Getting Started

Snoezelen: A Multi-Sensory Approach to Challenging Behaviors

Although this position paper was written in 1998 and some of the material is outdated due to the advancement of the sciences; I feel the basic philosophy and concepts remain current.

I have put the paper unedited here, but it was accompanied by a video tape of a consumer’s experience and behavioral changes documented over a six week period in the Snoezelen room. During this period in time, I utilized the Snoezelen Modality exclusively as a method of relaxation to help someone change their own behavior. By this I mean the equipment, music and projected images were slow, soft and never intense. What I now call the Phase One or Traditional Relaxation Phase. The objectives were to:

1. Lower someone’s stress, fear, anxiety and level of arousal.

2. Build a trusting relationship with the individual.

3. Follow up with treatment only when the first two objectives were achieved. (In this case the individual presented in this paper had Sensory Defensiveness.)

Treatment sessions were conducted utilizing the Snoezelen Environment not in a traditional Therapy room. The Snoezelen equipment was not necessarily turned on. But, the comforting and familiar Snoezelen Environment helped the individual maintain their own level of arousal. If the individual was exhibiting an increase in stress, anxiety, or level of arousal, as demonstrated by their behavior or asked for the equipment to be turned on, it was. This allowed for traditional techniques to be used with the individual without the emotional negative connotation. (For the individual in this paper it allowed for using Patricia Wilbarger’s Sensory Defensive Treatment Protocol.) [See text for explanation]

Note: Virginia continued to make progress after this paper was written. She can now sit and eat in a noisy cafeteria. She was severely underweight and gained eight pounds and maintained it. She no longer strips off her clothing. She can be touched and will initiate coming to the Snoezelen room when she is in a high state of anxiety or stress. Her sleeping pattern has changed and she sleeps through the night. Virginia is making choices for herself.

The consumers have taught me how to use Snoezelen over the years and I am very grateful to them. Thanks to my experience with Virginia and many other individuals’ with Challenging Behaviors, my Treatment Approach with Snoezelen has been developing and refining itself. I look forward to sharing it in the future. This article provides a detailed view of my approach.






















– Vestibular sensations

– Proprioceptive sensation

– Tactile sensations



The population I serve are all adults who have a developmental disability, ages twenty-one to our oldest – seventy-seven. They all have mental retardation from the profound to mild level, with a variety of other challenges including sensory disabilities, autism, and cerebral palsy. Most of the individuals can not speak and some are non-ambulatory.

Some historical background: To understand the population you have to understand the place, the environment, and the past that this group comes from. Many of these individuals grew up in very large institutions in the United States where the environments were horrific. The largest of these was Willowbrook State School in New York. This institution’s environment offered overwhelming amounts of sensory stimulation that could not be controlled by the individual. The wards were very noisy, even at night. There would be two to three TVS going at the same time, radios blaring, children screaming and running around, staff moving about and talking and all lights on. Because this system was too large to accommodate any individualization or normalization, routine procedures like laundry and house cleaning were disruptive and often threatening to individuals. Just a quick example: laundry had to go out by six A.M. Sheets, blankets and bed clothing were pulled out and off of individuals as they slept at 5:30 a.m. They were left naked on mattresses. Maintenance would start loud floor machines at six A.M., and push beds with naked children in them to one side of the room or the other together. Children who were aggressive would pick on children who were defenseless. Staff ratios were insufficient to provide these children with even the most fundamental safety protection.

When I began to work there in the seventies the prevailing treatments for an individual’s aberrant behavior were medication, behavior modification, restraints, and in a few cases shock treatments were still periodically used. The overuse of medications (especially anti-psychotic (neuroleptic) medications) was widespread.

