Integrare Senzoriala
Integrare Senzoriala
Integrare Senzoriala
5-2013
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Clifford, Lindsay, "Sensory Integration and Negative Behaviors" (2013). Education Masters. Paper 263.
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Sensory Integration and Negative Behaviors
Document Type
Thesis
Degree Name
MS in Special Education
Department
Education
Subject Categories
Education
Comments
Sensory integration is not abundant in the research on therapies and education. Due to the fact that there is so
little information on sensory integration correlating with behaviors of adolescent students with severe
emotional, behavioral, and intellectual disability, I decided to study just that. This study was done at a school
in New York State that is primarily a school for students with disabilities severe enough that their local school
districts cannot provide for them. There were a group of eight participants ranging from fifteen to eighteen
that all had behavioral episodes almost daily. When the participants exhibiting warning signs for a negative
behavior staff would administer sensory integration in the form of deep pressure, heavy work, compression
vest, or body sock to the participant to observe if the sensory integration deescalated the negative behavior.
During this study the eight students had a total of 140 negative behaviors. Out of the 140 negative behaviors
100 of these behaviors were deescalated with a form of sensory integration. Out of the 100 deescalating
behaviors 67 of the times deep pressure was administered; the remaining 33 positive responses were in the
form of other sensory integration. It was also noted that 78 times out of the 100 positive responses, sensory
integration was administered to the participant in less than five seconds of their warning signs.
By
Lindsay Clifford
Supervised by
School of Education
St. John Fisher College
May 2013
2
Abstract
Due to the fact that there is so little information on sensory integration correlating with
disability, I decided to study just that. This study was done at a school in New York State
that is primarily a school for students with disabilities severe enough that their local
school districts cannot provide for them. There were a group of eight participants
ranging from fifteen to eighteen that all had behavioral episodes almost daily. When the
participants exhibiting warning signs for a negative behavior staff would administer
sensory integration in the form of deep pressure, heavy work, compression vest, or body
sock to the participant to observe if the sensory integration deescalated the negative
behavior. During this study the eight students had a total of 140 negative behaviors. Out
of the 140 negative behaviors 100 of these behaviors were deescalated with a form of
sensory integration. Out of the 100 deescalating behaviors 67 of the times deep pressure
was administered; the remaining 33 positive responses were in the form of other sensory
integration. It was also noted that 78 times out of the 100 positive responses, sensory
integration was administered to the participant in less than five seconds of their warning
signs.
The topic I have chosen to research for my literature review is the effect of
sensory integration therapy on students with behavioral issues. This topic is very
significant to study because our senses control so many of our actions as human beings.
3
If these senses are not functioning properly then our responses to daily events will not be
appropriate. If one’s senses are malfunctioning sensory integration can help organize,
arose, and alert one’s body to react in its own environment appropriately (Ayres, 1989).
In so many school environments there are set guidelines and structures as to what
is appropriate school behavior and what is not. The students that don’t fit the mold of
these appropriate behaviors are often excluded from public schools and put into schools
with other students that have similar behaviors as they do. Conventionally, students with
learning disabilities and challenging behaviors are medicated and often physically
restrained (Blairs & Slater, 2007). These students are being given basic education due to
time spent on controlling their negative behaviors and not given the opportunity to
succeed and excel in the education system. The negative behaviors that some students
engage in are preventing them from learning in an inclusive setting and these students are
moved into more restrictive schools, when that is the opposite direction the school
systems for students with disabilities should be going. Sensory integration can assist in
decreasing aggressive, high anxiety, agitated behaviors and increase focus and
engagement for students that are lacking in sensory input (Thompson, 2011). With a
The areas covered in this paper will be research that supports and argues against
deep pressure and sensory diets being an effective calming strategy. Different
experiments have been done on different groups of people with disabilities, all revolving
around sensory diets as a calming therapy. This paper will also go into an experiment
4
that I will be conducting on deep pressure touch on students with behavior, emotional and
Theoretical Framework
The theory of sensory integration was introduced and intensively studied by Dr.
