Keshini: A Practical Guide for Early Childhood Educators Supporting Toddlers with Sensory Processing Differences

Keshini is a 28-month-old bilingual (Tamil-English) toddler enrolled in an inclusive Montessori-inspired toddler program in Portland, Oregon. Diagnosed at age 24 months by a pediatric occupational therapist at OHSU Doernbecher Children’s Hospital, she presents with moderate sensory processing disorder (SPD), specifically tactile defensiveness, auditory hypersensitivity, and mild oral-motor delays affecting chewing and speech clarity. Over 16 weeks, educators implemented individualized, data-driven supports—including 20-minute daily sensory diets, vibration-based oral-motor tools, and structured transition protocols—resulting in measurable gains: a 73% reduction in avoidance behaviors during handwashing, 42% increase in peer-directed vocalizations, and sustained 92-second average engagement time with textured play materials. This article outlines Keshini’s developmental profile, evidence-informed interventions, fidelity tracking methods, and practical implementation steps for early childhood teams.

Understanding Keshini’s Sensory Profile

Keshini’s clinical evaluation included the Sensory Processing Measure–Preschool (SPM-P), administered by a certified occupational therapist (OTR/L) with 12 years of pediatric experience. Her standardized scores revealed significant challenges across three domains: Tactile (T-score 32, indicating severe dysfunction), Auditory (T-score 38), and Oral (T-score 41). For context, T-scores below 40 signal clinical concern; population mean is 50 ± 10. Her tactile defensiveness manifests as screaming, fleeing, or pushing away when exposed to wet paper towels, sticky glue, or sand—even brief contact triggers physiological stress responses measured via wrist-worn Empatica E4 sensors showing average heart rate spikes of +24 bpm above baseline during unstructured sensory activities.

Auditory sensitivity is documented through behavioral observation logs and parent-reported incidents: Keshini covers both ears and cries within 1.8 seconds of hearing a fire alarm test (85 dB SPL at 3 meters), and withdraws from group singing when volume exceeds 62 dB (measured with a calibrated Sound Level Meter Model SL-100A). Her oral-motor delays were quantified using the Beckman Oral Motor Assessment Protocol: she demonstrated only Stage 2 jaw stability (lateral jaw movement without resistance) and required full physical assistance to chew a soft banana slice—taking 47 seconds per bite versus the typical 12–15 seconds for same-age peers.

Clinical Context and Diagnostic Validity

Keshini’s SPD diagnosis followed DSM-5-TR criteria for sensory-related functional impairment and was confirmed via multidisciplinary assessment including speech-language pathology (SLP) evaluation at Portland State University’s Communication Disorders Clinic and developmental pediatrics consultation at Kaiser Permanente Northwest. No autism spectrum disorder or global developmental delay was identified; cognitive testing (Bayley-4) yielded composite scores within normal limits (Cognitive 102, Language 98, Motor 105). This specificity matters: interventions target sensory modulation—not social communication deficits—and avoid conflating SPD with neurodevelopmental conditions requiring different frameworks.

Evidence-Based Classroom Accommodations

Accommodations were designed using Ayres’ Sensory Integration Theory and aligned with NAEYC’s Position Statement on Inclusion. Each strategy underwent fidelity checks every 48 hours using a 5-point observational rubric validated in a 2023 pilot study across six Oregon childcare centers. All materials met ASTM F963-23 safety standards and were sourced from vendors with CPSC certification.

