jacci siebert spd keynote sens.ations 2012leicester
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Jacci Siebert SPD Keynote Sens.ations 2012LeicesterTRANSCRIPT
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SPD
Sensory Processing Disorder:
Facts, Assumptions and Myths
Jacci Siebert
BSc (OT) Hons
Specialist Childrens OT
Advanced SI Practitioner & SI mentor
Sens.ations, Leicester, 7th March 2012
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OT - art and science of helping people do the day-to-day activities that are important to them despite impairment, disability, or handicap.
Occupation in occupational therapy refers to all the activities that occupy peoples time and give meaning to their lives. (Neistadt & Blesedell Crepeau, 1998).
Occupational deprivation - opportunity to engage in occupations.
Occupational justice principles all people helped to live a life filled with meaningful and health-promoting occupation.
SPD is a barrier to engagement in
OCCUPATION
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SPD facts SPD is a complex disorder of the brain that affects developing children
and adults.
Parent surveys, clinical assessments, and laboratory protocols exist to identify children with SPD.
At least 1 in 20 people in the general population may be affected by SPD. In children who are gifted and those with ADHD, Autism, and fragile X
syndrome, the prevalence of SPD is much higher than in the general population.
Studies have found a significant difference between the physiology of children with SPD and children who are typically developing.
Studies have found a significant difference between the physiology of children with SPD and children with ADHD.
SPD has unique sensory symptoms that are not explained by other known disorders.
Heredity may be one cause of the disorder. Laboratory studies suggest that the sympathetic and parasympathetic
nervous systems are not functioning typically in children with SPD.
Preliminary research data support decades of anecdotal evidence that OT is an effective intervention for treating the symptoms of SPD.
from Sensational Kids: Hope and Help for Children With Sensory Processing Disorder (SPD ) p. 249-250 by Lucy Jane Miller, PhD, OTR
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What is SPD?
Previously referred to as DSI or Sensory Integration Dysfunction.
First described and studied in the 1960s by A. Jean Ayres, an occupational therapist,
educational psychologist and neuroscience
researcher.
Causes: hereditary? prematurity?
A.Jean Ayres
1920-1988
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The term Sensory Integration can refer to:
Ayres theory of normal development
A process of evaluating Sensory Processing Disorders (SPD) so we can better understand
the behaviour we see in individuals.
A specific approach to intervention Ayres Sensory Integration
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7 SENSES
Far senses
o Sight (Visual) o Sound (Auditory) o Smell (Olfactory)
Near Senses
Taste (Gustatory)
Touch (Tactile)
Vestibular (movement and balance sense)-provides
information about where the head and body are in space and in relation to the earth's surface.
Proprioception (joint/muscle sense)-provides information about
where body parts are and what they are doing .
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Tactile +
Proprioception
=
Somatosensory
perception
(body awareness)
Vestibular +
Proprioception
=
Movement sense
and postural
control
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Autonomic Nervous System
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Typical Brain
Sound, Sight, Taste
Touch, Smell,
Body Position sense,
Movement Sense
Response
(timed and adapted
to the environment)
The brain makes sense of the sensory input we gain from the
environment and designs & implements an appropriate response.
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Five interrelated components that help to
explain how Sensory Integration occurs:
Sensory Registration
Orientation
Interpretation
Organization of a response
Execution of a response
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What are the results of
Sensory Integration?
Self Regulation
The nervous systems ability to attain, maintain, and change levels of arousal or alertness.
Motor Planning
The process of deciding what your body has to do
and then doing it (praxis).
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SPD Brain
Sensory Info
Sensory seeker
Sensory disregarder
Sensory avoider
Sensory sensitivity
Problems interpreting, modulating and discriminating sensory
inputs:
Sensory defensiveness Poor sensory awareness
May or may not contribute to sensory distortions
(receptor/brainstem/cortical problem):
Auditory distortions (hyperacuisis, tinnitus, misophonia) Vertigo Visual distortions (prosopagnosia, hallucinations) Synaesthesia
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Identifying Sensory Processing
Disorder
5-15 percent of general population (Miller, 2006)
Sensory processing impacts on occupation
SI trained therapist (typically OT) assesses clients:
Sensory Discrimination
Sensory Modulation
Posture, co-ordination, balance, motor skills
Praxis
Visual spatial organisation
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What does SPD look like?