Jean Ayres back in the 1960s. Back when sensory integration was still in its early stages
…the neurological process that organizes sensation from one’s own body
and from the environment that makes it possible to use the body
In other words, sensory integration is using the appropriate sensory input related to the
child’s neurological needs to spark a response from their senses. The purpose of sensory
advantageous for learning (Smith, Press, Koenig &Kinnealey, 2005). When our senses
are not functioning correctly, our body is not able to organize itself, and if it cannot
organize itself then it does not react and respond to situations appropriately; this is often
physically restrained and excluded from typical students and the education that they are
receiving (Blairs& Slater, 2007). The desired outcome is not to exclude students, but to
5
include while giving them the best, most appropriate education. Sensory integration is
also a non-restrictive approach, and can be very low tech and low cost, so it is realistic
sensory dysfunction problems can change a student’s negative behavior, whether that is
aggressive, disruptive, withdrawn, or anxious behaviors, so that they can succeed and be
accepted into traditional classroom settings. Sensory integration uses planned, illicit
sensory input that relates specifically to each student’s physical and mental needs. In
response the senses are stimulated, and the negative behavior can in turn change into a
positive behavior (Smith et al., 2005). Using planned sensory input allows physical
changes to occur in the child’s brain changing these negative behaviors. Thompson
(2011) says, “Providing students with opportunities for sensory experiences enhances the
ability of the central nervous system to process and integrate sensory information” (p.
202).
Degan (2005) says, “The shift in the educational placement for students with disabilities,
with emphasis on inclusion, is based on the premise that all students have the right to be
members of the school community and that no student should be excluded” (p. 192).
This statement shares what many people today are realizing; students with disabilities
should not be pushed into segregated schools, or classrooms, but should be able to stay in
The issue that rises with inclusive education is the differing behaviors that are
classroom. Ballard (1999) says, “Inclusion is about valuing diversity rather than a focus
on assimilation” (p. 192). In other words, the idea of inclusion is to preserve the
diversity inclusion would bring into the classroom and not try to change the students with
disabilities. Many questions arise about inclusive education settings because there are
concerns that students without disabilities will not be able to learn in an environment that
is disruptive from students that have disabilities and negative behaviors for a general
help students with negative behaviors succeed and be accepted in a general education
classroom.
Literature Review
students with disabilities. Sensory integration therapy can be developed into the daily
routines of students who need sensory input to help organize their senses and ultimately
not restrictive to students and with further research, implementation and analysis, can
possibly end the issue of excluding students with special needs from the rest of their
peers because they have disruptive and inappropriate behaviors for the current acceptable
school environments.
The theory of sensory integration examines the way the human brain works and
how sensory input can alter and improve problem behaviors, or a person’s ability to
function (Kinnealey& Miller, 1993). Throughout Ayres’s study she determined, “that
many of the behavioral and learning problems manifested by her clients had a biological
basis. She hypothesized that through therapeutic input designed to modify the
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Miller, 1993, p. 475). As Ayres’s approach to sensory integration began to grow, it also
began to spread into schools through occupational therapy programs. Schaaf (2005) says,
“The goal of intervention [occupational therapy] is to improve the ability to process and
integrate sensory information and to provide a basis for improved independence and
participation” (p. 143). Within these programs sensory integration can be a variety of
things depending on the individual students needs. Some sensory integration can be:
weighted vests or bags, putty that is used for therapeutic needs, deep pressure, swing,
It wasn’t until the mid-1980s that the group Sensory Integration International
(SII) took control over Ayres’s study and expanded it into categories studying treatment
and education. Although Ayres developed sensory integration into occupational therapy
practices it is still evolving in many ways within schools and other researchers are
sensory integration approach is designed to guide intervention for children who have
activities” (p. 143). Meaning, sensory integration will be intertwined into occupational
Sensory integration was created to treat children with learning disabilities, but
since then it has expanded and is being applied to children and adults with autism, mental
retardation, and other severe handicaps (Smith et al., 2005). It is believed that there is a
relationship between sensory dysfunction and negative behaviors which coincide with the
person with the appropriate amount of sensory input to improve their functional ability
and alter their negative behavior is still being researched and tested today, but many
Although there are many studies that have positive findings that support sensory
integrations effect on negative behaviors, most are followed up with some concerns about
their method and experiment. For example a study on the effects of a weighted vest on
problem behaviors found a correlation between positive behaviors and the weighted vest,
but still had concerns stating, “most of the research that indicated weighted vests as
having an effect on problem behavior appear to be used on data acquired through the use
of experimental designs that do not reliably control for confounding variables” (Quigley,
Peterson, Frieder & Peterson, 2011, p.531). Both the Ayres and Blairs studies seemed to
have found positive effects of sensory integration also state that there are other variables
The first theme is that the effects of sensory integration are beneficial for students
with high anxiety disabilities and with their calming process. It seems to decrease
negative behaviors for students with disabilities; also sensory integration is shown to
have the ability to increase focus of students with self-stimulating behaviors and attention
disabilities.
