Preface (by Tom McIntyre): While I’m not sure that what I’m going to help share below is totally valid, I do believe that the material is worth consideration.  The condition known as SID was first brought to my attention by my co-author in a paper he wrote for one of my graduate classes in special education.  I was motivated to read more on the topic.  The claims for the existence of the condition and the validity of practices are primarily testimonials or based on related area research.  In summary, the topic is controversial.  I’m still skeptical, but will consider SID as a possible explanation for many “behavior problems”.

Preface (by Robert Van Vorst): The occupational therapist in my school mentioned that many of my students who exhibited the symptoms found below might have a sensory integration disorder (SID).  I read the material that she provided, and came to believe that it was indeed the case for my pupils.  My newfound awareness and knowledge has changed the way I interact with my students and troubleshoot their individual needs.

INTRODUCTION
Long associated with autism, and often mistaken for ADHD and other disorders, SID is now thought (by its believers) to be more widespread.  According to advocates, it is common as a co-morbid condition with such disorders as autism, Asperger’s syndrome, pervasive developmental disorders, ADHD, fetal alcohol syndrome, Tourette’s syndrome, acute anxiety, and others, although it can exist by itself.  It is estimated (Biel & Peske, 2005) that there is at least one student with SID in each classroom.

Ayres defines well functioning sensory integration as “the neurological process that organizes sensations from one’s own body and from the environment and makes it possible to use the body effectively within the environment” (Bundy & Murray, 2002, p. 11).  In simpler terms, sensory integration (SI) refers to the way in which the brain interprets information sent to it via the senses.  The processing of incoming sensory stimuli is accurate and effortless for most of us.  We find no difficulty in tuning out the slight hum of our computer or the passing traffic outside our window.  Most of us feel pain when we stub our toes and become dizzy when we spin around in circles.

For those of use with intact sensory systems, it may be difficult to conceive, understand or recognize SID.  However, some individuals have a dysfunction in interpreting and appropriately responding to the stimuli gathered by their senses.  They experience the world differently.  They have difficulty making sense of what is happening inside and outside of their bodies.  People who experience malfunctions in the interpretation of sensory input may have Sensory Integration Disorder (SID).  In SID, the brain either has problems with “facilitation” (attending to the most important sensory input) or “inhibition” (filtering out or dampening unimportant sensory information).  Jean Ayres (1973), an occupational therapist, originally developed a description of this condition.
 
 
 

“When I was in elementary school, the school bell ringing hurt my ears like a dentist’s drill hitting a nerve.  Loud noises such as balloons popping terrified me.  Scratchy petticoats and wool clothes were like sandpaper against my skin.  I still wear my underwear inside out so that the stitching does not rub against me.  I wear old, well-washed, soft T-shirts under my new shirts to make them tolerable.” (Temple Grandin, 2005, p. ix)

Because they have difficulties making sense of the world, individuals with SID may react to it in ways that seem odd, lacking in confidence, defiant, rude, or “wacky”.  Students with SID might show the following maladaptive responses to ordinary situations handled well by others:
    -be distractible, with problems attending to directions or remaining focused on a task
    -have a high activity level in order to gather stimuli to send to the brain
    -be impulsive, showing little self control
    -difficulty attending to directions and lessons
    -fidgeting in the seat
    -frequent touching of nearby objects
    -be lethargic and slow due to problems organizing what is occurring
    -tune out or become withdrawn in order to escape over-stimulation
    -react in a manner that is out-of-proportion to the frustrating situation
    -appear inflexible and stubborn, engaging in the same activities in the same manner
    -resist group activities, especially those that occur out of seat
    -have difficulty with transitions to the next activity, or from an active level to an inactive one (or vice versa)
    -appear clumsy and/or careless
    -utter self-deprecating remarks (“I’m stupid.”, “I can’t do this stuff.”)
    -utter negative remarks about the request/activity
    -playing with items that are unrelated to the lesson
 

It can be frustrating when children persist with these behaviors even after multiple redirections.  Negative impressions can pop into our heads as we imagine that they consciously decided not to listen to our directions, or were voluntarily defiant.  Those of us with educational and psychological training would probably investigate emotional or environmental influences.  Some of us might consider a biological etiology, but probably not in the same way as some of our school-based occupational therapy colleagues who mention “sensory integration disorder” (SID).
 
