Harnessing Energy

Program Development

The Zone’in Program was originally designed by Cris Rowan while working for a decade as a Pediatric Occupational Therapist with the Sunshine Coast School District No. 46. Zone’in started as The Sensory Integration Observations and Strategies Assessment and Intervention, developed by Cris and administered by parents and teachers following workshop training and certification. As the attention deficit population grew, Cris wondered if she could design a classroom based, kid-driven assessment and intervention to better address need. Hence…the creation of the Zone’in Program! Cris began by distributing a questionnaire to the Sunshine Coast Special Education Teachers to determine incidence of attention deficits in the elementary population and found that 30% of children had attention delays that significantly impacted their ability to learn.

Prototype Testing

Prior to prototype testing, Cris held a meeting with the Sunshine Coast Special Education Committee where she surveyed the Resource Teachers regarding what parameters should be met with the final Zone’in Program, and they responded with the following requests:

  • No paper, booklets or folders
  • All inclusive kit
  • No requirement for teacher preparation time
  • Kid-driven to optimize motivation
  • FUN!

The Zone’in Program prototype was repeatedly implemented, revised and evaluated over a four month period at Madeira Park Elementary School with grade 1, 2, 3 and 6 students and teachers, resulting in a program that has proven to meet the Sunshine Coast Special Education Committee requirements, as well as be fun for the students.

Original Research

St. Anne’s Academy in Kamloops will be participating in a study to determine Zone’in Program efficacy in improving children’s ability to initiate, maintain focus and complete academic tasks, with results expected in the Spring of 2008. This study will be implemented in two grade 2/3 classrooms, where one classroom will be the “control” and the other the “test” classroom where each classroom child and teacher in both the “test” and the “control” classrooms, will fill out a pre/post Attention Questionnaire prior to and after two months of using the Zone’in Program, with “test” classroom receiving the Zone’in Program. The Attention Questionnaires will measure student’s ability to initiate, maintain focus on and complete academic tasks. The results of the questionnaires will be evaluated for comparative purposes.

Supporting Sensory Integration Research

Autism Society America (2003) Facts and Statistics. Autism Spectrum Disorder. www.autism-society.org/site/PageServer?pagename=FactsStats. This article states that autism is the fastest growing developmental disability with 2003 prevalence of 0.7% with a 10-17% annual growth.

Ayres A (1985) Developmental Dyspraxia and Adult Onset Dyspraxia. Sensory Integration International, California.

Ayres, A (1972) Sensory Integration and Learning Disorders. Western Psychological Services, California.

Ayres, A (1979) Sensory Integration and The Child. Western Psychological Services, California.

Barthell, K (2004) Evidence and Art: Merging Forces in Pediatric Therapy. Workshops and book available at www.labyrinthjourneys.com.

Becker-Weidman A (2001) Attachment Disorder Checklist. Mental Health Matters http://www.mental-health-matters.com/articles/article.php?artID=573. Checklist designed to identify children with Reactive Attachment Disorder.

Braswell J and Rine R (2006) Evidence that Vestibular Hypofunction Affects Reading Acuity in Children. International Journal of Pediatric Otorhinolaryngology Vol 70 Issue 11, 1957-1965. Study results found that reading acuity scores were significantly worse in children with vestibular hypofunction, and that reading acuity scores correlated with dynamic not static visual acuity scores. This reports high lights that gaze instability due to vestibular hypofunction affects reading ability in young children.

Braswell J and Rine R (2006) Preliminary Evidence of Improved Gaze Stability Following Exercise in Two Children with Vestibular Hypofunction. International Journal of Pediatric Otorhinolaryngology Vol 70 Issue 11, 1967-1973. This study found that visual-vestibular exercises improved critical print size and reading acuity.

Bundy A, Lane S and Murray E (2002) Sensory Integration Theory and Practice, 2nd Edition. F.A. Davis, Philadelphia.

Centre for Disease Control and Prevention (2003) Mental Health in the United States: Prevalence of Diagnosis and Medication Treatment for Attention Deficit/Hyperactivity Disorder. www.cdc.gov/mmwr/preview/mmwrhtml/mm5434a2.htm. This reports a 7.8% ADHD prevalence in 2003 with 56.3% of this population on medication.

Cotman C, Berchtold N and Christie L (2007) Exercise Builds Brain Health: Key Roles of Growth Factor Cascades and Inflammation. Trends in Neuroscience Vol 30 No 9, 464-472. This research profiles how exercise improves cerebral vascular perfusion, increases the production of neurogenic growth factor, and decreases inflammation with subsequent increase in the number and length of survival of nerve cells in the hippocampal region, implicated in learning and memory. This article also shows the positive effects of exercise on reducing depression.