There have been claims of considerable benefits from the use of deep pressure
touch on children and adults with high anxiety disorders. Blairs (2007) supports the
above statement, “With people who have sensory abnormalities or severe anxiety, there
have been accounts of the use of more specific therapeutic interventions…in forms of
9
touch” (p.215). Deep pressure can come in many forms. Equipment can be used to
squeeze students, mats, bean bags, compression vests, or body socks. It can also be as
simple as deep pressure touch which is simply squeezing the recipient’s arms, legs, head,
shoulders and back between your two hands. Quigley (2011) did a study using deep
pressure through sensory integration technology; he claimed that this technology, such as
weighted vest is intended to stimulate the proprioceptive and tactile system of students.
This deep pressure allows the student to calm their body and their senses to reorganize
themselves.
Studies on deep pressure touch have been done on people with autism, attention
deficit hyperactive disorder (ADHD), and students with severe learning disabilities.
Deep pressure has a calming effect on its recipients and leads to a decrease in pulse rate
and breathing, which overall will relax and calm someone with high anxiety (Blairs&
Slater, 2007). When a child has high anxiety they are not calm and they often feel unsafe
and nervous. In a classroom this student may have aggressive behaviors, or are unable to
focus because their senses are not working properly and they cannot react appropriately
to their environment.
The next theme is that students that need severe sensory input are students that
Students will lose the ability to communicate and interact with their classmates and
(Smith et al., 2005). Not only do self-injurious behaviors prevent the student from
learning, it also is a very big health risk to the student and significant damage can be done
to the tissue where the student is continuously hitting themselves (Smith et al., 2005).
sensory input that they are not receiving elsewhere. The reason people with disabilities
extent, which is not achieved through conventional adaptive behavior”(Smith et al., 2005,
p. 419). These behaviors are helping the student add to the sensory input they are lacking
to balance their senses and organize their bodies. Smith (2005) studied seven subjects
with severe mental disabilities. Each person was given a test based on certain sensory
needs and related behaviors. If certain behaviors were observed from these selected
This study allowed the researchers to select the appropriate type of sensory input for each
individual by directly observing them. The results from the study show that sensory
behaviors in the children compared to students with severe mental disabilities that did not
receive sensory integration. Quigley (2011) had different results when studying a group
11
of people with a variety of behaviors, but all including some form of self-injurious
behavior. He focused on three people with disabilities and observed their behaviors
while wearing a weighted vest at zero percent, five percent, and 10 percent of their body
weight. All three of the participants still had elevated behaviors even with use of the
weighted vest during all percentages of their body weight. Meaning there was no
significant difference between wearing the weighted vest and not wearing it for these
participants.
Sensory integration therapy can assist in contributing sensory input and replace
the stimulation that is gained through harmful self-injurious behavior. In other words,
integrating sensory into a student through controlled therapies can replace the negative
behavior of self-injury because they will be receiving the same sensory, just in a different
Research Stance
After reviewing the literature, sensory integration worked on both students with
behaviors that were due to anxiety, and students with self-stimulating and self-injurious
behaviors. The appropriate amount of sensory input was used for each individual student
to calm and organize their bodies so they didn’t need to engage in negative behaviors.
I am theorizing that sensory integration therapy will decrease negative behaviors, such as
aggressions and noncompliant behaviors in students with disabilities that have severe
heavy work, weighted bags, textile bins, and swing programs, then children with
disabilities will have their sensory needs met, so they will feel satisfied, safe, and
12
organized therefore decreasing the need for negative behaviors to communicate their
Conclusion
The literature on sensory integration shows how important and useful sensory
integration therapy can be to students that need more sensory stimulation than their
bodies are allowing them. As presented by the founder of sensory integration Ayres, this
specific technique can completely alter a student’s behavior allowing them to be much
Teachers are often the first people in an academic setting to realize a student may
need additional support or have a disability because they spend the most time with the
students. Teachers need to meet with their team in their school setting and spread the
word about sensory integration and what they have researched. They can talk with the
occupational therapist and see if this approach would be appropriate for certain students.