 
 
 

What Does SI Dysfunction Feel Like? Imagine yourself making a spaghetti dinner.  Using your eyes, you look around the kitchen and see your cooking equipment and all the ingredients for your meal.  Your ears hear the whooshing sound as you open the refrigerator door and the crackle of the garlic peel as you unwrap it.  Your skin senses the smooth, hard handle of the knife and the moist surface of the garlic clove as you chop.  Your joints and muscles sense the weight of the cleaver and your body position as you move around. Your nose senses the aromas, and as you pop a sliver of bell pepper in your mouth, you enjoy its sharp flavor. And, though you are unaware of it, your body senses the earth's pull of gravity. You might savor all these sensations or you might be oblivious to them because they're so, well, ordinary.  Because your nervous system is functioning normally, you are processing all the sensory input well.  Little pieces of sensory information are flowing into your brain in the form of nerve impulses.  How do you derive meaning from all these tiny bits of sensory input?  You bring all the parts together to make a whole.  It's kind of magical, as if a multimillion-piece jigsaw puzzle scattered around your home suddenly transformed itself into a recognizable picture.  Sensory integration allows you to focus on the "big picture" of what you are doing: in this case, preparing dinner. Now imagine that your senses aren't working efficiently. The fluorescent light gives you a headache, and you can't find the tomato sauce in your crowded pantry.  The lettuce in your hands feels slimy and repulsive.  The smell of garlic makes you queasy.  You don't hear the boiling water on the stove, and it bubbles over, flooding your pilot light so the stove won't relight.  You bump your head on a cabinet, trip over the cat, and spill the salad.  By the time dinner is on the table, you're a nervous wreck and you've yelled at everyone. All you want to do is crawl into bed and sleep. What if you were to experience this disastrous dinner scenario every night, and no one seemed to understand?  After all, everyone else is able to see the can on the shelf and the cat on the floor, so why can't you?  Strong smells don't upset them and flickering, harsh lights don't give them headaches.  In fact, they can prepare dinner under all these conditions without missing a beat, dropping a spoon, or feeling a moment's discomfort.  And, when you try to describe why you are so stressed out doing such tasks, people think you're being ridiculous or difficult or lazy.  If you can bring yourself to suffer through this unpleasant cooking experience again, the next time you decide to make the exact same meal because as difficult as it is, at least you have some experience making it. You definitely don't want to try something new and risk even more unpredictable annoyances. This is what everyday experiences can be like for a child with SI dysfunction.  For her, getting distracted and annoyed by her environment and her own body's response is the norm.  To make matters worse, the sensory input she receives isn't consistent, and neither is her nervous system's response.  The world seems like an unpredictable, frustrating, even dangerous place, and yet people expect her to happily go about the business of learning and focusing, and doing what Mom asks the first time she asks.  No wonder kids with SI dysfunction are often highly distractible, anxious, or irritable.  They may shut down and tune out or throw tantrums when yet another unpredictable stressor comes into their lives-a change in school routine, an unexpected cancellation of their plans for the morning, a favorite Elmo sippy cup unavailable for afternoon juice.  They might become controlling and demanding: the Elmo cup must be found or else!       Reprinted by arrangement with Viking, a member of Penguin Group (USA) Inc., from RAISING A SENSORY SMART CHILD (pages 15 & 16) by Lindsey Biel and Nancy Peske. Copyright (c) 2005 by Lindsey Biel and Nancy Peske

Things are difficult for these youngsters.  Low self-esteem and a negative self concept are likely to emerge.  You can imagine how scolding, chastisement, and disappointment/avoidance from others might affect a SID child’s sense of self.  Adults who work with these youngsters need unswerving patience and consistently even-natured demeanors. 
  
 

Click here to read a parent's story of her son's SID diagnosis

 

Click here for a Powerpoint presentation about why these students have a need for predictability, how they react to it, and how we can respond in a helpful manner.

A hyposensitive child may constantly fidget and touch things in an effort to send more information to a sensory starved brain.  On the other hand, s/he might also be lethargic and slow because the brain has filtered out too much information and doesn’t react to the environment “at the correct speed”

Advocates for SID talk of seven senses (any of which can be hyper or hypo sensitive).  There are the “far senses”; hearing, sight, taste, and smell.  There are also the “near senses”; tactile (touch), vestibular (balance and movement), and proprioceptive.  The latter are also known as “the hidden senses” because they are not under the control of the individual.  You can shut your eyes, plug your ears, wear nose clips, or by-pass the taste buds.  You can’t shut down the far senses.  They operate with or without your consent.  In all the systems, the sensors take in the information from the environment and send it to the brain for processing and determination of how the body should respond.  More information on the “near senses” is provided next.
 