Dennision, Paul (1992) Brain Gym: Simple Activities for Whole Brain Learning. Edu-Kinesthetics Inc, California.

DeGangi, G (2000) Pediatric Disorders of Regulation in Affect and Behaviour. A Therapist’s Guide to Assessment and Treatment. Academic Press, New York.

Diagnostic and Statistical Manual of Mental Disorders 3rd Edition (1987), 313.89 Reactive Attachment Disorder of Infancy or Early Childhood. American Psychiatric Association.

Driver J and Frith C (2000) Shifting Baselines in Attention Research. Nature Reviews Neuroscience Vol 1, 147-148. This commentary profiles new studies indicating that the attention state of the observer affects processing of incoming stimuli, and that the sensory cortex can actually prepare and modulate incoming stimuli. This information substantiates the importance of educating children regarding how to attain body energy necessary to improve attention by using Zone’in Tools and Techniques.

Dunn, Winnie (1999) The Sensory Profile. The Psychological Corporation, USA.

Engel A, Fries P, and Singer W (2001) Dynamic Predictions: Oscillations and Synchrony In Top-Down Processing. Nature Reviews Neuroscience Vol 2 704-716. This paper reports how descending pathways (expectations, attention, knowledge and memory) modulate ascending stumuli, and profiles how “the human brain should be regarded as a much more active and adaptive system”.

Frick S and Hacker C (2001) Listening With the Whole Body. Vital Links Press, Wisconsin.

Hall L and Case-Smith J (2007) The Effect of Sound Based Intervention on Children With Sensory Processing Disorders and Visual-Motor Delays. American Journal of Occupational Therapy Vol 61 No 2, 209-215. Results of this study indicate that a therapeutic listening program and sensory diet significantly improved participants scores on the Sensory Profile, with parents reporting improvement in their children’s behaviours related to sensory processing. This information validated use of therapeutic sound in the Zone’in Program.

Hannaford, Carla (1997) The Dominance Factor: How Knowing Your Dominant Eye, Ear, Brain, Hand, and Foot Can Improve Your Learning. Great River Books Publishing, Utah.

Hannaford, Carla (2005) Smart Moves: Why Learning Is Not All In Your Head. Great River Books Publishing, Utah.

Hillman C, Erickson K and Kramer A (2008) Be Smart, Exercise Your Heart: Exercise Effects of Brain and Cognition. Nature Reviews Neuroscience Vol 9 58-65. This article profiles the following studies: achievement in standardized test of reading and math was positively correlated with physical fitness scores; social isolation reduced positive effects of exercise on hippocampal neurogensis; exercise training improved depression; cognitive, physical and social engagement decreased the risk of dementia.

Hofler D and Kooyman M (1996) Attachment Transition, Addiction and Therapeutic Bonding – An Integrative Approach. Journal of Substance Abuse Treatment Vol 13 No 6, 511-519. This article profiles the concept that addiction is a maladaptive attachment transition and results from a fear of intimacy, and states the clinical implication of using therapeutic bonding as a treatment intervention.

Hubert, Bill (2001) Bal-A-Vis-X: Rhythmic Balance/Auditory/Vision eXercises for Brain and Brain-Body Integration. Bal-A-Vis-X Inc, Kansas.

Hulit L and Howard M (2005) Born to Talk, An Introduction to Speech and Language Development, 4th Edition. Allyn and Bacon, Needham Heights Press. This book defines components of attention as orientation, motivation, arousal and memory, and types of attention as focused, sustained, selective, divided and alternating.

Grossberg S (2005) Linking Attention to Learning, Expectation, Competition, and Consciousness. Neurobiology of Attention (Eds. Itti, Rees and Tsotsos). Elsevier Academic Press Chapter 107, 652-662. Grossberg discusses his Adaptive Resonance Theory which predicts that “All conscious states are resonant states”, and that there is a resonance between top-down attention modulation and bottom-up stimuli, and that this resonance leads to a synchronization which facilitates learning as “cells that fire together wire together”.

Insel T and Young L (2001) The Neurobiology of Attachment. Nature Reviews Neuroscience Vol 2 129-137. This article profiles the importance of attachment and quotes Baruch Spinoza who states “Humans are primarily a social animal, and it’s our social attachments we live for”. Insel and Young define a mother’s attachment to her infant as a process of “approach, identify and select/reject”, which are mediated by the neuropeptides oxytocin and vasopressin, found in the dopamine rich areas of the brain, the substantia nigra and preoptic areas. This study points out the similarity between social attachment and psychostimulant addiction, as they apparently use the same neurological pathways, resulting in social recognition, reward and euphoria.

