Sensory Processing Disorder: Treatment Model that works

Sensory Processing Disorder: Treatment Model that works

Following guest blog post was completed by Dr. Lucy Jane Miller.  Dr Miller is a founder of the first comprehensive Sensory Processing Disorder research program nationwide and author of groundbreaking Sensational Kids: Hope and Help for Children with Sensory Processing Disorder (SPD) and co-author of No Longer A SECRET. Dr. Lucy Jane Miller’s name is synonymous with sensory research, education, and treatment.

Dr Miller is a founder and director of STAR (Sensory Therapies And Research) Center in Denver, Colorado. STAR Center is the premier treatment and research center for children and families impacted by sensory processing and feeding disorders, ADHD, autism and other developmental disorders. To find out more about Dr Miller and STAR Center visit their website at .

Dr Lucy Jane Miller


By: Dr. Lucy Jane Miller.

Treatment for Sensory Processing Disorder (SPD) is quite complex. There are 8 sensory systems and at least 6 subtypes of SPD.  Since a child can have 1, 2, up to 8 sensations involved, and 1, 2, up to 6 or more types of SPD, that means there are 86 or over 2 million different “looks” of SPD. That is why children with SPD look and act so different from each other.

But there are a few things that all children with SPD need:

  • Good social participation
  • Ability to self-regulate
  • Excellent self-esteem and self-confidence.

Here at the STAR center we focus on these three attributes with all children we treat. We are fond of saying that we are “working” on joie de vivre (joy in life), rather than skills. We try to work outside the box with emphasis on parent interaction with their child.

We start with regulation activities and processes as a foundation, then we add on relationships and engagement. It is not until Regulation and Relationships are reasonably solid that we work on sensory integration (SI). SI is a means to an end and not an end in itself.

We also believe that if you can treat a child in natural settings, the parent is more likely to be able to work “treatment” which is really play, into the child’s daily routine. We work on establishing a sensory lifestyle (and we never give parents a sensory diet).

There couldn’t be a set of “sensory diet items” that could work for a child in all contexts… that is why we work with out parents to give them problem solving skills. (See No Longer A SECRET by Bialer and Miller).

Whenever possible we work outside in our sensory playground as sensory garden. Luckily, with over 300 days of sunshine a year, we can go out almost every day.

Playing on a structure


All our parents are active participants in every OT session. And 20% of our sessions are parents only (no kids) which helps explain our tremendous success rate.

As much as I do believe in OT, in Speech and Language and in therapy for mental health issues, what I believe in even more is family power! We have a formula here at STAR – kind of a guideline for our parents . . . that for every hour spent in therapy an equal amount of time should be spent in play. So play away! And have FUN!

For more information about the STAR model of treatment, see Sensational Kids 2nd edition, chapter 4.

Lucy Jane Miller


The Developmental Benefits of Playgrounds – Part 3

The Developmental Benefits of Playgrounds – Part 3

by Urszula Semerda with Dr. Lucy Jane Miller

In the first 2 parts of this 3 part series you learned about self- regulation strategies and self-esteem & self-confidence benefits from playing on a playground.  In this article I will discuss social participation benefits.

Social Participation

Children playing on tire

One of the most exciting benefits of children playing on the playground is the possibility of learning new skills. Skills that allow the child to become a ‘good friend’ and develop meaningful relationships with his or her peers.

The Sand and Water Circle Story

One of the most popular activities was playing in the STAR Center sand and water circle, which has a manually activated water feature. Children instantly gravitate to it.  Initially the play was not always successful due to children’s decreased awareness of their peers. They were self-aware and knew exactly what they wanted to do. This however, led to sand being thrown in all directions, water being unexpectedly splashed onto children and tears when there was not enough turn taking.

We knew that getting all the children to play together was a huge opportunity to increase their abilities to relate and engage… but how could we do that?

We decided to target each individual situation, one at a time. First came the water feature, then the sand play, and then turn taking. After some discussion with the children and some prompting from the camp leader we came up with a plan for Friday, the last day of camp.

Friday finally arrived. Now most children were playing in the sand area.

Water! Ready for water?” asked Ben as he carefully looked around at his friends while raising his thumb up acknowledging that he was ready to push the button to activate the water. One by one all the other children raised their thumbs and Adrian slowly moved away so the water could not reach him.

Waatttterrrrr START NOW!!!” Ben pressed the button with excitement.

As the water flowed down the rock into the sand Jack and Jamie jumped up and down with excitement.  Their aluminum boats were sliding down the rock pushed by the flow of water from the water feature.

We need more sand!” shouted Adrian as he started to pick up more sand.

