SPM and SPM-2 Quick Tips Case Study: What’s Behind Challenging Behaviors in the Classroom?

 

Music class rattled Johnny. The sounds disorganized his thoughts. During lunch in the cafeteria, the noises were downright painful. In the classroom, he frequently fell out of his seat. Even in PE class, which Johnny enjoyed, he needed to separate himself from his classmates and press his body against the wall to feel better. 

In response, his teachers sometimes limited his recess time or sent him to meet with school leaders. They didn’t realize Johnny had sensory processing issues. When they learned what he was dealing with, they made some simple alterations that changed Johnny’s life for the better. Johnny’s experience convinced his teachers that similar changes to the larger classroom environment could benefit many more students. 

“It’s hard,” said Johnny’s mother, Pamela. “You can see when someone has a broken arm. When it’s on the inside, you can’t tell what’s happening.” 

 

 

First signs of sensory processing issues 

When Johnny was six months old, Pamela used to rest him on her hip while holding him—until he bit her shoulder. When the biting became a regular response, she put him down when he bit.  

As Johnny grew up, Pamela noticed that getting ready in the morning was especially hard for him. He often became very emotional—but Pamela thought that was probably true for most kids. 

Johnny’s preschool teacher also noticed that Johnny’s behavior was different. Sometimes he lay down in a corner of the classroom and went to sleep or got upset when he wasn’t allowed to finish what he was working on. Occasionally, Johnny bit someone when they weren’t even mad at one another. 

Pamela wondered what this behavior at school meant. His teacher said Johnny seemed overwhelmed sometimes. She gave Pamela contact information for the ADHD clinic in town. 

 

Sensory and behavior issues continue in kindergarten 

In kindergarten, Johnny became more physically aggressive with other kids, getting in their space and even occasionally hitting them. He sometimes pushed other kids off the swing because he wanted a turn. 

Pamela wasn’t seeing such challenging behaviors at home. Sure, Johnny was sensitive to some loud sounds, but at home, she kept Johnny and his younger brother on a good schedule, getting them up in the morning and having lunch at the same time each day. They read a story and sang a song before bed. Their routine was firm but flexible. 

She and Johnny visited the local ADHD clinic, where she was told Johnny was demonstrating behavior problems that stemmed from a lack of discipline at home. Pamela and her husband, Bob followed the clinician’s recommendations. They put up behavior charts at home and instituted rewards and timeouts—but these strategies didn’t seem to change the behavioral concerns. 

 

Challenging behaviors in first grade 

Johnny’s first-grade teacher, Ms. L, noticed that Johnny kept to himself and grew defiant when he didn’t want to complete a task. Johnny typically removed himself from the class when he was upset. Ms. L said he had trouble focusing and had crying meltdowns. Her response “sometimes involved removing the rest of the class to ensure everyone was safe.” 

Ms. L let him take breaks and allowed him to leave the class to help him refocus. She took recess away when he threw or broke things, tore up papers, or messed up others’ projects. Instead of recess, Johnny was asked to write apology notes to his classmates. In the hallway, Ms. L sometimes held his hand so he was with the group and not lagging behind everyone. 

Johnny was frustrated. His mom was, too. 

“I was lost and not really sure where to turn next,” Pamela said. 

 

Clues from an old friend

Every summer, Pamela and Bob took their sons to a summer camp in the California redwoods where Pamela had visited since she was a kid. Johnny was fearless at the camp, climbing trees and exploring nature. There was also a large room where everyone gathered and sang. Johnny did not like the loud singing in the room, but Pamela always encouraged him to stay and participate. 

Pamela described Johnny’s struggles to a friend at the camp who happened to be an occupational therapy practitioner (OTP). The OTP observed Johnny, and after asking Pamela a series of questions, suggested that Johnny might have a sensory processing disorder. 

“I had never even heard of that before,” Pamela said. After they returned home, Pamela found an online sensory processing checklist. 

“I thought the questions were describing my child to a T,” Pamela said. “And I couldn’t believe it.” 

A local OTP visited the family at home and recommended that Johnny participate in a study conducted by Diana A. Henry, MS, OTR/L, an occupational therapist with 40+ years’ experience. She is also the author of the Sensory Processing Measure (SPM™) and SPM Quick Tips (SPM QT). Pamela sensed the study could be a great opportunity for Johnny. 

