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SPD Sensory Processing Disorder:

Facts, Assumptions and Myths

Jacci Siebert

BSc (OT) Hons

Specialist Children’s OT

Advanced SI Practitioner & SI mentor

Sens.ations, Leicester, 7 th March 2012

SPD Sensory Processing Disorder : Facts, Assumptions and Myths Jacci Siebert BSc (OT) Hons Specialist Children’s

SPD is a barrier to engagement in OCCUPATION

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 people’s 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 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

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

What is SPD? • Previously referred to as DSI or Sensory Integration Dysfunction. • First described

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®

7 SENSES

7 SENSES  ‘Far’ senses ‘Near’ Senses • Taste (Gustatory) o Sight (Visual) • Touch (Tactile)

7 SENSES  ‘Far’ senses ‘Near’ Senses • Taste (Gustatory) o Sight (Visual) • Touch (Tactile)

‘Far’ senses

‘Near’ Senses

Taste (Gustatory)

o Sight (Visual)

Touch (Tactile)

o Sound (Auditory)

Vestibular

o Smell (Olfactory)

 

(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 .

Tactile + Proprioception = Somatosensory perception (body awareness) Vestibular + Proprioception = Movement sense and postural

Tactile + Proprioception

=

Somatosensory perception (body awareness)

Tactile + Proprioception = Somatosensory perception (body awareness) Vestibular + Proprioception = Movement sense and postural
Tactile + Proprioception = Somatosensory perception (body awareness) Vestibular + Proprioception = Movement sense and postural

Vestibular + Proprioception =

Movement sense

and postural control

Autonomic Nervous System

Autonomic Nervous System

Typical ‘Brain’

Sound, Sight, Taste Touch, Smell, Body Position sense, Movement Sense
Sound, Sight, Taste
Touch, Smell,
Body Position sense,
Movement Sense
Typical ‘Brain’ Sound, Sight, Taste Touch, Smell, Body Position sense, Movement Sense Response (timed and adapted
Response (timed and adapted to the environment)
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.

Five interrelated components that help to

explain how Sensory Integration occurs:

Sensory Registration

Orientation

Interpretation

Organization of a response

Execution of a response

Five interrelated components that help to explain how Sensory Integration occurs: • Sensory Registration • Orientation

What are the results of

Sensory Integration?

Self Regulation

The nervous system’s 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).

What are the results of Sensory Integration? • Self Regulation The nervous system’s ability to attain,

SPD ‘Brain’

Sensory Info
Sensory Info
Sensory seeker Sensory disregarder Sensory avoider Sensory sensitivity
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

Identifying Sensory Processing

Disorder

5-15 percent of general population (Miller, 2006) Sensory processing impacts on occupation SI trained therapist (typically OT) assesses client’s:

Sensory Discrimination Sensory Modulation Posture, co-ordination, balance, motor skills Praxis Visual spatial organisation

What does SPD look like?

Symptoms and Red Flags individuals experience sensations differently – more or less intensely, don’t 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.

What is the impact of SPD on

function?

Emotional regulation Social participation Play Learning Coping skills

What is the impact of SPD on function? • Emotional regulation • Social participation • Play

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.

Miller et al (2007) proposed Nosology for SPD

Sensory Processing Disorder (SPD) Sensory Modulation Disorder (SMD) -SOR -SUR -SS
Sensory
Processing
Disorder (SPD)
Sensory
Modulation
Disorder
(SMD)
-SOR
-SUR
-SS
Sensory-Based Motor Disorder (SBMD) Sensory Discrimination Disorder (SDD) -Dyspraxia -Postural Disorder -Visual -Auditory -Tactile -Vestibular -Proprioception
Sensory-Based Motor
Disorder (SBMD)
Sensory
Discrimination
Disorder (SDD)
-Dyspraxia
-Postural Disorder
-Visual
-Auditory
-Tactile
-Vestibular
-Proprioception
-Taste/smell

SOR = sensory overresponsivity SUR = sensory underresponsivity

SS

= sensory seeking

Diagram from Pre-school Sensory Scan for Educators by Carol Stock Kranowitz

Sensory Integration Disorder Sensory Sensory Modulation Disorder Sensory Discrimination Disorder (Sensory Jumbler) based Motor Disorder Sensory
Sensory Integration
Disorder
Sensory
Sensory Modulation
Disorder
Sensory
Discrimination
Disorder
(Sensory Jumbler)
based
Motor
Disorder
Sensory
Sensory
Sensory
Postural
Over-
Under-
Dyspraxia
Seeking
Disorder
responsivity
responsivity
(Sensory
(Sensory
(Sensory
(Sensory
(Sensory
Fumbler)
Craver)
Slumper)
Avoider)
Disregarder)

Sensory Profile

by Winnie Dunn PhD, OTR , FAOTA

This is a standardised caregiver questionnaire which seeks

to identify the

nature of the

child’s

sensory

processing

difficulties.