Even without the occupational therapists approval teachers can do things in their
classrooms for students if needed. Teachers are always observing their students; if a
student seems to need a fidget toy, or a strip of Velcro on their desk to play with, or a
medicine ball to bounce on then the teacher should supply these items for their students
and monitor their effectiveness. These are all examples of sensory items that may work
for some students and help control their behaviors. If something more intensive is
With the use of sensory integration, students with disabilities relating to sensory
dysfunction are able to organize their senses and react in an appropriate way for the
environment they are in. Sensory integration therapy will not only help students with
13
how they physically feel, but I believe with enough research has the potential to reduce
medication use and physical restraints with this form of intervention. Sensory integration
is the least restrictive intervention that can be used to help students control their negative
behavior, and should be utilized more than it is. Sensory integration therapy is more time
consuming than medicating a child, or physically restraining them to control their bodies,
but in the long run sensory integration is, as New York State law requires, the least
restrictive intervention that can help a student help regain control of their bodies.
Methodology
Context
This study took place in a suburban school district in upstate New York.
This school is primarily for students with severe emotional, behavioral, physical and
intellectual disabilities. Many of the students in this school have multiple disabilities that
their local school districts cannot support in a public special education setting, therefore
they are sent from their districts to this school only for students with special needs.
These students come from many school districts to receive their education from preschool
until they graduate. Although it is not common, some students make enough
improvements in all areas of need, to be placed back into a special education program at
This school was picked for this particular study for a few reasons. The first
reason was because I have a personal connection to the school. The second reason
because I have this personal connection, I know about some of the students that attend the
school and they meet the criteria of characteristics that I needed for this particular study.
There are also enough of the particular participants that I need for this study in this
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school, so I can have a larger pool in the same school environment to keep that consistent
Participants
The participants for this study range from having classified mental retardation,
autism, post-traumatic stress disorder along with behavioral issues. The selected
participants all have behavioral episodes on a weekly basis at minimum. The students I
decided to select range from ages fifteen through eighteen; they are both male and female
Specifically, the pool of participants consists of four males and four females. The
males’ ages range from sixteen to eighteen and the females range from fifteen to
seventeen. Three of the males are African America and one is Caucasian. One girl is
African American and the other three are Caucasian. All of the participants have
multiple disabilities and severe behavior disorders. All participants except two have
required an approved physical restraint at least once this school year because their
behaviors escalated to an unsafe level. All of the boys are nonverbal and three out of the
four girls are nonverbal. Two of the eight participants have been identified as having a
sensory processing disorder; the other six participants have not been identified as having
that disorder, but staff currently implement deep pressure inconsistently throughout their
school day.
Research Stance
The interest in this study came from my work experience in a school with students
exposed to many positive and negative behaviors throughout the school day. I focus on
15
modifying these behaviors from negative to positive, or at least to decrease the severity of
the behavior to a manageable level while working on coping skills with the students. I
have had one student that was new to the school in the summer of 2012. I was at a loss
about the student’s behavior and function of his behavior. He was very impulsive and
had extremely high anxiety along with many trust issues. His mother died less than a
year before, his father and sister stopped visiting him, he moved into a new group home
and school. Everything in his life changed therefore he did not trust anyone. I didn’t
know what to do for him to make him comply, come to school, and eventually become an
active member of his school environment. It was two weeks into the school year and he
had yet to get off of his van and enter school. I didn’t know what to do, none of the
strategies I knew were working for this particular individual. I decided to sit on the van
with him for about an hour each day conversing and during this time I gave him deep
pressure on his arms, legs, shoulders, back and head. He responded very well to this
asking in an utterance for more and tapping his head where he wanted it. When the
pressure was applied he would close his eyes and his whole body would start to relax;
eventually he began to come into school. I began to use the concept of deep pressure as a
motivator for the student to persuade him into complying with the scheduled task once he
something relating to this particular moment I had with one of my students for my
During this study I was both an observer and a participant collecting the data for
this study. I created data sheets for each student that I was collecting data on. These
sheets were taped to the walls near each student’s area in the classroom, so they were
16
always available to staff. All classroom staff were trained to properly give deep pressure.