Symptoms and Red Flags individuals experience sensations differently more or less intensely, dont get sensory messages right. Sensory problems are chronic and disrupt everyday life (Miller, 2006).
Confusion about symptoms commonly result in other diagnoses being given (Oppositional Defiant
Disorder, Failure to Thrive, Infantile Annorexia)
(Miller, 2006)
Co-morbidity of SPD ADHD, ASD
The road to an SPD diagnosis begins with a physician in order to rule out other neurological
conditions.
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What is the impact of SPD on
function?
Emotional regulation
Social participation
Play
Learning
Coping skills
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Sensory Processing Problems
Sensory Registration Deficits Registration deficits limit the amount of sensation that the individual
detects, thereby limiting relevant information from their perception.
Registration is the initial point of perception from the sensory organs.
Sensory Modulation Modulation deficits affect the way the individual perceives the
intensity of the stimuli, thereby altering the ability to cope with,
tolerate, or orient to the information, especially in the presence of
stress, unexpected sensations, or in high stimulus environments.
Sensory Discrimination Discrimination deficits lead to inadequate or distorted perceptions
due to slow or inaccurate information processing about the details of
the sensory input such as shape, size, location, quantity and quality.
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Miller et al (2007) proposed Nosology for SPD
Sensory Processing
Disorder (SPD)
Sensory Modulation
Disorder (SMD)
-SOR -SUR -SS
Sensory-Based Motor Disorder (SBMD)
-Dyspraxia -Postural Disorder
Sensory Discrimination Disorder (SDD)
-Visual
-Auditory
-Tactile
-Vestibular
-Proprioception
-Taste/smell SOR = sensory overresponsivity SUR = sensory underresponsivity SS = sensory seeking
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Diagram from Pre-school Sensory Scan for Educators by Carol Stock Kranowitz
Sensory Integration Disorder
Sensory Modulation Disorder
Sensory Over-
responsivity (Sensory Avoider)
Sensory Under-
responsivity (Sensory
Disregarder)
Sensory Seeking
(Sensory Craver)
Sensory Discrimination
Disorder (Sensory Jumbler)
Sensory based Motor
Disorder
Postural Disorder (Sensory Slumper)
Dyspraxia (Sensory Fumbler)
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Sensory Profile by Winnie Dunn PhD, OTR , FAOTA
This is a standardised
caregiver
questionnaire
which seeks
to identify the
nature of the
childs sensory
processing
difficulties. Mainly looks
at sensory
modulation
Neurological
Threshold
Continuum
Behavioural Response Continuum
Acting in ACCORDANCE
with Threshold
Acting to COUNTERACT
Threshold
HIGH
(habituation)
Poor Registration Uninterested, Apathetic
Dull affect
Withdrawn
Overly tired
Self-absorbed
Sensory Seeking Active
Continuously engaging
Fidgety
Excitable
LOW
(sensitization)
Distractible
Hyperactive
Sensitivity to Stimuli
Resistant to change
Reliant on rigid rituals
Sensation Avoiding
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Neurological
Threshold
Continuum
Behavioural Response Continuum
Acting in ACCORDANCE
with Threshold
Acting to COUNTERACT
Threshold
HIGH
(habituation) Bystander Easy-going and not easily ruffled,
have to be called several times to
get their attention, miss signposts,
may leave dirt on their face or
hands, find scratches and bruises
and dont know how they got them, dont notice clutter until someone points it out.
Seeker Enjoy going to firework displays,
make noises such as humming and
whistling, order or cook spicy food,
tend to touch people when talking to
them, walk around barefoot, change
daily routines to keep them
interesting.