Early in my career, I had an opportunity to work with a professor whose specialty was working with children with autism. He was trying to put forth a controversial treatment approach he called “Intrusion Therapy”. This approach in simple terms was based on the premise that it is all right for me to hit myself, but not all right for you to help me or intrude on my space or body. (This approach assumed that the person had developed a sense of self.) Treatment consisted of matching the stimulus the client was self-providing by physically putting your hand over the clients and trying to exactly match the input of the stimulus. As an intern, I had the occasion to try this intrusion approach. I screamed seven hours in a room with a five year old non-verbal boy who screamed at the top of his lungs nonstop. I had to match the intensity, pitch, tone to his. The session finally stopped when he yelled “No”; This was the first word he had ever spoken. His parents were delighted and he started to talk from that point on. My reaction at the end of the day was to develop a blinding headache, be very dizzy, drive off the road on the way home and vomit. When I recovered forty-eight hours later, I was left wondering about the internal, external environment relationship and began to think about how this could be used in “feeding the sensory need”. Maybe the amount and type of external sensory stimulation could affect the internal processes. After all, my internal systems had gone into overload from too much stimulation, and yet it seemed to be what the boy responded to. I wondered later, what was it that our clients in the institutions were trying to communicate to us or to themselves through their self stimulatory behaviors? My quest for answers started.

One prevailing hypothesis that I looked at as part of that search for answers was that individuals who were self-abusive were that way because they did not receive enough love and attention. Also, the environments were devoid of activities that could promote learning and therefore these individuals either self-abused or self stimulated to make up for the lack of a stimulating external environment. The only trouble with this reasoning was that there were many individuals with devoted loving parents and stimulating environments who had never been institutionalized, who were exhibiting the same behaviors. So, something was wrong with this picture.

As I studied, I became more and more convinced that the key to understanding self-abusive behavior lay in working directly with sensory experience. I read about Snoezelen in the late seventies but it was unavailable in the United States until the nineties. But, as soon as it was available, I wanted to try it with our folks.

Later we were able to set up a Snoezelen Room in one of our Day Treatment Centers, and we now have, at different sites, three rooms and one mobile unit. I have been working with the Room since 1991.


Our Snoezelen room contains the following equipment:

Corner Sound & Light Wall

Mirror ball

Fireworks light display

Catherine Wheel

Fibre optic spray & curtain

Bubble tubes

Tall Noise Wall Cushion

Traveling light tube


Black light

Heated water bed

Stable based rocking chair & bean bags

Fireworks Display

Aroma therapy

Most of the equipment have adapted switches so our clients may control its function. Some of the equipment is on master switching devices to allow for optimum learning. (Switches are individualized to a clients’ capabilities).


The Neurology – Why Snoezelen Works

I need to step back a minute and offer some of my opinions and assump?tions. I feel that many of these folks are attempting to “self regulate” through their overt behaviors to get “enough” sensory input or eliminate sensory input (meaning sufficient amount and type of input) to allow the brain stem production of the biogenic amines either to excite, inhibit and the combination there of, the nervous system. [See Appendix A] The simplest way of thinking about what the Snoezelen experience does is it manipulates the brain chemistry through the senses to set the tone for motivation and functional attention. It lowers the stress chemistry and increases the relaxation chemistry. The key seems to be in finding the combination of sensory input that allows the individual to take control once a balance has been achieved. This balance is achieved through the chemical interaction that allows self regulation, motivation, organization, and integration to take place for the individual.

It appears that many of these individuals are in a “Chronic Fright, Flight and Fight” (referred to as the “3Fs”) or “Stress” state (In the U.S. some refer to this “Chronic Fright, Flight & Fight” state as “Sensory Defensiveness”* [See Appendix B]) If you can reach a state of relaxation then other sensory modalities can be introduced by their choice (in the case of our population). Achieving relaxation is what makes Snoezelen a treatment of choice. Unlike other relaxation methods it appears that the Snoezelen environment brings about the relaxation process without any conscious effort by the individual. Often other modalities, such as Tai Chi, demand some form of active participation in order for the process to be successful. According to a Tai Chi Chuan Master, the principle of relaxation requires self controlled movement and breathing. Massage requires the intrusion of personal space which can be threatening and heighten the “Sensory Defensive” state for many of our individuals. Many of our individuals with Sensory Defensive?ness also had traumatic experiences at the institution producing “Post Traumatic Stress Disorders”. The captivity, abuse, violation and helplessness would further complicate a neurological system already burdened with sensory processing problems. Snoezelen is the one treatment of choice that does not demand active participation to be effective, and does not carry a built-in demand: “experiencing” it is sufficient. This makes it a most powerful treatment modality for severely disabled individuals and a first step in treating Sensory Defensiveness. According to many of my teachers who are experts in the field of Sensory Processing Disorders, [See Appendix C] Sensory Defensiveness should be treated first. But, more on specific treatment later.