Liam and Emma joined him and the three of them started building more dams around the water feature as Jack and Jamie collected all the boats to get them ready for another ride.

As the positive interactions increased camp leaders were able to scale back the support and step in only at the times of need. Working in this wonderful natural setting provided numerous opportunities for children to grasp learned strategies and develop meaningful friendships. Another success at the Sensational Camp. We all couldn’t be happier!

Playing in a sandpit


Jacob’s Story

Positive friendships are very powerful and can affect or change children’s regulation.

This was very clear with a boy named Jacob who also participated in the summer camp. He was a sweet young boy who was very eager to participate in the camp. He did however struggle with regulating his body and was unable to stay on any task for longer then a minute.  The therapists tried numerous regulating strategies to help him slow down and participate in an activity for longer. Unfortunately Jacob continued to struggle.

During the free play on the third day of our Moovin’ and Groovin’ camp, Liam, another group participant was surrounded with few friends including Jacob who was quickly running from one play structure to the next.

Guys, guys!! Come on!” said Liam as he picked up a soft noodle and a foam ball “Let’s play!

He walked over to the open area between the structures.

What a perfect opportunity to see if Liam and Jacob could engage and play with one another. I walked over to Jacob and gave him some slow but deep pressure on his shoulders. This allowed him to slow down and look at me.

Jacob … Liam wants to play with you.”

Jacob looked up at Liam who was all set up to play baseball.  I guided Jacob towards Liam.

Liam wants to play some baseball. Would you like to play with him?” … “Sure” said Jacob.

Jacob was a ‘yes’ boy, always willing to do everything . . . but would he stay engaged? We were all eager to see what happened.

Liam… Jacob will play with you” I said.

Great!”  Liam walked over and started directing Jacob about what he could do and where he should stay. Jacob followed all of Liam’s instructions to the tee.

They played and played… I was overjoyed. I kept taking pictures to make sure I captured these wonderful moments for their parents. I looked down at my watch… 15 minutes had passed and they kept playing together, even when another friend came to join them.

As the days passed it was clear that their friendship grew and Jacob was able to stay regulated for most of the activities while playing with Liam.

He is my best friend!” Jacob kept telling everyone.

After the camp the boys were very clear with their parents about their friendship. The two mothers decided to support this wonderful friendship with play dates after camp was over.

Playgrounds have amazing benefits! It is rewarding to watch children be happy, having a good time, learning new skills, experiencing meaningful interactions with peers, and improving their ability to handle feelings and negotiate conflicts.

What could be more fun . . . than having fun?

❮ Part 2
The Developmental Benefits of Playgrounds – Part 1

The Developmental Benefits of Playgrounds – Part 1

by Urszula Semerda with Dr. Lucy Jane Miller

Playing on a structure

Playgrounds are fun, and they also provide many benefits. It doesn’t matter if you have a child with no challenges or one with a sensory processing disorder. Everyone benefits.

As an Occupational Therapist I frequently use playgrounds as part of treatment. In this 3 part series I will share with you my playground adventures at the STAR Center’s Sensation Camp. I will also dive into discussing the many benefits your child can get from playing on playgrounds.

Playing on a playground can bring on many rewards related to self-regulation, social participation, increased self-confidence and self-esteem. From an occupational therapy perspective it doesn’t get better than that. As a parent you too can take advantage of the many benefits.

The number one objective on the playground is to HAVE FUN! While having fun children can also learn new skills, develop new friendships, and interact with their environment in a meaningful and purposeful way.


Self- regulation refers to the child being aware of their own sensory and emotional needs and controlling their body and mind. ‘By the time a typically developing child is 5 years old, they are frequently in charge of most of their own regulation; unless they are tired or hungry. When arousal is in a good place we call that a quiet, alert state or a calm, alert state. This is the state a child must be in to learn…’ Lucy Jane Miller, Sensational Kids.

Children with SPD (Sensory Processing Disorder) are frequently dysregulated and benefit from occupational therapy. Treatment focuses on helping them get into the ‘just right’ arousal state  (quiet, alert state or a calm, alert state) and develop strategies that parents can use daily to create a sensory lifestyle.

Depending what particular difficulties a child might have there may be specific strategies that will benefit them. More details about these individual strategies will be discussed in my upcoming posts. Alternatively, you can have a look at my Recommended Sensory Resources page for more details.

Besides the individual strategies, here are additional methods that can be used to assist with regulation.

A.    Use of a theme



Using a theme assists regulation. Themes tend to increase attention and engagement to the activities. Using themes allows children to “enter” different worlds. One group may take children on a safari adventure, another may have them diving down into the ocean to explore the underwater worlds, or Presto! They can become superheroes or fairies. Whatever the theme, the excitement is reflected in the children’s eyes and their affect.  Every day the children come to our sensational camp eager to find out what new world we are entering that day.