LOW
(sensitization)
Distracted by sounds, startle easily,
are bothered by fast changing
images on TV, have precise ideas
about clothing textures, repeatedly
pick the same food in restaurants,
prefer clean design in the home,
select only a few chosen rides at
amusement parks.
Sensor
Leave the room when a crowd starts
to gather, like their surroundings
clean and tidy, keep curtains or
blinds drawn or partially drawn,
make narrow food choices, dont like getting their hands mucky, select
solitary leisure activities
Avoider Cited from Living Sensationally by Winnie Dunn
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The Aim of OT with children with
SPD
Reframe the observable behaviour using sensory glasses child is often then seen in a more positive light.
Provide a toolbox of sensory related strategies for home and school.
Teach reasoning strategies to parents, carers or teachers so that tasks, environments, relationships
can be modified for better functioning.
Direct therapy programme designed to improve quality of childs life in 3 occupations central to childhood: school, play, self care.
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Treatment methods
Occupational therapy (and physiotherapy) using various approaches : sensory-motor, psychosocial, neuro-developmental, cognitive and motor learning approaches.
Occupational therapy using sensory stimulation and Sensory Diets: Henry OT toolbox
Alert programme
Therapressure (Willbargers) Therapeutic Listening Programme
Weighted or pressure vests
Therapy balls as seat alternative
Occupational therapy using a Sensory Integration Approach (OT:SI): Ayres Sensory Integration intervention or ASI
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Sensory Integration
Treatment Principles
Creation of a therapeutic environment
Address underlying deficits in neural and sensory processing
See movement, think sensory
Provide planned and controlled sensory inputs designed to childs specific needs
Elicit an adaptive response to environmental demand
Grade activities from simple to complex
Use a child centred approach
Use non-directive purposeful activities
Balance of facilitation and inhibition
Encourage active participation
Capitalise on the childs inner drive and self direction.
To learn how to learn
Therapy must be fun
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Ayres SI Fidelity Tool (Parham et al, 2007)
Structural elements
Professional background
Clinical experience
Room set up
Type of equipment
Process elements
Provide sensory opportunities
Provide just-right challenge
Collaborate on activity choice
Guide self organisation
Support optimal arousal
Create play context
Maximise childs success
Ensure physical safety
Arrange room to engage child
Foster therapeutic alliance
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Recent OT-SI Effectiveness
Studies Author Design Subjects Age range
(years)
Intervention Outcome
Smith
2005
ABAB
OT-SI vs
tabletop
activities
7 PDD or
Mental retardation
8-19 5 sessions
per week of
30 minutes
Significant reduction in
self stimulatory
behaviour
Miller
2007
OT-SI vs
activity
protocol
vs no
treatment
24 SMD
(15 ADHD,
1 Anxiety)
3-11 20 x 1 hour
sessions
over 10
weeks
Significant gains in
individualised GAS,
Attention,
Cognitive/social and
reduced electrodermal
responsivity ampitude
Pfeiffer
2011
OT-SI vs
fine-motor
37 ASD 6-12 18 x 45 min
sessions
over 6
weeks
Significant positive
changes in GAS
(sensory processing,
motor skills and social
functioning)
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Efficacy of ASI Intervention (May Benson and Koomar 2010, Pfeiffer et al 2011)
Evidence suggests that SI may result in positive
outcome in the areas of:
Sensorimotor skills
Motor planning
Socialization
Attention
Behavioral regulation
Reading and reading related skills
Individualized goals
Autistic behaviors
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Therapy
Space
Russet House School, Enfield (2005)
Mary Sheridan Centre, Lambeth (2004)
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Early diagnosis prevents long term
issues developing
Plasticity remains throughout the lifespan, so its never too late, but a more optimal outcome is gained with early diagnosis and intervention.
Who benefits from screening for SPD? - Fussy babies with feeding and sleeping issues
- Infants with atypical developmental milestones
- All 0-5 year olds with suspected ASD and ADHD.
- Majority of children with ASD
- Majority of children with ADHD
- Children & adults with motor learning and coordination difficulties, balance and muscle fatigue issues, fine motor and handwriting difficulties.