Because of the unique background history of many of the individuals I serve, and because of the complications stemming from their often complex diagnoses, I would like to share with you, step by step, the route that I take as I approach an individual and invite him or her to enter into the Snoezelen experience.

4a. Before entering the Snoezelen – What information I try to obtain (namely, building a “Sensory History”). [see recourse list]

Prior to taking someone into the Snoezelen environment you want medical history, and birth history if possible, as well as current medications, living situa?tion, sleeping ,eating habits and behavior patterns. You want information that will give you a “whole person-centered picture”. You are looking at a photograph album of negatives. At this point in time you are not necessarily concerned about diagnosis and clinical opinion. The individual should be observed across as many different environments as possible. You are looking for clues to their sensory preferences. You may find clues on the transportation ride, their home and their community at large. Remembering that people may and do function differently in various environments. The idea is to configure the set up and potential priorities of equipment engagement that would be non-threatening to the individual and coincide with their personal preferences as much as possible. You want to try and ensure as much success on the first visit as possible. You are entering into a journey of trust with the individual that you hope will give them a quality of life of their choosing.

4b. Observing the first response – What I look for

I watch how a person uses their senses, mood, and overt behaviors. I look to see their first reaction at coming into a room with normal lighting and quiet and the absence of a lot of people. The noise level is very different than they are accustomed to, there is silence. Most of these individuals have had little opportu?nity to be alone, most came from large institutions. It is very important not to speak to the individual or invade their personal space. The person is allowed to be whoever they are, no instructions are given them and they are not touched. As I watch the person I observe their breathing, is it shallow, are there any deep breaths, sighs, coughs or hyperventilation, I look to see if they are drooling and the position of the mouth and what the jaw is doing, are they grinding their teeth; what is their level of excitation, where are they looking (if at all), is there a hypervigilence, are the eyes darting back and forth, or partially closed in a squint, are they focused on anything or are the eyes blank, is there a stare or is there sparkle or is there a nystagmus, do they make direct eye contact or what is the quality of their eye contact or other visual behavior. I look at the amount of gross movement or lack thereof, are they in constant motion such as pacing or rocking (and, if rocking, in what plane or direction) or are they glued to the ground. I watch their walk and their placement of their feet, do they seem to know where they are; are their steps tentative solid, hard, do they toe or heel walk? I watch their body tone, are they rigid, or tense do they hold their extremi?ties close to their sides or are they out far from their body. I look for their head position in space and their orientation to the environment. I listen for any vocaliza?tions or sound production, are they screaming, humming and at what volume level, pitch or tone. I look at their hands and at the musculature, is it underdeveloped. I look at what they are doing with their hands and how they hold them. Are they using their hands in a self stimulatory fashion? Do they touch themselves and is it lightly or with deep pressure or force. I look to see if they tear or remove clothing or shoes. Do they wrap themselves in their clothing? I make no judgements about the behaviors, only that they are happening and wonder what purpose it may serve the individual.

4c. Manipulating the enviroment – Starting to intervene actively

Once I have observed the person’s exploration, I gently start changing the environmental stimuli to see what the effect might be. The room lights are dimmed slowly and soft relaxation music is started along with the corner light wall. The bubble tubes and fibre optic spray are turned on. And eventually the projector is engaged with four different rotating patterns projected on the wall. The person is watched to see if any of the equipment is looked at or if they even move in the direction. The person’s reactions are monitored and the environment adjusted according to the person’s preferences as they are noted. I am allowing the person to choose through their actions, and configuring the room in line with those choices. Often this is the longest part of the process to figure out which equip?ment and which music works best for the individual to reach a state of relaxation.

4d. An example

“Virginia” is self abusive. She punches her face or hits herself with a shoe and disrobes, taking off her shirt. She locks her own arms in her shirt at other times. She appears to be in constant motion in her environment. She is either standing or sitting or attempting to lock herself into a corner of the activity room in direct site of people. She repetitively alternates between sitting in a chair (which she pushes continuously back into a wall), and standing up rocking and then sitting again. She will do this hundreds of times through out the day. She makes low pitched noises and rocks forward and back. Virginia appears to have no purposeful activity other then to feed herself. She does not smile or make direct eye contact. Her head position is held flexed and towards the side. She gazes up from this position to watch her surroundings. She is hypervigilent to her environ?ment and moves quickly when someone approaches. Virginia is a toe walker.