B.   Use of an alertness chart

While using themes and strengthening children’s ability to self regulate an alertness chart can really increase success.  The figure below is an example of one of the charts used in our summer camps at STAR Center.

Figure 1-A. Alertness Chart

Alertness chart

Group Scoop

During our “Group Scoop”, all the children would come together at the beginning of each day of our camp. They would review their own body speed using an alertness chart. Each person would devise their own strategies to keep their bodies regulated. Some kids were in the ‘just right’ zone and they could sit nicely and pay attention.  Some bodies were in the ‘too slow’ zone and needed an alerting activity to get going. Some children were in the ‘fast’ zone and their bodies just would not stop moving. They needed an organizing activity to bring their level of arousal down.  Finally, on few occasions children could go into a ‘too fast’ zone as their bodies encountered sensations that send them over to the fight or flight.

One day, during our Group Scoop while most of the group was sitting comfortably on large beanbags discussing where their body was, Mikey’s body was in the ‘fast’ zone.  His little legs just could not stop running around the room.

“Mikey” I said, “Where is your body right now?”

The group waited patiently for his response but his little legs kept on running and running. You could see that he had a hard time slowing down to come up with an answer.

All of the sudden Emma, another group participant jumped up and said “I know!…Mikey is fast”.

“That’s right” I said. “His body is ‘fast’ and he needs something to get him to the ‘just right’ zone.”

“I think lying under a heavy blanket will help.” Emma said feeling happy with her answer.

“Wow!” I thought. They are getting it!!!

I lifted up the blanket as Mikey ran towards me.

“Blanket…. Let’s lie under it”.

In a quick manner Mikey stopped and I placed the blanket on top of him. He wiggled and wiggled under the blanket but after few minutes his body started to calm down and he became ‘just right’.

From that day whenever Mikey came into our Group Scoop he would first find his heavy blanket. He would curl up underneath it and stay engaged and regulated while we spoke about our adventure for the day.

What an amazing result!  Seeing how the campers became more self aware of their own and others’ arousal states but to also brainstorm and try out different strategies was incredible.

C.    Emotional Regulation

Kids driving on playground


I find that challenging situations may occur more frequently on a playground as you find multiple children. This is perfect because it provides an opportunity to learn and implement alternative and appropriate strategies in real time, and with the support of a parent.

During our summer camps children had the opportunity to interact with many different pieces of equipment that brought out many unpredictable reactions.  Adrian was a young boy who really enjoyed coming to the Sensational Camp at the STAR center. He enjoyed it so much he ended up coming to three different camps.  His sensory profile included sensory over responsivity to many sensations and he frequently encountered challenging situations.

On the second day of our Animal Adventures camp all the children were getting ready to go onto our sensational playground to experience a safari adventure.  Running towards the door Ben accidentally bumped Adrian. “Ouch!!!” I heard.  As I turned around I saw Adrian biting Ben on his arm. “Oh No!” I thought.

When the boys were separated I took Adrian to the side. We knew that once Ben bumped into Adrian it triggered a fight or flight response and Adrian responded by biting Ben. This was a great opportunity to teach Adrian some very valuable skills.  We sat away from all our friends and excitement onto the comfy beanbags.

What happened?” I asked.

He hurt me! He really hurt me!!” exclaimed Adrian.

Is that why you bit him?”

Yes!” Said Adrian loudly.

How do you think that made him feel?” Adrian shrugged his shoulders.

Do you think it hurt his hand?”…..

Maybe” he said quietly.

Hmmmmmm” I said, “I wonder if there is another way we could tell Ben that he hurt you without hurting him?”

After some pondering and receiving nice deep pressure through the beanbags Adrian looked at me and said: “Maybe I can tell him not to push me?”

I was so excited that he came up with this idea on his own. Now we all needed to help him implement his excellent plan.

Over the next few days Adrian had many opportunities to follow his plan. He wasn’t always successful but he certainly tried.

Then on the second last day of the first camp Adrian got bumped once again. His little face scrunched up in pain, his arms came close to his body. He turned over to his friend and said “You are too close… I need space”. His friend casually moved away while I was secretly jumping up and down in my head and screaming “Yey!!!!”

He did it and I could not have been prouder.   As Adrian continued to participate in the other camps he became more independent in using his words versus hitting and biting.

There you have it! Some great strategies that can assist with regulation. To learn more read the Part 2 of Developmental Playground Benefits discussing self-esteem & confidence.

Part 2