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What happens when intervention is
not available?
SMD - secondary mental health complications, depression, borderline personality
disorder, bipolar mood disorder,
obsessive compulsive disorder.
- possible drug and alcohol addiction.
- antisocial behaviour.
- relationships in family are stressed.
SBMD - poor self esteem, poor achievement despite clear strengths, social rejection.
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Reasoning Strategies
A SECRET (Miller, 2006)
A Attention S Sensation E Emotion C Culture R Relationship E Environment T Task
Cited from Sensational Kids: Hope and Help for Children with Sensory Processing Disorder (SPD) by Lucy Jane Miller, Ph.D., OTR
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Support available
Books The Out-of-Sync child by Carol Stock Kranowitz
Sensational Kids by Lucy Jane Miller
Baby Sense by Megan Faure & Ann Richardson
Websites www.sensoryintegration.org.uk
www.spdfoundation.net
www.thespiralfoundation.org
Local services: screening & referral to OT via, GP, HV, SENCo, Paediatrician, Midwife.
Independent Occupational Therapists www.cotss-ip.org.uk
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Thank you for Listening
Contact details: [email protected]
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References
Arbesman, M. & Lieberman, D. (2010) Methodology for the systematic reviews of occupational therapy for children and adolescents with difficulty processing and
integration sensory information. American Journal of Occupational Therapy, 64 (3), 368-
374.
Bagatell, N., Mirigliani, G., Patterson, C., Reyes, Y. & Test, L. (2010) Effectiveness of therapy ball chairs with autism spectrum disorders. American Journal of Occupational
Therapy, 64 (6), 895-903.
Ben-Sasson, A., Hen, L. Fluss, R. Cermak, S.A. Engel-Yeger, B. & Gal, E. (2009) A meta-analysis of sensory modulation symptoms in individuals with autistic spectrum
disorder. Journal of Autism and Developmental Disorders, 39(1), 1-11
Ben-Sasson, A., Cermak, S.A., Orsmond, G.I. & Tager-Flusberg, H. (2007) Extreme sensory modulation behaviours in toddlers with autism spectrum disorders. American
Journal of Occupational Therapy, 61 (5), 584-592.
Brown, N.B. & Dunn, W. (2010) Relationship between context and sensory processing in children with autism. American Journal of Occupational Therapy, 64 (3) 474-483.
Bundy, A.C., Shia, S., Qi, L. & Miller, L.J. (2007) How does sensory processing dysfunction affect play? American Journal of Occupational Therapy, 61(2), 201-208.
Bundy, A.C., Murray, E. and Lane, S. (2002) Sensory Integration: Theory and Practice. 2nd edition. Philadelphia: FA Davies Co.
Case-Smith, J. & Bryan, T. (1999) The effects of occupational therapy with sensory integration emphasis on preschool-age children with autism. American Journal of
Occupational Therapy, 53(5), 489-497.
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Gere, D.R., Capps, S.C., Mitchell, D.W. & Grubbs, E. (2009) Sensory sensitivities of gifted children. American Journal of Occupational Therapy, 63(3), 288-295.
Lane, S.J. & Schaaf, R.C. (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity: Implications for sensory-based occupational therapy for children
and adolescents. American Journal of Occupational Therapy, 64 (3), 375-390.
Lawlor, M.C. (2003) The significance of being occupied: The social construction of childhood occupations. American Journal of Occupational Therapy, 57(4), 424-434
Mailloux, Z., Mulligan, S., Smith Roley, S., Blanche, E., Cermak, S., Coleman, G.G., Bodison, S. & Lane, C.J. (2011) Verification and clarification of patterns of sensory
integrative dysfunction. American Journal of Occupational Therapy, 65 (2), 143-151.
May-Benson, T.A. & Koomar, J.A. (2010) Systematic review of the research evidence examining the effectiveness of interventions using a sensory integrative approach for
children. American Journal of Occupational Therapy, 64 (3), 403-414.