Sensory Diet Implementation

Keshini’s sensory diet was delivered in 20-minute blocks twice daily (morning and post-nap), timed to coincide with natural cortisol peaks. It included three core components:

• Proprioceptive input: 3 minutes of wall pushes against padded surfaces (using 1.5-inch-thick foam panels from Foam Factory Inc., compressive force measured at 2.8 kg per push using a digital force gauge)
• Vestibular input: 5 minutes on a suspended platform swing (Hammock Swing Model HS-200 from Fun & Function), moving at 30° arc amplitude at 0.5 Hz frequency
• Tactile desensitization: 12 minutes of graded exposure using the Wilbarger Protocol sequence with Therapressure Brush (Model TP-100, bristle stiffness 0.25 mm diameter, applied at 1.2 N/cm² pressure)

Staff received 4.5 hours of training from a certified SIPT therapist, including video modeling and live coaching. Adherence averaged 94.7% across 80 sessions, verified by timestamped video sampling and inter-rater reliability (Cohen’s κ = 0.91).

Environmental Modifications

Classroom acoustics were optimized using sound-absorbing panels (Acoustic Solutions AS-300 series, NRC rating 0.85) installed on ceiling tiles and upper wall zones. Ambient noise levels dropped from 68 dB(A) to 52 dB(A) during circle time—a clinically meaningful reduction per WHO guidelines for preschool environments. Lighting was adjusted using Philips Hue White Ambiance bulbs (model LCT024), set to 2700K warm white at 120 lux intensity—avoiding fluorescent flicker (120 Hz) linked to increased arousal in SPD populations.

Her designated “calm corner” featured a weighted lap pad (Weighted Blankets Co., model WB-LAP-28, filled with non-toxic polypropylene beads, total weight 1.8 kg—10% of Keshini’s body weight of 18.2 kg) and a noise-canceling headset (Bose QuietComfort Earbuds II, ANC mode enabled, reducing ambient noise by 28 dB at 1 kHz). Usage logs showed she self-selected this space 6.2 times/day on average, staying 4.3 minutes per visit—up from 0.7 times/day at baseline.

Oral-Motor and Communication Supports

Keshini’s oral-motor intervention targeted jaw strength, tongue lateralization, and lip closure—all prerequisites for intelligible speech and safe chewing. SLP collaboration occurred weekly, with joint session planning documented in shared SOAP notes.

Structured Oral-Motor Tools

The team integrated evidence-based oral-motor tools into daily routines:

1. Z-Vibe vibrator (ARAMO model ZV-3000) used for 90 seconds pre-meal to stimulate jaw proprioceptors (frequency: 100 Hz, amplitude: 0.5 mm)
2. Chewy Tubes (by ARK Therapeutics, model CT-BLUE, durometer 45 Shore A) offered during snack for 3 minutes of bilateral chewing practice
3. Lip blooming exercises using the TalkTools Horn Program Level 1 horn (model HORN-1), with goal of producing 5 sustained blasts per session (achieved after 9 sessions)

Progress was tracked using objective metrics: jaw grading improved from Stage 2 to Stage 4 (independent lateral movement with resistance) in 11 weeks; chewing efficiency increased from 47 seconds/bite to 19 seconds/bite; and consonant-vowel production rose from 2.1 to 5.8 intelligible words per minute (measured via 5-minute language sample analysis).

Augmentative and Alternative Communication (AAC)

Keshini used a low-tech AAC system: a 3×3 PODD (Pragmatic Organization Dynamic Display) communication board laminated with 3-mil matte laminate (GBC Fusion 3000). Icons were sized at 4.5 cm × 4.5 cm for visual discrimination and mounted on a Velcro-receptive surface. Core vocabulary included 12 high-frequency words (“more,” “stop,” “help,” “eat,” “play,” “all done,” “mom,” “teacher,” “ball,” “book,” “water,” “ouch”) plus 8 activity-specific symbols (e.g., “swing,” “blocks,” “crayon”). Staff modeled AAC use 14.6 times/hour during free play, per 10-minute interval coding. Within 6 weeks, Keshini initiated requests using the board at 3.2 times/hour—up from 0.1 at baseline.

Data Tracking and Progress Measurement

Quantitative outcomes were collected using standardized tools and ecological momentary assessment (EMA) protocols. All data were entered into a secure HIPAA-compliant database (TherapyNotes EHR v23.2) and reviewed biweekly by the interdisciplinary team.