I had a meeting with all the staff where they received a brief explanation as to when to
administer deep pressure during escalated situations, what the data sheets implied and the
information that I was looking to collect. I did not give them any more information on
the study because I didn’t want them to subconsciously skew the data. At the end of each
week the classroom staff turned in the data sheets for me to analyze and graph.
Method
The purpose of this study was to examine if sensory integration can deescalate a
situation when a student began to exhibit warning signs that lead to engaging in negative
behavior, specifically aggression. The behavior does not have to change from negative to
positive, but the negative behavior needs to decrease while deep pressure is being given.
For example an aggressive behavior that turns from aggression to noncompliance, would
be looked at as a decrease in the negative behavior as long as the student was able to
When this study began I started out as both an observer and a hands on participant
of this study. I would spend time in the different classrooms where my participants were
would assist with one or two other staff in giving deep pressure to the student. A lot of
the time the student’s behavior would begin to escalate quickly, so one staff was not
enough to safely control the situation as well as administer the sensory input in the form
of deep pressure. If I was not in the classroom, the staff working with that student would
administer the deep pressure and record the information needed on the data sheet
provided.
17
All of the students selected for this study exhibit warning signs before their
behaviors fully escalate; each students warning signs are specifically written in their
Behavior Intervention Plan, so all staff are aware of what these signs look like. When a
student began to exhibit warning signs the staff would immediately go to their side and
start to administer deep pressure on their arms, shoulders, and head. Individual students
would respond better to certain body parts. With certain students their behavior would
escalate quickly. In this case multiple staff would be needed for the student. One or two
staff would be needed for arm control while the other staff administered the pressure over
the student’s upper body. If the behavior began to escalate to an unsafe situation, then
the staff would decide if an intervention other than the deep pressure would need to be
used. If I was not in the room and the behavior could be managed without an
intervention for a brief amount of time, staff would call me to come make that decision.
If deep pressure was interrupted due to an intervention this would be recorded as well. If
the deep pressure was positively received by the student, or no emergency intervention
was needed then the pressure would continue, but begin to be faded to ensure the student
was calm. When the student regained control they would be redirected back to their
scheduled activity prior to the behavior. The student would need to complete one
demand task before aggressing again for the deep pressure to be counted as a positive
response from the student. If at any time the student verbalizes that they do not want
pressure, or if they are non-verbal and indicate they are uncomfortable or are pulling
away from the pressure, it would then be ended immediately and a negative response to
Data Collection
18
There were only two ways in this study that data was collected; either directly or
indirectly. Direct data collection happened when I was present at the time the deep
pressure was administered. If I was not in the classroom when the deep pressure was
administered then I received the data on the data sheets every Friday after the classroom
staff tallied up the information on the data sheets and turned them into me to be analyzed
and graphed. Upon collecting the data on Fridays, I would also frequent the five
classrooms I collected data from to look over the data on a daily basis. The reasoning for
this was if there was something I didn’t understand I wanted the staff to clarify the
information while it was still recent, to better validate the information. Once all data was
collected from March 4, 2013 through March 29, 2013 I graphed all data per individual
child examining their behavior in response to the sensory integration and looking for
commonalities between the students, their behaviors and their responses to the sensory
integration.
Introduction
Before starting this study I decided to start basic in the study of sensory
integration deescalating negative behaviors. I decided this because there is not a lot of
research published that supports or does not support sensory integration correlating with
that if I start basic and look for commonalities among a general group of students with
severe behavioral and emotional disabilities I could then eventually expand my research
into commonalities between different disabilities, ages or gender to look for more
specific correlations. Without looking into specific disabilities, such as autism or other
19
health impairments, I found commonalities with the length of aggression before the
sensory integration was administers correlating with the success of sensory integration
The most crucial aspect to sensory integration being successful in this study was
the response time to administering the sensory input. If a student expressed warning
signs and sensory integration was administer within five seconds or less of the behavior
data shows that the behaviors was more apt to decrease to a lesser behavior than if
administered at a longer period. Out of the 140 behavioral episodes during this study,
100 of the responses towards sensory integration were positive responses and 78 of these
responses were when sensory was given to the student within five seconds or less (see
Appendix A).
