Interview: Sensory Inclusive Schools
Beth Smithson is a former occupational therapist in the NHS who now helps to tackle school avoidance and refusal — by better understanding our senses.
Hello Beth. What prompted this new Sensory Inclusive Schools initiative?
It’s tough in education at the moment. We’re seeing a decline in school funding and increase in pressures on staff time. There’s also a big focus on the importance of school attendance, which leads to better attainment. But, as I know from my clinical experience in the NHS, a lot of students aren’t absent from school by choice. A lot have been let down by the education system because their sensory needs are not understood.
Photo by Jeremiah Lawrence
A student’s unique sensory profile not being understood can lead to escalations in behaviour at school and their behaviour at home. Young people I work with ultimately end up avoiding and refusing to attend school. This then results in the need for specialist services and therapists. Statutory services — the NHS and education — are now so stretched that it can take time to get that specialist support, so things escalate even further.
Sensory Inclusive Schools was created to support schools to support students’ unique sensory profiles at the earliest opportunity and create sensory inclusive learning environments. It is a package of support to ensure the education workforce are upskilled in being able to recognise student’s sensory processing needs and to remove barriers at the earliest opportunity. We support schools to implement good universal sensory provision, to support all students, through online learning and direct access to HCPC-registered sensory integration practitioners via online forum and zoom drop-in sessions.
What is sensory integration?
It’s also called ‘sensory processing’ and is the way that our brains interpret the sensations from the environment and from within our own body, then integrates, organises the information and decides on our behaviour our motor response. A sensory integration trained therapist will be considering eight senses.
I know five of them: hearing, taste, touch, sight and smell.
We have three more important senses. Our vestibular sense tells us about movement. It also has an important role in attention, concentration and the movement of our eyes. Our sense of proprioception provides us with information about where our body is in a space, body awareness and how much force and pressure to use. Our sense of interoception is the ability to tell what’s happening internally: whether we’re hungry or thirsty, breathing fast or slow, or feeling hot or cold. It also includes whether we need to go to the toilet. Sensory integration is the ability of our brain and central nervous system to take these eight kinds of information, process them and then respond.
We’re all processing sensory information all the time, integrating and trying to make sense of our environment. It is important to understand that we are all have unique sensory profiles and each of us interprets the world differently. That means that how we each move our bodies or respond with our behaviour/emotions is slightly different to the same sensory input.
What are the sensory issues in a school?
We see students who are over-responsive to sensations. The classroom environment can just be too much: maybe it’s the sound or the smell, or the lights are too bright. The result is that we see students refusing to go into certain school environments or withdrawing from activities. A lot of students are dysregulated, so can’t maintain a good level of arousal or concentration, because the sensory environment is overwhelming.
Sensory processing also affects your motor skills so students may have difficulties in things like being able to write — writing is a motor skill. They may have difficulty in PE or dressing and organising themselves. There may be children that can’t follow a timetable and get lost or forget their work. We also see children who don’t have the physical skills to sit still in a chair, so they’re up and moving all the time.
When the sensory demands get too much, students withdraw and refuse to be in an environment, not because they don’t want to be there but because their unique sensory profiles are not being supported and their nervous system is under stress. Students generally want to be at school, to interact with their peers and to learn. School refusal is not a ‘choice’.
You’re saying that it’s the school environment that that’s the problem.
It can be. And that’s why it’s really frustrating when, if autistic students or students with ADHD behave in what seem unusual or inappropriate ways, it’s written off as, ’Oh, it’s because they’re autistic,’ or ‘Because they have ADHD.’ It is not ‘them’ or their ‘diagnosis’ but their unique sensory profiles not being accounted for and supported by the environment or the task they are being asked to do.
Then there’s a link between sensory integration and neurodiversity.
Yes. The estimate is that around 90% of autistic people have sensitivities in sensory processing that impact on their ability to participate in day-to-day life. We also see high rates of sensory processing difference in other conditions such as ADHD, dyspraxia and dyslexia.
However, you can also have a sensory processing difficulty in the absence of neurodiversity. Again, the estimate is that about one-in-six students have sensory processing difficulties impacting on their ability to participate in school. Getting a good universal sensory offer right benefits every child in the class and school, as well as their teachers and families back home. It often takes only very simple adaptations to get the environment right. But you get happier students and life is easier and less stressful for everyone.
Which is where you come in.
We offer a lot of free resources and other support to help staff to recognise and support the underlying, unique sensory processing needs. Unlike other packages, we work through staff in school to upskill and empower them to recognise and support sensory needs via direct access to our team of therapists.
What’s your experience in this area?
I was a children’s occupational therapist in the NHS for 18 years, most recently at Buckinghamshire NHS Trust where I managed Children’s Integrated Occupational Therapy Services. In 2017, I took a job with Sensory Integration Education, working as an e-mentor on their online master’s degree course. In October 2023, I joined the organisation full-time as programme facilitator.
Sensory Integration Education, which is celebrating its 30th birthday this year, has historically provided training for professionals: occupational therapists, physiotherapists, and speech and language therapists who are on our master’s pathway. To become a qualified sensory integration practitioner, you have to go through a master’s level of training, which we provide in partnership with Sheffield Hallam University. We offer CPD to therapists so they can keep up to date with current research. We also have a free family support service, Sensory Help Now, where parents can access a sensory-trained therapist for free via our forum. There’s also free training for parents.