The Auditory System
While the auditory systems may be intact in students with sensory integration disorder, the ability to use the systems may be impaired.  In other words, they can “hear” adequately, but they can’t “listen” well.

A student with problems in processing (making sense of) auditory input that arrives at the brain might:
-report static (white noise) in the environment.
-find certain pitches/frequencies to be excruciating.
-cover the ears to shut out sounds/voices
-seek out “noisy” environments for their extra stimulation.
-not be able to understand when teachers talk fast.
-follow written directions perfectly, but have great difficulty following oral directions.
-have problems with “figure-ground” listening (being able to filter out unimportant sounds and focus on the important one such as attending to the speaker when an overhead fan makes a clicking noise at every rotation, or being able to locate which person in a group is talking).
 
 

The Visual System
Kids who are visually hypersensitive might become overly excited in visually stimulating environments.  Hyposensitive kids might not perceive all the visual cues available and have to touch/hold the object to gain information gathered by others who merely viewed it.

A student with problems in processing (making sense of) visual input that arrives at the brain might:
    -squint.
    -look at objects out of the corner of the eye.
    -report that:
    -black print on white background vibrates or jiggles.
    -fluorescent lights and computer monitors flash on and off.
    -there is “snow” or static in their sight.
    -have trouble following moving objects.
    -have trouble refocusing the eyes to objects at different distances (as when copying from the board to their paper).
    -have trouble seeing objects in the periphery of the item being observed.
    -be overwhelmed by the visual input such as when sent to a closet to retrieve crayons, but can’t find them among the many other items and
        packages on the same shelf.
 
 

The Olfactory (smell) and Gustatory (taste) Systems
If the information sent from the nose to the limbic system of the brain doesn’t get processed properly, smells can be a far different sensation from what others are experiencing.  Muffins and cookies baking in the oven may smell foul.  On the other hand, the scent of rotten meat or skunk might be enjoyed.  While preferred and non-preferred smells certainly have an experiential/memory/learning component to them, smell also serves a survival function…one should avoid gas fumes, spoiled milk, etc.

The sense of taste is closely connected to smell.  Hold your nose and you won’t taste the onion you’re biting.  Get a cold, and foods just don’t taste as flavorful.  Kids with taste issues may dislike or prefer certain textures, temperatures, or levels of spiciness (outside of family food preparation practices).  The result is that they reject many food offerings enjoyed by others, and seem “picky” with regard to the food that is enjoyed.  For example, the French fries served in the cafeteria might not be juicy or flavorful enough (in comparison with the youngster’s preferences), may be of the wrong size, shape, color, or temperature, or not be palatable because the smell of the cooking oil is different than that of the favorite restaurant.
 
 

The Vestibular System
 The vestibular system senses movement of the body, balance, and vibration.  It is though this system that we know whether our bodies are moving, the direction of travel, and the speed.  We use this system as we attempt to walk around our darkened bedrooms looking for the light switch, or run along side a child learning to ride a bicycle (who is also using the vestibular system along with other ones).

The sensors for this system exist in the inner ear in a part known as “the semi-circular canals”.  Small hairs with crystals attached, shift position in fluid as the body moves, bends, turns, etc., sending this information to the brain for processing.  A student with a hypoactive dysfunction in the vestibular system might be able to spin excessively without becoming dizzy, or may move constantly.  A hypersensitive child might not be able to enjoy a see saw/teeter totter, use a swing, or climb the ladder of a slide due to the resulting disorientation and nausea.  A very hypersensitive child might resist moving or being moved unexpectedly.

The vestibular system needs to be connected well to the other senses in order to validate the information received.  If senses fail to agree on what is occurring, disorientation can result.  For example, when traveling in a plane or sailboat (or reading in a moving car…but not while driving!!), your environment (walls, seats, magazine) appear to be stationary while your vestibular system tells you that you are moving.  Many folks start to become nauseous (airsick, seasick, carsick) when their systems fail to validate one another.
 