 

Observation leads to insights

When Diana Henry walked into Johnny’s school for the first time, she met one of Johnny’s former teachers, who said Johnny had behavior problems, not sensory issues. 

In addition to using the SPM and other assessment tools, Diana observed Johnny sitting on a small cushion in his first-grade classroom. At that point, no one had analyzed his posture, his movement patterns, or his ability to interpret sensory information. 

Johnny was legitimately falling out of his classroom chair. He wasn’t fooling around, as his teachers thought. He couldn’t keep his head up for very long and often rested his head in his hand, which made writing difficult because he couldn’t hold down the paper. As a result, he grew tired quickly and became distracted. 

Johnny was more attentive and performed better with additional movement, such as in PE class. But just like in the loud cafeteria, Johnny still had to press his body against the wall for relief and the deep-touch pressure he craved. In music class, Johnny had to get away from the loud sounds to calm down. He lay down on the carpet to get some relief. Without understanding his sensitivity to sounds, the music teacher told Johnny to rejoin the class or go to the principal’s office. 

“Unless you are looking for these things, you just think he has behavior challenges,” Diana said. 

In addition to school-based occupational therapy (OT), Johnny was able to attend clinic-based sensory integration intervention. At one of the first sessions following evaluation, clinic-based OTP Kathy Barrett brought out some extra-heavy blankets and large foam rollers to provide deep-touch pressure. 

“It feels sooooo goooood,” Johnny said, refusing to come out from under the weight. 

“Is it too heavy?” Kathy asked. 

“It’s perfect,” Johnny said. 

 

SPM Quick Tips across environments

Johnny’s parents completed the SPM home form, and school staff completed the SPM classroom, PE, music, recess, and cafeteria forms. Afterward, the adults in Johnny’s life selected the SPM QT intervention strategies that were most relevant to Johnny’s needs. Diana Henry also provided sensory integration and Integrated Listening System interventions at the clinic. Each individual tracked the frequency of use on their SPM QT record forms. Over time, this provided the team with information about which SPM QT technique had been used, how often, and to what effect. 

When working on homework, Johnny wore soft music headphones to help with his sound issues. He sat on a 55-centimeter stability ball or “ball chair,” which increased his attention and alertness through gentle bouncing. In the mornings and evenings, Pamela piled on layers of pillows and blankets they called “toppings” in their “Pizza Game.” She also gave him joint compressions and bear hugs in which she squeezed him as hard as he needed. It was all designed to provide deep-touch pressure sensory input to help him feel calm, resulting in increased focus. 

“That’s what we’d do right before he went to school so that he could be a functioning child in the classroom,” Pamela said. “And we’d do those things at bedtime, too, to help him sleep.” 

At school, Diana recommended that Johnny carry heavy books from one classroom to another. Doing this SPM QT “heavy job” engaged his muscles. The activity also allowed Johnny to feel he was being helpful. He also did some wall push-ups or bounced on an exercise ball. He wore his coat between classes to protect him from unexpected bumps by other students, which could lead to fight-or-flight responses. 

These SPM QT interventions gave Johnny’s proprioceptive, vestibular, and tactile systems the additional sensory input they needed. Ultimately, the SPM QT techniques were used across environments at home, school, clinic, and summer camp. 

“Diana taught me so much, and I’ve taken it and used it,” Pamela said. “Johnny has always been a free spirit. He’s always been happy and loving. That is something that has never changed throughout his 13 years, which I am happy about.” 

 

 

Johnny makes strides

Providing the sensory input Johnny needed enabled him to sit in his seat, focus, and participate in classroom activities. He wasn’t as physical with the other students and no longer felt the urge to run into or jump on people. 

Ms. L, Johnny’s first grade teacher observed that consistency in providing the SPM QT interventions was key. It was also more effective, she said, to be proactive in applying the strategies, so they could prevent challenging behaviors.  

Before sensory integration therapy, Johnny often ran up to one of his classmates—intending to put his arm around them—but collided with them instead because he did not have a sense of how hard he was pushing. After therapy, that kind of contact didn’t happen as often.  

After six years of school-based OT followed by twice-weekly OT interventions, Johnny was much better at self-regulation. He rarely became physical and didn’t have emotional “meltdowns.” 