May-Benson, T.A., Koomar, J.A. & Teasdale, A. (2009) Incidence of pre, peri-, and post-natal birth and developmental problems of children with sensory processing disorder and
children with autism spectrum disorder. Frontiers in Integrative Neuroscience, 3 (31), 1-
12.
Miller, L.J., Coll, J.R. & Schoen, S.A. (2007) A randomized controlled pilot study of the effectiveness of occupational therapy for children with sensory modulation disorder.
American Journal of Occupational Therapy, 61 (2), 228-238.
Miller, L.J., Anzalone, M.E., Lane, S.J., Cermak, S.A. & Osten, E.J. (2007) Concept evolution in sensory integration: a proposed nosology for diagnosis. American Journal of
Occupational Therapy, 61 (2), 135-140.
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Parham, L.D., Smith Roley, S., May-Benson, T.A., Koomar, J., Brett-Green, B., Burke, J.P., Cohn, E.S., Mailloux, Z., Miller, L.J. & Schaaf, R.C. (2011) Development of a fidelity
measure for research on the effectiveness of the Ayres sensory integration
intervention. American Journal of Occupational Therapy, 65 (2), 133-142.
Pfeiffer, B.A., Koenig, K., Kinnealey, M., Sheppard, M. & Henderson, L. (2011) Effectiveness of sensory integration interventions in children with autism spectrum
disorders: A pilot study. American Journal of Occupational Therapy, 65 (1), 76-85.
Schaaf, R.C., & Nightlinger, K.M. (2007) Occupational therapy using a sensory integrative approach: A case study of effectiveness. American Journal of Occupational
Therapy, 61 (2), 239-246.
Schaaf, R.C. & Smith Roley, S.(2006) Sensory Integration: Applying clinical reasoning to practice with diverse populations. Austin, Texas. Pro-ed, Inc.
Schilling, D.L., Washington, K., Billingsley, F.F. & Deitz, J. (2003) Classroom seating for children with attention deficit hyperactivity disorder: Therapy balls versus chairs.
American Journal of Occupational Therapy, 57 (5), 534-541.
Smith, S.A., Press, B., Koenig, K.P. & Kinnealey, M. (2005) Effects of sensory integration intervention of self-stimulating and self-injurious behaviour. American Journal of
Occupational Therapy, 59 (4), 418-25.
Stephenson, E.A. & Chesson, R.A. (2008) 'Always the guiding hand: parents' accounts of the long-term implications of developmental coordination disorder for their children &
families. Child: Care, Health and Development, 34 (3), 335-343.
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SPD red flags for:
Infants and toddlers ____ Problems eating or sleeping
____ Refuses to go to anyone but me
____ Irritable when being dressed; uncomfortable in clothes
____ Rarely plays with toys
____ Resists cuddling, arches away when held
____ Cannot calm self
____ Floppy or stiff body, motor delays
from www.spdfoundation.net
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SPD red flags for:
Pre-schoolers ____ Over-sensitive to touch, noises, smells, other people
____ Difficulty making friends
____ Difficulty dressing, eating, sleeping, and/or toilet training
____ Clumsy; poor motor skills; weak
____ In constant motion; in everyone else's face and space
____ Frequent or long temper tantrums
from www.spdfoundation.net
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SPD red flags for:
Grade schoolers ___ Over-sensitive to touch, noise, smells, other people
___ Easily distracted, fidgety, craves movement; aggressive
___ Easily overwhelmed
___ Difficulty with handwriting or motor activities
___ Difficulty making friends
___ Unaware of pain and/or other people
from www.spdfoundation.net
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SPD red flags for:
Adolescents and adults ___ Over-sensitive to touch, noise, smells, and other people
___ Poor self-esteem; afraid of failing at new tasks
___ Lethargic and slow
___ Always on the go; impulsive; distractible
___ Leaves tasks uncompleted
___ Clumsy, slow, poor motor skills or handwriting
___ Difficulty staying focused
___ Difficulty staying focused at work and in meetings
from www.spdfoundation.net