 

The Proprioceptive System
 The proprioceptive system provides feedback as to where specific body parts are placed, whether the muscles are stretching or contracting, and whether the joints are bending or straightening.  The information is sent to the brain for interpretation from receptors located in the muscles and joints.  The stimuli for these receptors are movement and the pull of gravity.  Well-functioning proprioceptive systems give us a sense of where the body is placed in space.  For example, right now, your proprioceptive system might be telling you that your feet are flat on the floor, buttocks and upper legs are in contact with the horizontal surface of a chair, and that your thumb and fingers of one hand are pressing in opposition while touching the sides of a page.  You are able to remain stable, even without thinking about it.

People with proprioceptive difficulties would not have this same bodily awareness and sensations.  They would instead have to rely on movement or vision to provide feedback regarding the position of their body parts.  Hypersensitive individuals might appear rigid and tense, while hyposensitive youngsters may slump or slouch.  Clumsiness and awkward movements result.
 
 

The Tactile System
The tactile system receives the sensations of pressure, temperature, and pain through receptors in the skin, mouth, throat, ear canals, etc.  There are two types of tactile sensations to be assessed: whether the child can use touch to evaluate objects (for example, pulling a pencil rather than a pen out of his/her desk without looking) and whether the child can identify which area of the body is being touched while his/her eyes are closed.  Breakdowns in the tactile system can manifest themselves in one of two ways, depending on whether the children are hypersensitive or hyposensitive to tactile input.

Hypersensitive kids “overreact” to touch (sometimes referred to as being “tactually defensive”).  Physical contact might result in the youngsters screaming or striking out.  They do not like being in groups, being physically close to others, or being seated in a high-traffic area due to concerns about being touched.  They may withdraw socially, even finding parental hugs to be uncomfortable.  Those concerns can affect concentration in the classroom.

On the other hand, hypoactive kids are under-responsive to touch and may have difficulty discriminating between different types of tactile input.  They may even have difficulty registering pain and pressure.  They might unknowingly bump into objects and other people, appearing clumsy or inconsiderate.  They may not feel the same degree or type of pressure or pain as others in the same situation.  They may seek touch to such a degree that adults become irritated at the seemingly constant need to be touched and held.

Kids with tactile concerns (of either hyper or hyposensitivity) might also be unwilling to try new fine and gross motor activities (due to the irritating feelings in hypersensitive kids or the desire to avoid feeling clumsy in hyposensitive students).  It may also be because of co-ordination problems or difficulty in motor planning (doing physical acts in the correct sequence of movements).

Sensory problems in the mouth/brain connections can affect the ability of the student to speak or make his/her needs known to others.  Those same problems could result in the avoidance of certain food textures.

In a tactually hyposensitive child, it could result in mouthing of objects, licking others, or biting.  In a similar vein, hand sensation problems could affect the desire/ability to use eating utensils, or the intensity of contact with others (hitting or pushing when “just touching” others).  They may brush their hair or teeth too hard, wear clothing that seems uncomfortable in fit, or scratch itches too intensely.

Some children have a mixture of the two sensitivities, being hypersensitive to one type of touch (for example, sensations in the mouth) while being hyposensitive to another type of touch (for example, sensations on the skin and pulling of hair strands).  Some children’s sensitivities also change from day to day and situation to situation.  Each youngster has his/her own idiosyncratic sensory makeup when it comes to the senses.
 

OVERALL INDICATORS OF SID
A sensory integration disorder is suspected when the child is exhibiting one or more of the common symptoms with greater frequency, intensity, and/or duration than is common among the vast majority of kids.  It is important for teachers to understand that if their students display behavior indicative of SID that this behavior lasts for several minutes at any one time and recurs frequently throughout the day over a long period of time.  Its persistence despite disciplinary interventions is a key indicator.

After considering the behaviors that are common for students with SID, it is probably apparent that some of these behaviors could be a manifestation of other disorders.  For example, learning disabilities and attention deficit disorder (ADD) can produce behaviors similar to those displayed by children with SID.  The behaviors could also reflect the interaction or co-morbidity of SID with other conditions.  However, if SID is present, it will not respond positively to the same interventions.  It is therefore treated differently than AD(H)D and learning disabilities.
 

One of the most telling ways to distinguish SID from other conditions is to implement sensory intervention and observe whether symptoms subside.  If a student responds positively to these sensory techniques, then his or her sensory system was craving the input that you provided.  A sensory deficit is “confirmed”.