“Things he did when he was one year old that make sense now,” Pamela said. “The only way he could get the stimulation he needed was through his jaw, so he’d have to bite something.” 

 

Schoolwide changes

Johnny’s success eventually benefitted students throughout the school.  

“I learned which SPM QT interventions worked for Johnny,” Ms. L recalled. “Because they were easy to implement, some strategies could be used with other students as well. I learned that Johnny had a different way to process his feelings, and the strategies I learned were beneficial to so many students.” 

After seeing Johnny’s success of the stability ball, for example, Ms. L wrote a grant through donorschoose.org. Family, friends, and some community members funded the project, and she received a class set of stability balls. Since then, she has added to the flexible seating movement with wobble stools, crate seats, scoop chairs, standing areas, and wiggle seat cushions. 

Students, parents, and teachers also adopted stability balls as an alternative to regular chairs. Three years later, Ms. L wrote another grant and provided three stability balls to each classroom to expand student choice of seating. 

Ms. L said, “Giving children options for seating and increasing the ability to move throughout the day has provided much-needed movement while learning.” 

For Pamela, seeing the change was heartwarming. “Teachers are hearing what their students need, realizing that they can make these small changes. It’s not just going to benefit students diagnosed with ADHD and Sensory Processing Disorder. It’s going to benefit many of them,” she said. 

 

A team approach helps 

School professionals often observe different aspects of a child's behavior. Gym teachers, counselors, classroom teachers, and diagnosticians should share perspectives before a diagnosis is made. 

 

Breakthrough results continue

At the start of each new school year, Pamela meets with Johnny’s teachers and any other staff who will see him throughout the day. 

She explains Johnny’s sensory needs and related behaviors, and she shares SPM QT strategies they can use with him. Most teachers are grateful for her tips. Some come up with their own techniques to help Johnny. 

“It’s just like all the information and tools I can give to that person to help them because, like me, I didn’t know what this was,” Pamela said. “Most people saw him as a behavioral problem. It’s like, OK, there’s behavior involved, but it’s coming from somewhere. There’s a foundation. These behaviors are a symptom of what’s happening.” 

The benefits of Johnny’s sensory integration journey also extend to the camp setting. After using and sharing SPM QT with camp counselors, Johnny now climbs trees safely. When indoors, he rolls around on the floor whenever he needs. And he can remove himself from uncomfortable situations such as loud rooms when he needs to do so.  

Before therapy, Pamela often urged Johnny not to climb on this or that. She often warned him to be careful and to be still.  

“All that time I had no idea I was doing the exact opposite of what he needed. He didn’t know it and I didn’t know it,” she said. “He, I think, has had such a better experience at camp because I’ve awoken to his body’s needs. So that’s something that I absolutely love. I’m so grateful that I know what’s going on with him now and so does he. Now I have different boundaries at camp. It’s like, I know now what you need at camp, and from now on you’re going to get it.” 

 

 

The actual names of Pamela, Bob, and Johnny have been changed to protect Johnny’s identity. This SPM-2 case study provides information based on the SPM and SPM Quick Tips. The SPM-2 and the SPM-2 Quick Tips had not been published when Johnny was receiving intervention following assessment. WPS published the SPM-2 and SPM-2 Quick Tips in 2021. 

View a pdf of this story that includes ball chair instructions and three forms related to Johnny’s assessment and intervention. 

 

Related to this SPM-2 Case Study:

• Webinar: SPM and SPM-P Quick Tips Case Study: Helping a Preschooler with ASD and Sensory Processing Issues
• Social-Emotional Products and Resources
• Webinar: Reveal Their Story: How the MIGDAS-2 Process Individualizes Autism Assessments
• 17 Assessment Terms and What They Mean

 

 

Research and Resources:

 

Head Start Early Childhood Learning & Knowledge Center. (2023, February 8). Dual language learners with challenging behaviors. https://eclkc.ohs.acf.hhs.gov/culture-language/article/dual-language-learners-challenging-behaviors 

Joseph, R. Y., Casteleijn, D., van der Linde, J., & Franzsen, D. (2021). Sensory modulation dysfunction in child victims of trauma: A scoping review. Journal of Child & Adolescent Trauma, 14(4), 455–470. https://doi.org/10.1007/s40653-020-00333-x