Out of the 140 behavioral episodes during this study, 100 of them were positive
responses to sensory integration, therefore during 40 behavioral episodes the student that
engaged in the negative behavior had no response to the sensory integration and their
behavior did not deescalate. During this time deep pressure was administered to the
students for a quick response. If deep pressure did not work then a weighted backpack,
body sock, compression or weighted vest were attempted depending on the student, their
state of aggressive behavior and their liking of these certain items. If a student’s behavior
was too escalated and aggressive these items would be available and offered to the
student verbally. There were zero times during this study that a student selected a
20
sensory item while they were escalated past the point of deep pressure working to calm
Another commonality I found while analyzing the data were the comparisons
between deep pressure and other forms of sensory integration relating to the de-escalation
de-escalation responses were associated with the use of a compression vest. A body sock
was used to deescalate negative behaviors three out of the 100 times. A weighted
backpack was only chosen by one student, but deescalated her behaviors 18 times during
this study. Deep pressure was the last sensory integration strategy used and that
deescalated negative behaviors 67 of the 100 times when there were a positive response
and other forms of sensory integration. This could be for many reasons. First, deep
pressure in this study was more staff assisted calming for the student. The staff, although
not holding the student’s arms down, was able to control the student’s body more so that
giving the student a weighted backpack and letting them walk around to calm themselves.
Secondly, deep pressure required a staff or multiple staff to be around the student. A lot
of times behaviors occur when a student feels unsafe, or that they do not have a
controlled environment. With staff being so close to a student to administer the deep
pressure, that may have given the student the feeling of being safe and having a
controlled environment.
Conclusion
21
After analyzing the data collected I do think that sensory integration has a positive
effect on students that need sensory input. Specifically, I believe deep pressure has a
significant impact on students with disabilities that need sensory integration in their daily
routine. I think within this small study it is significant that 100 times out of the 140
behavioral episodes there was a positive response to sensory integration. It seemed that
most students were able to move on once their behavior was finished and engage
appropriately in at least on demand task after the sensory integration was given. Much
like Smith et al. (2005) stated, sensory integration is to create stimulation increasing
attention to the environment that is most advantageous for learning. I found very similar
I would like to expand this study using a larger pool of students with behavioral,
emotional and intellectual disabilities to see what the results would be in response to
sensory integration. I think there were multiple gaps within this study that could have
skewed some of the data collected. First off, there were multiple staff within a classroom
implementing sensory input to students that needed it. Many of the students have
preferred and less preferred staff, which I believe would affect the de-escalation in
behavior. If a student was attention seeking and sensory integration was given to the
student there could be two reasons that the behavior deescalates; it could be either that
the student needed sensory input, or that the student received the attention they were
looking for. Lastly, some staff would motivate students and converse with them while
administering sensory integration. I would like to have a study where there was no
22
communication with the students during a behavior to see if the sensory integration is the
actual reason for de-escalation of a negative behavior or if it was the motivation to get
This study was very broad with the amount of possible sensory integration
interventions that were available for the students. If I were to expand on this study I
would choose to focus more on the effect of deep pressure on students with a specific
disability. I think this study has shown that deep pressure has a positive impact on
deescalating behaviors for students that need sensory input, therefore I would choose to
expand on that research with a larger and more specific group of students.
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Appendix
Positive Response
More
than five
seconds
22
Less five
seconds
78
28.57%
71.43%
This graph shows the total percent of behaviors and their responses. The purple is the
percent of time the participants responded positively to sensory integration. The dark
purple is the percent of participants that did not respond to sensory integration at all.
24
References
Ayres, A. J. (1989). Sensory integration and praxis tests. Los Angeles: Western
psychological services.
Ballard, K., (1999). (Ed). Inclusive Education: International Voices on Disability and
Blairs, S., & Slater, S. (2007). The clinical application of deep touch pressure with a man
Quigley, S., Peterson, L., Frieder, J., & Peterson, S. (2011). Effects of weighted vest on
Smith, S. A., Press, B., Koenig, K., &Kinnealey, M. (2005).Effects of sensory integration