Most of the compensatory strategies that can be provided within a school setting are appealing to students at first, making intervention a pleasurable experience.  If after a few trials with the compensatory strategy, the student continues to seek it, then you can be fairly confident that a sensory system dysfunction was at the root of the displays of “inappropriate behavior”.  These students will often seek out the use of the sensory equipment when they are in need of it.  The use of these strategies helps to regulate the sensory system and allow their bodies to function better.  Given that the severity of SID varies from student to student, multiple strategies might have to be implemented in a trial-and-error manner.

Classroom Interventions for Students with SID
Anyone interested in assessing the sensory profile of a youngster and then intervening, should seek out other sources beyond this web page.  The book by Biel and Peske (see below) is an especially good resource.

Herein, we offer a few examples of some common interventions.  The following activities are organized by the various sensory systems for which they are intended.  These activities should be carefully monitored by the teacher and occupational therapist in order to determine the degree of effectiveness.  These sensory suggestions would probably benefit all students in the classroom because kids tend to respond to a “sensory rich” environment.  Therefore, the activities do not need to be limited to students suspected of having sensory processing issues.
 

Visual Interventions
For this type of disorder:
    -Suggest that parents make an appointment with an ophthalmologist familiar with the prescription of tinted lenses designed to assist in
        improvement of reading vision
    -Try tinted plastic overlays on printed pages in order to determine if they assist in stabilizing the print that appears to be vibrating.
    -Obtain flat-screen computer monitors and television screens which seem to decrease the perception of flickering light.
    -Provide incandescent desk lamps or natural lighting, and reduce fluorescent lighting.
 

Proprioceptive (Heavy Work) Interventions for the Classroom
For this type of disorder, provide sensory “satisfaction” or “satiation” (in order to reduce the striving for it during lessons) by having the students:
    -Erase or wash the chalkboard.  Direct the students to use both hands to perform this activity.
    -Wash the desks using both hands at the same time.
    -Help rearrange desks in the classroom.
    -Fill crates with books to take to other classrooms or the library.  You can ask students to move these books back and forth as needed.
    -Help the physical education teacher move mats and other heavy equipment.
    -Staple papers onto bulletin boards.
    -Perform “wall push-ups” (face the wall, move feet out, use arms to push away from wall and return one’s head to it).
    -Perform chair push-ups or animal walks such as the “crab walk” (face/chest up with arms and legs stretched backward) and the “bear walk”
        (moving same side arm and leg at the same time).
    -Enter active activities involving running and jumping.
    -Open and hold doors for the students in the class.
    -Open or close classroom windows.
    -Use a bean bag chair during quiet reading time (allow the youngster to lie over or under it).
    -Color on paper placed on the floor while they position themselves on their hands and knees.
    -Use playground equipment (crawling under bars, hanging from bars, running up steps).
 

Vestibular (Movement) Activities for the Classroom
For this type of disorder, during the lesson have the students:
    -Rock in rocking chairs.
    -Stretch/shake body parts.
    -Shift their weight in their chairs using a disc-o-sit cushion/donut cushion.
    -Sit on a large therapy/exercise ball or T-stool in place of a chair.
    -Roll their necks and heads slowly in circles.
    -Fidget productively so that they can then attend.
    -Allow them to hold/squeeze a small ball (perhaps a “kush-ball”…the type of rubber sphere with rubber strands that emanate from the ball).
    -Stretch a large rubber band (1 to 2 inches wide) between the front legs of a desk.  They can then bounce their legs/feet against the tense
         band.

Between lessons, have the students:
-Deliver “pretend” notes to other teachers or the office.  Preferably, the destination should be a good distance from their classroom.
-Propel themselves on scooter boards.
-Swing on suspended equipment such as platform swings, hammocks, inner tubes, or tires.
 
 

Tactile Activities for the Classroom
For this type of disorder, have the students do the following during lessons:
    -Fidget with any of the following:  straws, paper clips, pencils/pens, stress balls or putty.
    -Engage in the hands-on lessons you have designed to incorporate more touch.
    -Make things to show acquisition of knowledge/skills taught during your lesson.