Mainly looks at sensory

modulation

Neurological

Behavioural Response Continuum

Threshold

Acting in ACCORDANCE

Acting to COUNTERACT

Continuum

with Threshold

Threshold

HIGH

Poor Registration

Sensory Seeking

(habituation)

Uninterested, Apathetic Dull affect Withdrawn “Overly tired” Self-absorbed

Active Continuously engaging Fidgety Excitable

 

Distractible

 

Hyperactive

Resistant to change Reliant on rigid rituals

LOW

(sensitization)

Sensitivity to Stimuli

Sensation Avoiding

Neurological

Behavioural Response Continuum

Threshold

Acting in ACCORDANCE

Acting to COUNTERACT

Continuum

with Threshold

Threshold

HIGH

(habituation)

Bystander

Seeker

Easy-going and not easily ruffled,

Enjoy going to firework displays,

have to be called several times to

make noises such as humming and

get their attention, miss signposts, may leave dirt on their face or hands, find scratches and bruises

whistling, order or cook spicy food, tend to touch people when talking to them, walk around barefoot, change

and don’t know how they got them,

daily routines to keep them

don’t notice clutter until someone

interesting.

points it out.

 

Distracted by sounds, startle easily, are bothered by fast changing images on TV, have precise ideas about clothing textures, repeatedly

Leave the room when a crowd starts to gather, like their surroundings clean and tidy, keep curtains or blinds drawn or partially drawn,

pick the same food in restaurants,

make narrow food choices, don’t like

LOW

prefer clean design in the home, select only a few chosen rides at

getting their hands mucky, select solitary leisure activities

(sensitization)

amusement parks.

Sensor

Avoider

Cited from “Living Sensationally” by Winnie Dunn

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 child’s life in 3 occupations central to

childhood: school, play, self care.

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 (Willbarger’s) 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

Treatment methods • Occupational therapy (and physiotherapy) using various approaches : sensory-motor, psychosocial, neuro- developmental, cognitive

Sensory Integration

Treatment Principles

Sensory Integration Treatment Principles  Creation of a therapeutic environment  Address underlying deficits in neural
  • 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 child’s 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 child’s inner drive and self direction.

  • To learn how to learn

  • Therapy must be fun

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 child’s success

  • Ensure physical safety

  • Arrange room to engage child

  • Foster therapeutic alliance

Recent OT-SI Effectiveness

Author

Design

Subjects

Studies

Age

Intervention

Outcome

range

(years)

Smith

ABAB

7 PDD or

8-19

5 sessions

Significant reduction in

2005

OT-SI vs

“Mental

per week of

self stimulatory

tabletop

retardation”

  • 30 minutes

behaviour

activities

Miller

OT-SI vs

24 SMD

3-11

  • 20 x 1 hour

Significant gains in

2007

activity

(15 ADHD,

sessions

individualised GAS,

protocol

1 Anxiety)

over 10

Attention,

vs no

weeks

Cognitive/social and

treatment

reduced electrodermal

responsivity ampitude

Pfeiffer

OT-SI vs

37 ASD

6-12

18 x 45 min

Significant positive

2011

fine-motor

sessions over 6 weeks

changes in GAS (sensory processing, motor skills and social functioning)

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

Efficacy of ASI Intervention (May Benson and Koomar 2010, Pfeiffer et al 2011) Evidence suggests that

Russet House School, Enfield (2005)

Therapy

Space

Mary Sheridan Centre, Lambeth (2004)

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.

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.

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

Reasoning Strategies • A SECRET (Miller, 2006) A – Attention S – Sensation E – Emotion

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

Local services: screening & referral to OT via, GP, HV, SENCo, Paediatrician, Midwife.

Independent Occupational Therapists www.cotss-ip.org.uk

Thank you for Listening

Thank you for Listening Contact details: jacci@sensoryjunction.co.uk

Contact details: jacci@sensoryjunction.co.uk

Thank you for Listening Contact details: jacci@sensoryjunction.co.uk

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. 2 nd 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.

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-

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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.

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.

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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.

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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

SPD red flags for: • Infants and toddlers ____ ____ ____ ____ ____ ____ ____ Problems

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

SPD red flags for: • Pre-schoolers ____ ____ ____ ____ ____ ____ Over-sensitive to touch, noises,

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

SPD red flags for: • Grade schoolers ___ ___ ___ ___ ___ ___ Over-sensitive to touch,

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

SPD red flags for: • Adolescents and adults ___ ___ ___ ___ ___ ___ ___ ___