When applying an intervention for children with social-emotional challenges/delays, caregivers and professionals must maintain focus on the core fundamental process driving social-emotional development, sustained dynamic co-regulated interactions. Creating a sensory and emotionally supportive environment for a child can maximize the effectiveness of an intervention.  However, if the environment does not support both the sensory and the social-emotional systems, then the intervention will be less effective at successfully addressing the child core goals.  While we want a child to explore their environment learn how to use the many ‘tools’ and opportunities it provides, we also have to make sure it facilitates sustained social engagement and interaction. For children with developmental delays like Sensory Integration Disorder, ASD, PDD, and many others, using the equipment/toys and exploring the space should encouraged primarily within a meaningful continuous social exchange.  While these developmental delays have many roots in the motor and sensory systems, they are still social emotional delays stemming from a lack of integration of the sensorimotor system with the emotional/affect processing systems, not just a dysfunction of the sensorimotor system. Because these systems are supposed to all work together, we cannot effectively work on separate areas in isolation.  Targeting these areas separately can lead to further poor integration. Instead, the vast majority of activities a child engages in should be ‘fully integrated’ experiences (sensory-affect-motor™) and not simply a sensorimotor integration experience. 

Jean Ayres, the mother of sensory integration, identified that for a sensory motor experience to have a long term therapeutic impact, that the participant must exhibit a purposeful social response while participating in the experience (Read Article).   Years later, Dr. Stanley Greenspan said that it was the social-emotional exchange within the sensory experience that was the glue integrating the different areas of the sensory system.  In his early research at NIMH he identified that a child’s difficulty integrating their sensory-motor system with their emotional system was the driving force behind most developmental delays.  Current research supports these theories.  These beneficial social interactions (ongoing reciprocal social patterns) that utilize gross motor sensory input based on the child’s needs, are ‘fully integrated’ experiences. 

Rules for ‘Fully Integrated’ Sensory-Affect-Motor™ Rooms/spaces,

  1. Avoid small, visually self-involving objects. These are typically hard plastic or metal toys like matchbox cars, figurines, Legos, or even pictures and puzzles and other small objects.
    1. The goal is an integrated sensory and emotional experience or activity where a child is connecting with a ‘caregiver’ focusing on their face and gestures, reading and responding to their subtle emotional cues, listening to their voice, and understanding the context.
    1. Visually distracting and visually self-involving activities or objects will always work against our primary goal of sustained social engagement.
      1. Hyper-focusing on a small object, rice and beans, pictures, or some other sensory input, will work against our primary social-emotional goals.
      1. Small toys can be introduced when the child has mastered social engagement, i.e. when their preference is to engage with people and not objects, and the child can easily switch engagement between the object and person. 
  2. Include larger toys; big stuffed animals (like IKEA’s), large foam cars, large cardboard blocks, yoga balls, pillows, etc.
  3. Create a nook, fort, or enclosed space (like a tent).
    1. This can be combined with a platform to climb up onto.
  4. Avoid visual contrast on the walls, floor, or ceiling.
    1. Contrast is one of the most distracting and attention grasping elements in our environments. When we see straight lines with different colors on either side, our attention is naturally drawn to it, leading to greater distractibility.
  5. The size of the room should be based on the child’s needs. Bigger is not better!
    1. Learning to modulate (control) their bodies by moving fast and then purposefully slowing down is more important than simply running around. 
    1. The fact a child needs to move and run does not mean they need a giant sensory room.
      1. Having a giant space for burning off energy is not necessary for children with sensory regulatory difficulties. It can lead to the child continuing to be hyper and seek out more and more sensory input instead of learning to self-regulate over time.
  6. Make sure specific types of equipment are available, but not too much equipment. Focus on Movement (Vestibular), Pressure and muscle usage (Proprioceptive), and touch (Tactile) opportunities.
    1. Vestibular stimulation: swings, spinning office chairs, hammocks, trampolines, and climbing vertically up to platforms can be effective.
    1. Proprioceptive stimulation: trampolines, inclines, crash pads, Lycra/Spandex, and weighted stuffed animals, etc.
    1. Tactile stimulation: Toys with different textures; spiky, soft, plush, etc.
    1. Too many of any object can increase fragmentated attention and distractibility.
      1. For example, you do not need 5 different swings. You want one, maybe two, so that the child can be on it with you and focus on it with you instead of running around doing it by themselves.

Traditional OT gyms provide children with so much space and soooo many options they end up moving from object to object, activity to activity, running a circuit, or not knowing what to do. They don’t maintain engagement with an adult or peer and learn to rev up, burn off energy, and then ‘crash’/stop.  This should not be the goal and will not lead to long term changes in the child’s activity level.  That ‘peak and valley’ activity/energy pattern will continue to replicate instead of the child developing a balanced, consistent, and regulated arousal state. 

Aspects of these spaces can be beneficial for motor development, but are not ideal for developing self-regulation. In these environments, children learn to regulate off of physical input but not they’re not learning to regulate off of a social-emotional stimulus. They’re not interacting with people continuously or processing their emotional communication while experiencing physical and motor stimulation. As a result, a child burns off energy but needs to do the same thing the next day and the next day and the next day. This does not lead to long-term changes in their sensory regulatory system. Jean Ayres identified the principles necessary for integrating these systems in her ground breaking work establishing the concepts of sensory motor integration (Read Article)In a socially purposeful and sensory supportive environment that prioritizes social engagement interaction, children can learn to modulate both their sensory and emotional systems.  When a meaningful emotional interaction is a main component of our regulation experience, children need less sensory stimulation over time.  Emotional stimulation and interaction has a largest impact on all of our ability to self-regulate. Read more about Co-Regulation and Counter Regulation here. Children at different developmental levels benefit from different learning opportunities and different spaces. For children who are well organized within their sensory systems, and can be socially calm and focused, but still need to work on executive functioning and planning and sequencing, then slightly larger spaces can be beneficial.  Organizing activities that require more planning and coordination, like creating a chase game, a large obstacle course, or playing treasure hunt/hide n’ seek can be beneficial. These types of activities are different from sensory stimulatory/modulatory activities.  When a child’s nervous system, sensory and emotional, is fully regulated and they become stronger at planning and sequencing their actions and ideas, then they can benefit from the more traditional play environments and be socially engaged and interactive. The Greenspan Floortime Approach®, Dr. Greenspan’s version of Floortime, is the only version of Floortime that takes these concepts into consideration within it’s rules for application.

Learn how to apply his version of Floortime, Greenspan Floortime®.  Register for the Professional or Caregiver/Parent Course at www.stanleygreenspan.com. Parents and Professionals can also receive Greenspan Floortime® Expert Tele-Coaching with additional video analysis and feedback.   For in-person Greenspan Floortime® based OT, SLP, Social Group Programs, and coaching contact The Floortime Center®, www.thefloortimecenter.com.