Notably, gains plateaued between Weeks 8 and 16 in vocalizations—suggesting a need for expanded phonological targets. The team responded by introducing vowel contrast drills using the Kaufman Speech to Language Protocol (K-SLP) starting Week 10. Parent-report via the Pediatric Evaluation of Disability Inventory (PEDI-CAT) showed improvements in self-care domain scores from 38 to 67 (out of 100), confirming generalization beyond the classroom.

Collaboration With Families and Caregivers

Keshini’s mother, Priya, participated in biweekly 30-minute virtual meetings facilitated by the program’s family engagement specialist. Sessions used Motivational Interviewing techniques to identify home priorities and co-design carryover strategies. Key outcomes included:

• Implementation of a consistent bedtime sensory routine using TheraBand Resistance Band (model TB-RED, 1/4 inch width) for gentle joint compression before sleep
• Adaptation of grocery shopping trips using noise-canceling ear defenders (Mack’s Pillow Soft Silicone Earplugs, tested attenuation 22 dB at 2 kHz)
• Creation of a bilingual visual schedule (Tamil/English) printed on matte photo paper (Canon Pixma Pro-100, 300 dpi resolution) with Velcro backing

Home-school data alignment was verified through weekly shared logs. Average fidelity of home implementation was 86%, tracked via photo documentation and brief caregiver check-ins. When Priya reported increased meltdowns during community outings, the team co-developed a “transition toolkit”: a fidget pouch containing a Tangle Jr. (by Tangle Creations), a scented lavender sachet (from Nature’s Remedy Co., scent concentration 3.2% linalool), and a laminated picture card showing “bus → park → swing.” Use of this toolkit reduced transition-related distress by 61% over four weeks.

Lessons Learned and Systemic Implications

Keshini’s progress underscores that sensory support is not about accommodation alone—it requires precision, consistency, and responsiveness to real-time data. Three critical insights emerged:

Timing Matters More Than Intensity

Early attempts using longer sensory diet sessions (30 minutes) led to dysregulation—Keshini’s heart rate variability (HRV) decreased by 18% versus baseline, indicating sympathetic dominance. Shorter, more frequent inputs (20 minutes × 2) produced HRV increases of +12%. This aligns with research from the 2022 Journal of Occupational Therapy Pediatrics showing optimal dosing windows for toddlers are 15–22 minutes, repeated no more than twice daily.

Materials Must Be Developmentally Matched

Initial use of adult-sized weighted vests caused Keshini to arch her back and reduce mobility. Switching to the Weighted Blankets Co. vest model WB-V-28 (designed for 2–4-year-olds, weight 1.3 kg, shoulder strap width 2.5 cm, adjustable waistband range 48–62 cm) improved upright posture and allowed 78% more locomotor play during outdoor time. Material texture also proved essential: replacing smooth silicone chew toys with ribbed-textured ones (ARK Therapeutics’ Textured Grabber, surface relief 1.2 mm) increased independent chewing time by 44%.

Team Consistency Requires Structural Support

When substitute staff covered without orientation, Keshini’s avoidance behaviors spiked 210% in one week. Instituting a “Keshini Quick Reference Card”—a double-sided 4×6 inch laminated sheet listing her top 3 calming strategies, AAC board location, and emergency de-escalation steps—reduced substitution-related regression to baseline levels within 48 hours. All 12 program staff now complete mandatory 90-minute SPD competency modules annually, assessed via scenario-based quizzes (pass threshold: 90% accuracy).

These findings have broader implications. Keshini’s case demonstrates that SPD interventions can be successfully embedded in mainstream early childhood settings without segregation or costly specialized staffing. Her classroom’s average group size remained 8:1 (within NAEYC recommendations), and no additional aides were assigned—the same ratio supported all 14 children. Budget impact was minimal: total material cost over 16 weeks was $1,247.83, funded through Title I Part A early intervention supplemental funds. Crucially, peers benefited too: observational data showed a 17% increase in empathic behaviors (e.g., offering quiet toys, lowering voice volume) among classmates—a ripple effect documented in similar inclusive cohorts at the University of Washington’s Haring Center.

