Wednesday, February 6, 2008

Parameters of Modulation

I recently read the March/April, 2007, Sensory Integration issue of AJOT. Lots of great articles. I was especially interested in the lead in article that describes the push for three SI diagnosies in the DSM. They are Sensory Modulation Disorder, Sensory-Based Motor Disorder and Sensory Discriminiation Disorder. With this breakdown (and some sub-categories underneath them) we come closer to being able to perform meaningful research in the area of modulation. Although we have diagnostic and therapeutic tools for motor and discrimination, these are not in place for modulation.

For example, we have developmental scales and excellent assessments for a child's motor skills. They are quite specific, and provide a therapist working with a child with motor delays with a measure of the disability as well as indicate an enumerated set of goals to reach.

Similar OT-based tools for modulation will tell us what modulation behaviors are typical for children at various ages. This in turn will allow us to create assessment tools for children with sensory disorders (including autism) and will allow us to estimate the degree of problem a child has, as well as where they are on the developmental scale. Good assessments will give us milestones for our treatment, and allow us to determine if indeed our treatment is effective. On a larger scale, these tools will allow us to perform quantitative research interventions on large populations. (This topic is also addressed in depth in other articles within the same issue of AJOT).

We need to know precisely the qualities of modulation and their developmentaly characteristics. According to Williamson and Anzalone, the qualities of modulation for infants and toddlers include arousal, attention, affect, and attention. Can we quantify these, assess them in clinical (and other) contexts? For example, can we talk about joint attention, object manipulation, object play, etc.? I am guessing that there are many subtleties here. I hope that we can find specific assessable qualities that are general enough to give us a picture of the child (as the motor assessments do). A resource I have not yet looked at is the zero-to-three foundation's publications (with the exception of the book cited below).

1. Miller, L.J., Anzolone, M. E., Lane, S. J., Cermak, S. A., & Olsten, E. T. (2007). Concept evolution in sensory integration: A proposed nosology for diagnosis. American Journal of Occupational Therapy, 61, 135-140.

2. Williamson, G. G., & Anzalone, M. E. (2001). Sensory integration and self regulation in infants and toddlers: helping very young children interact with their environment. ZERO-TO-THREE: National Center for Infants, Toddlers and Families.


Anonymous said...

i want to know about Self-Modulation or physical corner but i don't understand to start that.

Teresa said...

Modulation refers to the ability to maintain calm. When a person has poor modulation skills, noises, touch, or other environmental input can cause them to become anxious or agitated. At the other extreme, a child/adult with low modulation may not react at all to sensory or environmental input.

A person can have general modulation issues affecting all the senses and the emotions, or the poor modulation may be triggered by a single sense like touch or hearing.

A good guide for small children is "Sensory Integration and Self-Regulation in Infants and Toddlers: Helping Very Young Children Interact With Their Environment" by G. Gordon Williamson & Marie E. Anzalon. It can be found on this website:

In addition, there is some information in the Out-of-Synche series of books. You can look for them on

Hope that this helps.