation can limit a child’s ability to attend to tasks, perform coordinated motor actions, plan and sequence novel tasks, develop social relationships, manage classroom demands, perform self-care tasks, and participate in family activities. When problems in processing sensory information interfere with the child’s ability to perform or participate in age-appropriate activities of daily life or “occupations,” occupational therapy using an ASI® approach can help to address these concerns.

Although a variety of children may benefit from occupational therapy using an ASI® approach, the children who are most typically referred for intervention include children ages birth through adolescence who are struggling academically but who do not have a clear diagnosis, as well as children with such specific diagnoses as:

autism spectrum disorder
learning disability
nonverbal learning disability
developmental delay
ADHD [attention deficit hyperactivity disorder]
regulatory disorder
developmental coordination disorder

The STAR Institute for Sensory Processing Disorder states that “Sensory Processing Disorder (SPD) is a complex disorder of the brain that affects developing children and adults who were not treated in childhood. It has also been referred to under different names such as sensory integration disorder or dysfunction of sensory integration. Children with SPD misinterpret everyday sensory information, such as touch, sound, and movement. Some feel bombarded by sensory information; others seek out intense sensory experiences or have other problems. This can lead to behavioral problems, difficulties with coordination, and other issues. Symptoms of SPD, like those of most disorders, occur within a broad spectrum of severity. While most of us have occasional difficulties processing sensory information, for children and adults with SPD, these difficulties are chronic, and they disrupt everyday life. Sensory signals don’t get organized into appropriate responses. Pioneering occupational therapist and neuroscientist A. Jean Ayres, PhD, likened SPD to a neurological “traffic jam” that prevents certain parts of the brain from receiving the information needed to interpret sensory information correctly. A person with SPD finds it difficult to process and act upon information received through the senses, which creates challenges in performing countless everyday tasks. Motor clumsiness, behavioral problems, anxiety, depression, school failure, and other impacts may result if the disorder is not treated effectively. Sadly, misdiagnosis is common because many health care professionals are not trained to recognize sensory issues.”

In her book Sensational Kids (2006), Lucy Miller, PhD, OTR/L describes “Sensory Modulation Disorder [as] a chronic and severe problem involving the ability to turn sensory information into behaviors that match the nature and intensity of the sensation. Children with difficulties modulating sensory input may under-respond to sensation, over-respond to sensation, seek intense sensation, or display a mixture of the three. Sensory modulation difficulties can occur in any of the seven senses [visual, auditory, gustatory (taste), olfactory (smell), tactile (touch), vestibular (movement and relation to gravity) and proprioceptive (position of joints and muscles)].”

Praxis is comprised of three components:
1) ideation-the ability to conceptualize a new or different activity
2) motor planning-the ability of the brain to organize and sequence novel motor actions
3) execution-the ability to perform motor actions

When children have dyspraxia, or difficulties with praxis, there is often a deficit in the motor planning component. Underlying that deficit is frequently poor processing of tactile, proprioceptive and/or vestibular sensory input. These three sensory systems are foundational for the development of a body percept. A. Jean Ayres discusses how forming neural memories to create a body percept is essential for motor planning in her book Sensory Integration and the Child, 25th Anniversary Edition. As children move and interact with their environment, their bodies store sensory information about their body parts—size, weight, boundaries, movements, and positions in relation to the rest of the body. The brain also stores information about the environment, such as gravity, texture, density, temperature, tensility, etc. Using the sensory information gleaned about his/her own body and incorporating the sensory information about his/her environment, the child is then able to know how fast and hard each muscle in his/her body needs to work in order to perform various tasks, how to properly use a tool, and if he/she will fall when performing a specific movement. Children with dyspraxia are often considered clumsy or awkward, and frequently have physical accidents because they lack an adequate body percept.

For most people, motor planning requires no conscious effort, they just do it. Their brains are able to do the work (motor plan) spontaneously. They might need to practice initially when learning something new, but the brain adapts; motor planning is no longer needed (remember, motor planning involves novel actions), and the action becomes automatic. For children with dyspraxia, the action does not become automatic, and they have to motor plan it over and over again. Dyspraxic children work very hard, more than other children, just trying to keep up. Subsequently, children with dyspraxia are frequently frustrated and anxious.

In the book Sensory Integration and the Child, 25th Anniversary Edition (2005), A. Jean Ayres, PhD, OTR states that “Tactile defensiveness is one type of sensory modulation disorder. It is the tendency to react negatively and emotionally to touch sensations. The reaction only occurs under certain conditions. Tactile sensations are constantly entering everyone’s nervous system; however, most individuals are able to inhibit their perception of these sensations and prevent their nervous systems from responding to them. Children with tactile defensiveness do not have enough of this inhibitory activity, and so many of these sensations make them feel uncomfortable. These reactions to touching can interfere with their ability to engage in daily self-care tasks (ex. dressing, eating, bathing, brushing their teeth), participate at school (ex. playing tag, participating in art, standing in line, paying attention), or interact socially with family and friends (ex. holding hands, hugging, kissing, tickling).”

IIn their How does your engine run?: A leader’s guide to the Alert Program for self-regulation (1994) curriculum, Mary Sue Williams, OTR/L & Sherry Shellenberger, OTR/L state that “Arousal can be considered a state of the nervous system describing how alert one feels. In order to attend, concentrate, and perform tasks in a manner suitable to the situational demands, one’s nervous system must be in an optimal state of arousal for that particular task. Self-regulation is the ability to attain, maintain, and change arousal appropriately for a task or situation. Most individuals self-regulate their arousal levels throughout the day, with no conscious thought or effort. In the morning when they wake up, they are able to move from a low arousal state (sleep) to an optimal level so they can focus on the day’s activities. And when the day is done, they are able to move back down to a low arousal state in order to fall asleep.”

Arousal levels can mildly fluctuate throughout the day in response to various sensory events (ex. a car honking on the freeway or burning a hand on a hot pan may momentarily startle, eating too much for lunch may produce a brief food coma) , but most individuals are usually able to self-regulate so that their arousal stays within an optimal zone. Some individuals, however, are unable to self-regulate their arousal level and may 1) have low arousal throughout the day (ex. cannot seem to get going, lethargic, slow, usually sedentary), 2) have high arousal throughout the day (ex. seems unable to calm down, hyperactive, seemingly minor incidents result in major meltdowns, fight or flight response, becomes overwhelmed and freezes or shuts down), or 3) have large fluctuations throughout the day ranging from very low to very high arousal.

(parts taken from How does your engine run?: A leader’s guide to the Alert Program for self-regulation, Mary Sue Williams & Sherry Shellenberger, 1994)