“Virginia” is one of our individuals who appears to be in a chronic state of “Fright & Flight & Fight” with “Sensory Defensiveness”.

Observations in the Snoezelen room:

Virginia’s behavior on the first session was that she entered the room and stood in constant motion, with her head position facing down at the floor and her eyes glancing upward in fleeting vigilance to watch her surroundings. She was hitting the side of her face with her shoe and hand. She had kicked off both of her shoes as she entered the room. As the lights were slowly dimmed and the light and sound wall started, she came over to me and stood six inches from my chest, but continued with the above behavior. Virginia stayed in this position for an extended period of time and then side stepped to look around me at the corner sound and light wall. She turned and went and sat in the rocking chair for a few seconds. She stood and rocked, but the rocking pace slowed down and than sat down again and crossed her legs. This was repeated six times. Her face slapping had stopped and her arms which had been held close to her chest were down and at her sides away from her body. She finally sat for a prolonged time and made gentle sounds and smiled. At the end of this first session, Virginia walked over to a mirror, looked at herself, and then looked around the room with her head up at the projected images rotating on the wall. With each session Virginia’s behavior has changed and on the tenth session she came in and sat right down in the rocking chair, leaving her shoes on. During this session, the rocking chair had been left in the locked position (unintentionally) and Virginia tried five times to reach down and unlock the chair, before a staff member realized what she was attempting to DO. VIRGINIA for the first time was using purposeful hand function to interact with and make an impact on her environment.

What did we find out about Virginia?

By looking at her discovery and exploration in Snoezelen we found that Virginia’s primary sensory preferences are Vestibular (rocking) and Proprioceptive (heavy work) input. She avoids light touch. Virginia used the Snoezelen experience to become calmer. She relaxed through the exploration of light and sound and began to rock in the rocking chair in a slow rhythmical pace. (Slow rhythmical vestibular input is calming.)

So, what is next for Virginia? Has there been carry over of reduced challenging behaviors back into the activity room? Not yet, but now within the Snoezelen room we can touch her and treat the Sensory Defensiveness by adding “brushing”* (*Which is an approach/protocol developed by P. Wilbarger which consists of putting pressure touch into the tactile system by use of a non-scratching surgical brush and then proprioceptive input into the system through joint com?pression.) (Note: Treatment should be done by individuals trained in Sensory Processing Disorders.) The effect of adding pressure touch is to further calm the overarousal (Fright, Flight or Fight) and help the individual to gain control and set the readiness for further choices in adapted responses. (Functional actions) This is done by enhancing brain stem stimulation. Pressure touch through the skin, stimulates receptors that cause brain stem production of the biogenic amine chemistry which enhances the parasympathetic system to counteract the sympa?thetic system and clear stress chemicals.

Has Virginia changed? Maybe only in the Snoezelen room, but it has reduced her stress and enabled her to function and seem happy there. For our severely disabled folks who’s compromised nervous systems don’t allow them to experience peace, Snoezelen had provided it.





In order to understand how the Snoezelen experience helps individuals, you need to know some information about the nervous systems interaction. Just a review, in simplistic terms of how I understand the process of relaxation. The Autonomic Nervous System (ANS) comprising of the Sympathetic and Parasympathetic nervous systems is centered in the Brain Stem and is responsible for Life itself. This system integrates autonomic and neuroendocrine functions for homeostasis and communicates directly with other brain stem centers that control heart rate, respiration, and hunger. All behavior is accompanied by an ANS reaction. The Brain Stem includes the Sympathetic and Parasympathetic nervous systems and Reticular System (sometimes referred to as the Reticular Activating System).

The Sympathetic system is responsible for the neurotransmitters of the adrenaline chemistry class which is responsible for your “Fright, Flight & Fight” responses. (The adrenal gland also adds to this.) It can be thought of as preparing the system for action (arousal). Some characteristics of sympathetic arousal include sweating, pupil dilation, pallor (color) associated with blood flow, increased heart rate and increases in respiration. The adrenaline chemistry is part of a sub group of the biogenic amines, one group of neurotransmitters released from the brain stem. The biogenic amines can be thought of as the “Modulation” chemistry of the brain stem. Adrenaline helps produces high states of arousal. The “adrenaline rush” you feel when you respond to a dangerous event.