Klenberg L, Korkman M, Lahti-Nuuttila P (2001) Differential Development of Attention and Executive Functions in 3 to 12 Year Old Finnish Children. Developmental Neuropsychology Vol 20(1) 407-428. This study profiles confusion in the literature regarding the terms attention, executive function and memory. Authors described attention as having 4 subfunctions of arousal, focus, sustain and shift, and describe 3 developmental sequences of attention as impulse control, sustained attention and executive function. 10 subtests used in this study on 400 normal 3-12 year olds measured impulse control, auditory and visual attention, visual search, planning and verbal and visual fluency. Girls out-performed boys on all subtests, and children of parents with higher education levels out performed children of parents with lower education only on the subtests of execute functioning (not on inhibition or visual/auditory attention subtests). Results suggest a staging of development that begins at age 6 years with maturing of inhibitory functions, followed by a relative maturation of auditory and visual attention at age 10 years.

Korkman, M (2001) Introduction to the Special Issue on Normal Neuropsychological Development in the School-Aged Years. Developmental Neuropsychology Vol. 20(1) 325-330. This article points out that lack of neuropsychological research on age-related changes in school-aged children, and recommends utilization of existing databases for study on normal development.

Learning Disabilities Association of British Columbia – Fact Sheet Statistics (2007) Learning Disabilities Fact Sheet. www.ldav.ca/info.html. This document states that 15% of the elementary population has learning disabilities, with reading deficits the most prevalent condition. 35% of the learning disabled population will drop out of school, 60% will receive treatment for substance abuse, and they will have twice the unemployment rate of the non-disabled population.

Mannuzza S, Klein R, Bessler A, Malloy P, and LaPadula M (1993) Adult Outcome of Hyperactive Boys, Educational Achievement, Occupational Rank, and Psychiatric Status. Archives of General Psychiatry Vol 50 No 7 pp 565-576.

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May-Benson M, Koomar J (2007) Identifying Gravitational Insecurity in Children: A Pilot Study. American Journal of Occupational Therapy Vol 61 No 2, 142-147. This study reports that the GI Assessment is a promising clinical tool for objectively identifying children with gravitational insecurity, and was referenced in the Zone’in Workshop when reporting movement related sensory processing disorders.

Miller L, Coll J and Schoen S (2007) A Randomized Controlled Pilot Study of the Effectiveness of Occupational Therapy for Children with Sensory Modulation Disorder. American Journal of Occupational Therapy Vol 61 No 2, 228-238. Children diagnosed with Sensory Processing Disorder made significant gains following a sensory integration approach on goal attainment scaling and on the Attention subtest and the Cognitive/Social composite of the Leiter International Performance Scale-Revised. This study validates use of sensory integrative approach in design of the Zone’in Program.

Miller L, Anzalone M, Lane S, Cermak S, and Osten E (2007) Concept Evolution in Sensory Integration: A Proposed Nosology for Diagnosis. American Journal of Occupational Therapy Vol 61 No 2, 135-140. This article defines terminology for Sensory Processing Disorder diagnosis for eventual inclusion in the Diagnostic and Statistical Manual V, as described in the Zone’in Workshop.

Mirsky A, Anthony B, Duncan C, Ahern M, Kellam S (1991) Analysis of the Elements of Attention: A Neuropsychological Approach. Neuropsychology Review Vol 2 No. 2, 109-145. This study reports three elements of attention and their respective anatomical origins: focus/execution – temporal and parietal lobes, sustain/encode – hippocampus and amydgala, and shift – prefrontal cortex.

Montagu, A (1978) Touching, The Human Significance of the Skin 2nd Edition. Harper and Row Publishers Inc. New York.

Mukaddes N, Bilge S, Alyanak B, Kora M (2000) Clinical Characteristics and Treatment Responses in Cases Diagnosed as Reactive Attachment Disorder. Child Psychiatry and Human Development Vol 30(4), 273-287. This study was conducted on 15 children with RAD who were misdiagnosed with PDD, and found that 66.6% of RAD children were exposed to 7.26 hours of TV use per day with age of onset at 7.16 months, and conclude that “excessive TV exposure might be a form of neglect that is specific for RAD patients”.

National Dissemination Centre for Children With Disabilities – Fact Sheet 7 (2004) Learning Disabilities. www.nichcy.org/pubs/factshe/fs7txt.htm. This document reports that one in five children have a learning disability requiring the services of a school-based special education team, and prevalence of LD children have increased 22% over the past 25 years.