Between lessons, have the students:
-Retrieve objects through sand, rice, beans, or other highly tactile stimuli.
-Use their hands (no brush…just hands) to paint with shaving cream or finger paints.
-Engage in activities that involve many tactile sensations and use of hands or fingers to poke, draw, open, close, differentiate, and follow a pattern.
-Draw shapes into a zip-lock bag filled with hair styling gel.
-Perform activities that involve glue, glitter, and painting.  Bottled glue should be used rather than glue sticks (so as to promote the squeezing motion).
-Submit to deep tissue massage (as opposed to light touch), as kids with tactile issues often respond more positively to gentle, but deep pressure.

SUMMARY
This page provided general overview information on SID.  You will want to engage in further study and locate an occupational therapist that is knowledgeable in retraining the nervous system.  S/he will be able to make suggestions on how to create a more sensory-friendly environment.

Why go through all these elaborate modifications?  Because we care about our kids!  Additionally, while the changes may require some time and effort, if effective, they will make your job more rewarding and enjoyable.  Imagine the child with ADHD that is sent to school without medication.  Strategies used for SID might help to calm that active and distractible youngster and help him/her focus on the lessons and activities.  Time and effort will actually be reduced over time.

Direct quotation from a research review (November, 2012): "New research is casting doubt on the merits of a popular autism treatment which relies on weighted vests, bouncy balls and other sensory stimuli.

Researchers reviewed 25 existing studies looking at sensory integration therapy and found that the method is not scientifically supported.

“Rigorous, methodologically sound studies do not indicate that it helps and, in fact, the majority of studies that were reviewed reported no benefits for children with ASD,” said Mark O’Reilly of the University of Texas at Austin who worked on the analysis, which was published in the journal Research in Autism Spectrum Disorders.

Sensory integration therapy is intended to address the atypical responses that many with autism have to sight, sound, touch and other sensory stimuli. Therapists utilize swings, balls, brushes and other specially-designed tools to help those on the spectrum learn to cope.

The review is not the first to question the value of sensory integration therapy. Earlier this year, the American Academy of Pediatrics issued a policy statement indicating that support is lacking for the method, but did not go so far as to advise against it.

“Parents should be informed that the amount of research regarding the effectiveness of sensory integration therapy is limited and inconclusive,” the pediatrics group said." ( http://www.disabilityscoop.com/2012/11/20/benefit-autism-questioned/16854/ )

J. Ayres (1973). Sensory integration and learning disorders.  New York: Western Psychological Services.

L. Biel & N. Peske (2005). Raising a sensory smart child: The definitive handbook for helping your child with sensory integration issues. Penguin Books.

A. Bundy & E. Murray (2002). Sensory integration: Theory and practice. Portland OR: Book News.

C. Kranowitz (2003). The out of-sync child has fun: Activities for kids with sensory integration dysfunction.  New York: Berkley Publishing Group.

C. Kranowitz & L. Silver (1998). The out-of-sync child: Recognizing and coping with sensory integration dysfunction.  New York: Berkley Publishing Group.
 

http://www.geocities.com/~kasmom/sid.html   This web site explains SID in non-professional layman terms.
 

http://www.thegraycenter.org/sensory_integration.htm  This web site explains the various sensory systems and what a dysfunction in each one might look like.  The vestibular and proprioceptive systems are explained thoroughly and clearly.

  For information regarding the following areas, visit the web sites listed.
  > Reflexes: www.inpp.org.uk/reflexes/index.php
  > Auditory: www.aitinstitute.org
  > Visual: www.add-adhd.org/vision_therapy_FAQ.html

References Used In This Writing

L. Biel & N. Peske (2005). Raising a sensory smart child: The definitive handbook for helping your child with sensory integration issues. Penguin Books.

A. Bundy & E. Murray (2002). Sensory integration: Theory and practice. Portland OR: Book News.

Grandin, T. (2005). Foreward.  In Biel, L. & Peske, N. Raising a sensory smart child: The definitive handbook for helping your child with sensory integration issues. Penguin Books.

If a student has a problem with his “6th sense”, will we have problems talking to him telepathically?
 
 
 

Is this puppy so active because of SID?

Fetch Dr. Mac's Home Page

Pup…when we click on you to go back to the home page, you might feel a funny sensation.
 

Robert Van Vorst is a teacher in the New York City School System.  He graduated from the childhood special education program at Hunter College Department.
 

Contact the authors at DoctorMac@Behavioradvisor.com