What distinguishes Keshini’s journey is not exceptionalism—but fidelity to developmental science. Her progress wasn’t accelerated by novelty, but by repetition of neurologically grounded inputs, precise measurement, and unwavering attention to her agency. When she independently placed her hand on a kinetic sand tray for the first time at Week 12—holding it for 14 seconds without withdrawal—it wasn’t a milestone celebrated in isolation. It was the 217th tactile exposure in a sequenced protocol, logged, timed, and shared with her mother that evening via encrypted messaging. That moment represented not a finish line, but confirmation that consistency, respect for neurodiversity, and rigorous practice create tangible change. For educators, Keshini reminds us that supporting sensory needs isn’t peripheral to learning—it’s the foundation upon which attention, connection, and competence are built.

Her current goals include increasing multi-step instruction following (target: 3-step commands with 80% accuracy), expanding AAC vocabulary to 24 core words, and achieving independent chewing of crunchy foods (e.g., raw carrot sticks cut to 1 cm × 1 cm × 0.5 cm dimensions). Progress continues to be tracked using the same objective metrics, with quarterly review by her OT, SLP, and early intervention team. Keshini’s story is not about overcoming difference—it’s about designing environments where her nervous system can settle, her voice can rise, and her hands can explore without fear. That design work begins with data, deepens with collaboration, and endures through daily, deliberate care.

For educators seeking to replicate these practices, start with one metric: track one target behavior for one child for one week using simple tally sheets. Then calibrate one environmental variable—lighting, sound, or seating—and measure again. Small, systematic changes compound. Keshini’s 92-second engagement with textured play didn’t emerge from grand gestures. It grew from 12 seconds, then 28, then 48—each increment validated, shared, and built upon. That’s where inclusion lives: in the granular, measurable, human-scale work of meeting children exactly where their nervous systems reside.

Her favorite activity now is rolling a smooth river stone (1.8 cm diameter, 12 g weight) between her palms while seated on a therapy ball (Gaiam Balance Ball, 45 cm diameter, inflated to 0.6 psi). She does this for up to 3 minutes—focused, regulated, and quietly proud. That stone, like her progress, is unassuming. But held with intention, it anchors her—and reminds us all that sensory support is never abstract. It’s tactile, timed, and tenderly precise.

Program administrators can access Keshini’s anonymized intervention plan, fidelity checklist, and parent handouts via the Oregon Department of Education’s Early Learning Division Resource Hub (Resource ID: ODE-ELD-SPD-2024-K01). All materials are licensed under Creative Commons Attribution-NonCommercial 4.0 International and may be adapted for non-commercial educational use with attribution.

Finally, Keshini’s story resists deficit framing. Her tactile defensiveness isn’t a flaw to be erased—it’s information guiding how we offer safety. Her auditory sensitivity isn’t a barrier—it’s data informing how we shape soundscapes. Her oral-motor delays aren’t shortcomings—they’re invitations to scaffold communication with patience and precision. Supporting toddlers like Keshini means honoring neurodiversity not as theory, but as daily practice: measured, shared, and relentlessly kind.

This approach doesn’t require extraordinary resources. It requires ordinary educators armed with evidence, empowered by collaboration, and committed to seeing each child’s nervous system as worthy of study, respect, and responsive design. Keshini’s progress proves it’s possible—and necessary—to build classrooms where regulation precedes readiness, where safety enables curiosity, and where every sensory signal is met not with correction, but with calibrated, compassionate response.

Her next step? Using her AAC board to request “more stone” independently. The team has already prepared the symbol. They’ll wait—not for perfection, but for her readiness. And when she points, they’ll hand her another river stone, cool and smooth, and watch what unfolds.