The Parasympathetic system is responsible for maintenance of ongoing function of levels of action or arousal. (It primarily inhibits high states of high arousal). Some characteristics of parasympathetic action is a slowing of the heart rate and respiration, and the low state of alertness after eating. Note: Meditation can be thought of as a function of parasympathetic action as it lowers the respiration rate through deep breathing.

The sympathetic and parasympathetic systems work jointly together to produce states of arousal from high to low. The “just right” combination allows for “Doing & Learning” in very simple terms.

The Reticular System (RS) can be thought of as the basic rhythm generator responsible for levels of awakeness, alertness, asleep, attention (sometimes referred to as the 4As) and circadian rhythms. The RS can modulate cell thresholds which increase or decrease (excite or inhibit) sensitivity to sensory signals (input) depending on the importance in relation to survival at any point in time. The RS can be thought of as the filter that prioritizes flow to give us “selective unconscious attention”. For example, we might be more alert to sounds being alone in a dark alley than we would in daylight since we feel more vulnerable to threat in darkness.

The Limbic System which is anatomically situated over the Brain Stem is highly interactive with many limbic structures and is primarily responsible for the emotional component of human behavior. Emotions must be integrated and coordinated with rational behavior through the frontal lobes and with the level of alertness through the Reticular System. The limbic system sets the basic mood for behavior based on past experience. (Memory development and retrieval.) It contributes to interpretation of all new sensory input by comparing it to past experiences. The Limbic System also has connections to the Autonomic Nervous System and you could say assigns emotional experiences to the visceral components controlled by the ANS. (such as changes in breathing, heart rate, gastrointestinal functions, etc). One could suggest that if a sensory experience was pleasurable, then based on this past experience the sensory stimulus would be approached. If the sensory experience has been traumatic or negative then the sensory stimulus would be avoided. (For example, eating something you find pleasurable vs eating something you tried for the first time and vomited, chances are you avoid that food).

The above systems can be thought of as interfaced with overlapping and interacting functions with one another, that produce and mediate states of arousal that prepare a person for “fleeing” or “higher function”. Snoezelen contributes to this process by the use of sensory pleasurable experiences. (See resource list for references on Neuroscience Information for a complete picture.)



Sensory Defensiveness is defined by Patricia Wilbarger as a constellation of symptoms concerning aversive or defensive reactions to non-noxious stimuli across one or more sensory modalities. Reaction involves primitive survival and arousal mechanisms which have a potentially negative effect on every aspect of a person’s life.

The concept of Sensory Defensiveness has two components: Sensory Defensive Behavior and Emotional Behaviors. Sometimes the emotional behaviors fall into the clinical category of Sensory Affective Disorders. According to the Wilbargers, Sensory Defensiveness can be Mild, Moderate or Severe.


is a normal system pushed to extreme? These people are considered Touchy, Slightly Picky and Slightly Controlling. They can be close with relatives and a few close friends. They can be affectionate with loved ones, have a social life and recreational pursuits.


Two or more areas of life are involved, primarily self care and relationships. It is categorized by seeking and avoiding behavior, with extreme control of the sensory environment. Intimacy is difficult and is with only a trusted few and under structured relationships. They can be thought of as Controlling, Compulsive, Phobic, Anxious, Avoiding and often suffer from Stress and Anxiety Disorders. They will often have Sleep Disorders. They will often avoid the dentist and other aspects of self care. They typically avoid, crowds, shopping, movies, theaters, elevators and any extraneous noise. All senses are defensive in over alerting.


All aspects of life are affected. They have rigid routines; often can not work; if at all, only in sheltered work. They are very isolative, avoid particular sensory input or seek out a particular input, and are often self abusive. They would be considered “psychotic” or “near-psychotic”.

Our focus here is on those with severe sensory defensiveness, who manifest their anxiety in the form of self-abusive behavior.



Sensory Processing allows us to take in and make sense of many different kinds of sensations coming into the brain through different sensory receptors and channels at the same time. Our ability to respond and function is dependent upon adequate and accurate sensory processing. The sensations ultimately are responsible for much of how we learn to function. They are not often thought about consciously and are taken for granted. These sensations produce automatic responses and are the following:

Vestibular sensations:

Arise from firing of the vestibular apparatus in each inner ear.