And now the Sensory Inclusive Schools initiative.
What I found in my years in the NHS is that school staff might go on a CPD course, webinars or training day — which is great — but there’s then no follow up to embed that learning and make long-lasting change. Sensory Inclusive Schools has a range of bite-size, on-demand training videos, but we support this learning with direct access through an online forum and Zoom drop-ins with qualified professionals. We provide remote training through our app, so that you have that support in your hands. The aim is to embed a gold-quality universal offer for sensory processing. As a not-for-profit organisation, we keep costs as affordable as possible for schools.
If schools have students with these kinds of issues, what do you advise them to do?
The most important thing is that you upskill your workforce to be able to identify where these behaviours may be linked to sensory processing. It is partly about providing knowledge, but also about changing attitudes. We need a workforce who do not see the student as ‘naughty’ or ‘difficult’, but put the focus on understanding the reasons behind the behaviour.
We’re not looking to change the student; the interventions we want schools to engage in involve changing the environment and scaffolding learning tasks to support regulation and motor skills.
Look for interventions you can implement at a universal level – those that you can implement for a whole class or school. This includes things like changing environments to make a classroom less overwhelming, or reviewing your school uniform policy to accommodate students who may be sensitive to different textures. It may be encouraging additional movement sessions in your classes. Do you offer sensory safe spaces within your classrooms for all students to go to when they feel overwhelmed? Can you offer a variety of seating in your class – do children need to sit? – so students can make a choice about the type of chair they want to sit on, or can they sit on a gym ball or on the floor? Sensory circuits are also popular within schools and can support a group of students to regulate and be ready to learn.
I would also advise schools to listen to the student. Many times, the student has the answer to support their own sensory needs but it is the adults/school who create the barriers. For example, I worked with a secondary student who refused to go to school. She told me she loved school but couldn’t manage the classroom environment. I asked her what would support her to be able to return to school. She said she’d need access to a trusted person who she could talk to when she felt she needed to, and she needed the freedom to move when she felt dysregulated. The movement she needed was to walk two laps of the playground, then come in again. The school had said no to this in the past, they couldn’t possibly allow her out when it wasn’t playtime. Without that strategy to support her sensory needs a barrier was put up to her attending school.
My role was to listen to this student and act as an advocate for her. Together, we educated the school on the importance of allowing her to go out and do those laps when she needed. They tried it, along with her designated trusted person, and she no longer refuses to go into school. Two very simple solutions that the student identified made a big difference.
What are sensory circuits?
These are widely used in schools and very effective if done well. They’re a sequence of sensory activities to help support regulation, and can be set up very easily in classrooms, corridors, the school hall or a playground. You start with alerting activities, which is your main vestibular or movement activities. You then go on to organising activities, which is getting the students to coordinate their body and move, and gets them integrating and organising the senses in their brains. Then we do calming activities. By taking students through a circuit of those three kinds of activity — alerting, organising and calming — we help them regulate their central nervous systems and get them ready for learning. Sensory Inclusive Schools offers a lesson on running sensory circuits, and then staff can use the online forum or drop in sessions to feedback on how they worked, and get advice on how to improve or adapt them.
What sorts of results are you seeing?
We are in the early stages of the launch of our programme and the schools we are working with are all working through the training and starting to implement advice. We take them through the assess, plan, do and review model. Now, the school SENCOs [special educational needs coordinators] are in the doing phase. They’ve done the assessment, coming to us with their difficulties. We’ve helped them plan a response and they’re doing that now. We have schools doing sensory circuits or making environmental adaptations.
An early win has been that a teaching assistant reported working with a student who refused to go to the toilet at school and this was becoming an issue as the student was not able to attend in class as they were concentrating on their full bladder. The teaching assistant, after listening to our training, identified that the student was very sensitive to smell and that’s why they were refusing to use the toilet. I suggested that a reasonable adjustment to support this student’s unique sensory profile would be to allow the student to use the accessible toilet instead as it was less smelly, and the smell could be controlled with the student’s choice of air freshener prior to use. That small environmental adjustment means the student is now going to the toilet at school and can attend better to learning.
A SENCO we’re working with said their biggest concern was a number of students who were so dysregulated by the end of the day that their parents reported escalated behaviour when they got home. It wasn’t a whole-school issue but the SENCO wanted to make these families’ lives a bit easier. Together, we looked at the school timetable and came up with a plan. I suggested implementation of sensory circuits during the afternoon break, rather than it being an unstructured 20 minutes of students running around. We discussed together what activities to put in, and then together tweaked those activities so they were most effective. We also worked on getting other teachers on board, using our drop-in Zoom sessions to explain the importance of this intervention. We will also now run support for these parents through our Sensory Help Now service to help that transition back into the home. By linking our Sensory Inclusive Schools service and our Sensory Help Now Family Support service we can offer that complete package and, for the majority of cases, it has been very successful.
You said ‘assess, plan, do and review’. When do you review this initiative as a whole?
By the end of the school year we will have have two terms’ worth of data. We’ll use that to update the package and ensure it’s in its most appropriate form for the target audience of teachers and teaching assistants. Once we’ve got that package amended, from September I’ll be seeking funding from external organisations to support more formal research into the effectiveness of universal provision for sensory needs. There’s not a lot of research in this area and we want to lead the way.
Beth Smithson, thank you very much.
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