Occupational Therapy &

Speech and language Therapy Lenses on Assessment

Jenny Jones Occupational Therapist Julie Mullis Speech and Language Therapist

Clinical leads for ASD ServicesCardiff and the Vale University Health Board

Aims

To have a greater understanding of Sensory Processing and ASD

To explain the valuable role OT and SLT have in the assessment and diagnosis of complex children

To outline the benefits of joint working

Sensory – Perceptual Atypicalities and ASD

“It is estimated that 90% of individuals with ASD have some abnormality of sensory and perceptual functioning and considered by some as CORE FEATURES”

(Geschwind 2009)

How does that look ?

ASDAtypical

Sensory & Perceptual

90%

Sensory Processing Disorders

70-80% Synaesthesia Sensory distortions Sensory tune outs Sensory overload Overselectivity Perceptual dysfunction Sensory modulation

What are Sensory Processing Disorders?

Effects of poor sensory modulation on learning and behaviour

Under- Normal Over-Reactivity Sensory Modulation Reactivity

Under-Arousali.e. misses non-verbal cues,

slow affective responses

Over-Arousali.e. over-reacts to non- verbal

cues, anxious, too alert

Impaired Social BehaviourNeeds large amount of stimulation for arousal

Must attend to all stimuli asmuch as possible

“Spacey” & “Slow” Distractible & FragmentedDefective Attending Behaviouri.e. fails to look, listen, process,

and remember

Learning is impaired

A Sensory hypothesis to Autism…..New or just the “in thing” ?

1943- Kanner rejected a sensory hypothesis1949 – Bergman and Escalona offered the first version of a sensory hypothesis“The child's need to protect himself or herself from the sensory onslaught resulted in developmental distortions that eventually led to the symptoms that Kanner had first described”

Main hypotheses concerning Autism ….60s and 70s

Specific sensory dysfunctions and their affects on motoric-social and cognitive functioning in Autism were recognised and empirical studies began…..

Still current today ………

Current clinical and treatment literature treats sensory dysfunction as an established core deficit in autism, with a theoretical focus on possible abnormalities in subcortical neural systems.

Rogers & Ozonoff 2005

“The objective of therapy for the autistic child is to improve the sensory processing so that more sensations will be effectively ‘registered’ and modulated and to encourage the child to form simple adaptive responses as a means of helping him learn and organise his behaviour”

Ayres 1979

Native Experts..90s

The last decade……Research studies on sensory processing

and ASD 2002 Baranek 2005 Rogers and Ozonoff 2006 Kern et al 2006 Adamson, O’Hare and Graham 2007 Kern et al 2007 Tomchek and Dunn 2007 Ben-Sasson et al 2010 Tomchek And the list goes on……………

Occupational Therapy Assessment Sensory processing functions Developmental play and interactions with

environment Motor planning/praxis and sequencing Postural motor control Bilateral integration Gross and fine motor skills Visual motor integration Prewriting and writing skills Functional abilities in different daily living activities

Why have an Occupational Therapist on Diagnostic and Assessment teams?

A detailed assessment of atypical sensory behaviours helps to distinguish whether a child's symptoms result from SPD, autism or other co-morbid disorders

Sensory integration approach provides an alternative explanation for behaviours

Accurate diagnosis = appropriate intervention Sensory processing disorders may represent

another core diagnostic criterion ASD-DSM-V

Play Observations Observations

SLT Observations

Not turning to nameNot looking to mum for help with clothes discomfortDevelopmental delayNo intentional communication – growlsPoor awareness of environment and other toys around him.No exploratory or object play.No enjoyment from parental interaction and sharing of toy

OT Observations

Poor registration to the turtle, Possible dysregulation by the singing and flashing of the toyInterested in string of turtle not the turtle.Praxis- not sure what to do with the turtle?Clawing at clothes, hands often fisted or looking at them flicking – tactile defensive? visual seeker? Biting clothes, hitting headDistracted/distressed by fathers video game- auditory?

PLAYChild’s main Occupation

Registration

Modulation Praxis ideation

Object / Exploratory

Play

RelationalPlay /

Constructional

SensorimotorPlaySocial Play

Symbolic PlayFunctional Play

Principles of Assessment for Speech and Occupational Therapy

On going process Skilled observations essential Observed in at least 2 different settings, over

several visits and with a variety of people Assessment of child's sensory profile essential Detailed understanding of myriad of internal

and external mechanisms that will influence child's communication and occupations

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