Tell the brain we are moving, surrounded by something that is moving, on something that is moving, or a combination of the three.

Tell the brain where down is because the vestibular apparatus registers the pull of gravity.

The Vestibular system talks to and influences every other system .

Proprioceptive sensations:

Arise from firing in tiny receptors located in muscles, tendons and ligaments that surround joints.

Tell the brain where body parts are and what they are doing without our having to look.

Provide the sense of our body contents.

Proprioceptive sensations helps us feel grounded, secure, organized, settled and calm. Movement is needed to keep the Proprioceptors from going to sleep. The best proprioceptive sensory feedback is active movement of the muscles and joints and when the muscles contract against resistance.

Tactile sensations:

Arise from receptors located in the skin that fire when we touch or are touched by something.

Provide the brain with body boundaries so we can differentiate “me” from “not me”.

Are processed in two separate and distinct touch systems that make it possible for us to differentiate light touch from pressure touch. (Sometimes referred to as Deep touch)

Some Characteristics of the tactile systems that are important to know:

Light touch system carries: pain, temperature, tickle, itch, and scratch. It is a primitive system. The sensations tend to spread rapidly making it difficult to tell precisely where the original contact was made. Your response is to most naturally avoid the sensation. It is a Dominant sensation. Its pathways lead to the RS, Limbic System and ANS. It can “tripwire” strong sympathetic response to activate and energize (produce High Arousal) for possible “Flight or Fright or Fight”.

It is an evaluative system: “Is it new?”, “Do we Care?”, “Are we concerned?”

Pressure touch system carries: vibration, and joint and muscle sensations. It’s a newer system and is discrete, the sensations tend to be precise. We can tell where contact was made, when it started and stopped and how hard it is. This sensation is usually approached. It is a Subordinate sensation and pathways go to the area of the brain that gives us a vague sense of what it is and then to the cortex for precise identification. It inspires us to learn and explore. It calms and organizes us.

It triggers parasympathetic responses to counteract sympathetic arousal.

** Information adapted from Evaluation & Treatment of Sensory Processing Disorders, Bonnie Hanschu, OTR



* Sensory Integration Inventory – Revised – For Individuals With Developmental Disabilities., Judith E. Reisman, Ph.D., OTR, FAOTA & Bonnie Hanschu, OTR, 1992, PDP Press, Inc. Hugo, MN. (612) 439-8865
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The American Occupational Therpy Association

1383 Piccard Dr., PO Box 1725, Rockville, MD 20850-0822

* Aroma Therapy, An A-Z., Patricia Davis, The C.W. Daniel Company Limited, 1 Church Path, Saffron Walden, Essex CB10 0JP, England
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* The Astonishing Hypothesis., F. Crick, New York: Charles Scriber�s Sons
* Emotional Intelligence., D. Goleman, New York: Bantam.
* Inside the Brain: Revolutionary Discoveries of How the Mind Works., Kansas City, Mo: Andrews & McMeel.
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* Neurotransmitter Revolution: Serotonin, Social Behavior, and the Law., R. Masters & M. McGuire, Southern Illinois University Press.
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* Evaluation & Treatment of Sensory Processing Disorders By Bonnie Hanschu, OTR
* Sensory Defensiveness and Related Social/Emotion and Neurological Problems by Patricia Wilbarger Med, OTR, FAOTA, Julia Wilbarger
* Autism & Attention Deficit Disorder/Hyperactivity: a SENSORY PERSPECTIVE by Bonnie Hanschu, OR, 3415 East Sweetwater, Phoenix, Arizona 85032
* Focus on The Vestibular, Auditory, Visual Triad for Increased Treatment Effectiveness, Sheila M. Frick, OR/L, Steven J. Cool, Ph.D., FAOTA
* “Catch the Beat! The Power of Music as a Therapeutic Tool” , Dee Joy Coulter, EdD, Lois E. Hickman, MS, OTR, Concetta Tomaino, DA, MT-BC (301) 652-2682 FAX (301) 948-5512

Sensory Integration International
1602 Cabrillo Avenue, Torrance, CA 90501-2819 USA


* Sensory Defensiveness with Patricia Wilbarger, Med, OTR, video, PDP Press, Inc.