National Resource Center on ADHD – Statistical Prevalence (2007) About ADHD. www.help4adhd.org/en/about/statistics. This report states that 7% of elementary children have a diagnosis of ADHD, with 61% of these children also having learning disabilities.

Parham L, Cohn E, Spitzer S, Koomar J, Miller L, Burke J, Brett-Green B, Mailloux Z, May-Benson T, Smith Roley S, Schaaf R, Schoen S, Summers C (2007) Fidelity in Sensory Integration Intervention Research. American Journal of Occupational Therapy Vol 61 No 2, 216-227. This article describes identification of 10 core sensory integration intervention elements, with subsequent review of 34 sensory integration studies showing only one core element was addressed in all studies. These results show that validity of sensory integration outcomes studies is threatened by weak fidelity in regard to therapeutic process, as described in the Zone’in Workshop.

Parker-Pope, T (2005) Risk of Over-Diagnosing ADHD. Wall Street Journal, Health Journal. January 25, 2005.

Paris B and Murray-Slutsky C (2005) Is it Sensory or is it Behavior? Behavior Problem Identification, Assessment and Intervention. Harcourt Publishing, San Antonio Texas. This book clearly outlines behavior as a coping strategy, and discusses that as this coping strategy is repeated, the behavior becomes firmly established appearing “willful”.

Pelligrini A. and Bohn C. (2005) The Role of Recess in Children’s Cognitive Performance and School Adjustment. Educational Researcher Vol 34 No 1, 13-19. This study reports that providing breaks over the course of a child’s school day enhances their ability to attend and learn. This study also reports that kindergarteners’ playground social behaviour was a significant factor in first grade achievement, and discussed that the playground may be the only area where “latch-key” kids get to socialize with their peers. This study support Zone’in premise that children learn first with their bodies, then their brain, and supports Zone’in recommendations that children should employ a variety of movement techniques to optimize learning.

Porges, S (2005) The Vagus. The Neurobiology of Autism, Eds Bauman & Kemper, John Hopkins University Press, 65-77.

Rine R, Braswell J, Fisher D, Joyce K, Kalar K, and Shaffer M. (2004) Improvement of Motor Development and Postural Control Following Intervention in Children with Sensorineural Hearing Loss and Vestibular Impairment. International Journal of Pediatric Otorhinolaryngology Vol 68 Issue 9, 1141-1148. This study showed that motor development scores increased significantly in children with sensorineural hearing loss and vestibular impairment following balance, visual and somatosensory training. This study substantiates that impaired vestibular development affects postural and motor ability.

Schaaf R and McKeon Nightlinger, K (2007) Occupational Therapy Using a Sensory Integrative Approach: A Case Study of Effectiveness. American Journal of Occupational Therapy Vol 61 No 2, 239-246. This single subject design of a child with poor sensory processing indicates improvement in goal attainment and behaviour with occupational therapy using a sensory integrative approach. This study validates use of sensory integrative approach in design of the Zone’in Program.

Shaffer, David (1994) Attention Deficit Hyperactivity Disorder in Adults. The American Journal of Psychiatry. Vol 151, pp 633-638.

Schilling D, Washington K, Billingsley F and Deitz J (2003) Classroom Seating for Children With Attention Deficit Hyperactivity Disorder: Therapy Balls Versus Chairs. American Journal of Occupational Therapy Vol 57 No 5, 534-541. This research found that use of therapy balls for students with ADHD facilitates in-seat behavior and legible word productivity.

Schmidt R and Lee T (2005) Motor Control and Learning: A Behavioral Emphasis. Human Kinetics Publishing, Illinois. This book reports the immense role that vision has in determining behavior, and states that 87.7% of behavior is driven by vision.

Schneider M, Moore C, Gajewski L, Laughlin N, Laron J, Gay C, Roberts A, Converse A, DeJesus O (2007) Sensory Processing Disorders in a Nonhuman Primate Model: Evidence for Occupational Therapy Practice. American Journal of Occupational Therapy Vol 61 No 2, 247-253. This study profiles development of a Sensory Processing Scale for monkeys that measured behavioual responses to a series of tactile stimuli in monkeys exposed to prenatal alcohol, stress or post-natal lead. Results showed while control monkeys from undisturbed pregnancies showed a habituation pattern, prenatally stressed monkeys showed sensitization, and prenatal alcohol-exposed monkeys showed relatively high responsiveness without habituation. Lead exposed monkeys showed sensitization, reduced with chelation.

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