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SENSORY PROCESSING
By Louise Williams Dip COT MBAOT PGCSI HCPC Reg
January 2018
Aims of the session today
• To clarify the terminology used
• To discuss the range of interventions used to address sensory issues
• To discuss current issues particularly relating to SEND Tribunals
What is Occupational Therapy?
Occupational Therapy enables people to participate in daily life to improve their health and wellbeing. Daily life is made up of many activities (or occupations).
Occupations for children or young people may include self-care (getting ready to go out, eating a meal, using the toilet), being productive (going to nursery or school, or volunteering) and leisure - playing with friends or doing hobbies.
(Royal College of Occupational Therapists 2017)
Confusing Terminology!
• Sensory Processing
• Sensory Integration
• Sensory Modulation
• Sensory Regulation
• Sensory Over Responsiveness
• Sensory Under Responsiveness
• Sensory Strategies
• Sensory Diet
What is Sensory Processing?
• The ability to receive, interpret and make an appropriate adaptive response to incoming sensory information from oneself and from the environment. Information is gathered from seven senses: vision, olfactory, gustatory, auditory, tactile, vestibular and proprioception.
• Adequate sensory processing promotes cognitive and motor growth, as well as the ability to control emotion and regulate levels of alertness.
• Sensory processing occurs at an unconscious level.
• Individuals with poor sensory processing have a disorganised flow of sensation and thus often respond incorrectly to that incoming sensory information.
Symptoms of poor sensory processing:
• Hyper – responsivity over sensitive / reactive to sensory information • Unable to tolerate loud noises
• Unable to tolerate clothing against skin
• Restlessness/poor attention
• Fearful of movement eg walking on uneven surfaces
• Hypo – responsivity under sensitive / reactive to sensory information • Seeks out extreme movements, often no fear of
danger
• Loves tight hugs, clothing
• Restlessness/poor attention • Poor Praxis (Somatodyspraxia) difficulty organising
movements
• Poor modulation – difficulty modulating responses to sensory information
• Fluctuating levels of attention/alertness • Emotional lability- mood swings, tantrums
What is Sensory Integration?
• Ayres Sensory Integration (ASI) is the therapy technique developed by Jean Ayres in the 1970’s in the USA.
• She developed a theory about what happens when sensory integration does not
develop well, and developed a way of assessing these difficulties ,and a method of treating them. She carried out research to further develop and understand SI. She treated many children with SI difficulties and since then, many OT’s have continued her work.
• With the development of brain imaging techniques, much of what Jean Ayres postulated has infact been supported and much current research is being done in this area.
• In order to use the term ASI, therapy needs to adhere to the ASI Fidelity Measures (Parham) set out in 2007, which has 10 essential elements.
SENSORY BASED INTERVENTIONS
These may include: • Weighted blankets • Sensory Diets • Use of headphones • Therapeutic Listening Programmes • Collaboration and Coaching
These are NOT Sensory Integration Therapy, but can be useful tools in an OT’s toolbox.
How do we assess for sensory processing difficulties?
• Sensory Integration and Praxis Test (SIPT) developed by Jean Ayres, soon to be replaced the EASI • Clinical Observations by suitably qualified OT (as specified by SINetwork UK) • Questionnaires : Sensory Profile 2 (SP2) Sensory Processing Measure (SPM)
It is important to note that Sensory Processing difficulties can, and often do co-occur with other Diagnoses such as:
• Autistic Spectrum Disorders (ASD) (Tomchek & Dunn 2007) (Klintwall 2010) (Brock 2012)
• Attention Deficit and Hyperactivity Disorders (ADD and ADHD) (Miller et al 2011)
• Anxiety and Sensory Modulation (Pfeiffer 2012)
• Developmental co-ordination Disorder (DCD) / Dyspraxia (Zwicker 2010) (Smith-Roley 2015)
• Obsessive Compulsive Disorders (OCD) (Dar, Kahn & Carmelli 2012)
• Foetal Alcohol Syndrome (FAS) (Hanser & Jirikowic 2013)
• Schizophrenia (Brown et al 2002)
• Borderline Personality Disorders (Brown, Shanker 2009)
• Attachment and sensory modulation (Whitcomb , Carrasco, Neuman & Koos)
• Asthma (Engel-Yeger B, Almog A, Kessel A 2014)
The College of Occupational Therapists Practice Briefing 2015. This caused much upset amongst the OT profession. It queried the use of ASI, the effectiveness of sensory based interventions, suggested the research into ASI be inconclusive, and suggested that “bottom up approaches apply specific techniques in isolation, and do not address a person’s occupational performance in daily life occupations.” This has resulted in confusion and misunderstanding. However, the briefing is no longer in the public domain, and the SI Network have issued a strong response to this briefing.
SO where are we now? We are working towards Sensory Processing Disorder (SPD) being a recognised diagnosis. Sensory Processing Difficulties IS now recognised within the DSM V and IS a criteria within the diagnosis of ASD. ASI is considered an evidence based practice for individuals with ASD. There is emerging evidence into the efficacy of Sensory Based Interventions. “Hyper- or hypo reactivity to sensory input or unusual interests in sensory aspects of the environment” (autism speaks https://www.autismspeaks.org/what-autism/diagnosis/dsm-5-diagnostic-criteria) Families report participation in daily living activities is restricted due to difficulty processing and integrating sensory information, causing social isolation for both them and their child (Schaaf et al, 2011). Consequently, parents of children with ASD are increasingly requesting interventions to address problems associated with sensory processing (Green et al, 2006; GoinKochel, 2009). Alongside this, The NICE guidelines for children on the Autistic Spectrum specify the need for an assessment to have an understanding of their sensory needs. This is supported by Schaaf et al (2012) who believe SI methods should be used within an occupational therapy assessment with ASD.
Advice regarding Education and Health Care Plans:
• Ensure adequate assessment has been carried out, eg OT assessment to consider Sensory, Physical, Self Care and Independence skills. Difficulties need to be related to functional outcomes. • Ensure difficulties are specifically and adequately described in Part B of the EHCP.
• In Part F, ensure direct and indirect therapy is specified and quantified. The
therapist must also have appropriate training. • Ensure the environment is also specified eg “small, low arousal setting”, “small class sizes” REMEMBER, IF THERAPY IS QUANTIFIED AND SPECIFIED IN AN EHCP, THEN THE LOCAL AUTHORITY IS OBLIGED TO PROVIDE IT.
Useful links
• SINetwork UK https://www.sensoryintegration.org.uk/ The SI Network (UK & Ireland) is a not-for-profit organisation, promoting education, good practice and research into the theory and practice of Ayres' Sensory Integration. Find out more about how sensory integration difficulties can interfere with everyday life and how sensory integration therapy can help. • ROYAL COLLEGE OF OCCUPATIONAL THERAPISTS https://www.rcot.co.uk/ The RCOT is the professional body for OT’s in England, Scotland and Wales. It is a registered charity and is based in Borough High Street London. They have a Children and Young Peoples (CYPF)Specialist Section.
Additional Reading
Is It Sensory or Is It Behavior?: Behavior Problem Identification,
Assessment, and Intervention Paperback – 30 Dec 2004
by Carolyn Murray-Slutsky (Author)
Sensory Integration: Answers About Autism Paperback – 2011 by Susanne Smith Roley (Author), Zoe Mailloux (Author), Gina Geppert Coleman (Author), Shay McAtee (Illustrator) The Out-of-Synch Child Paperback – 30 Sep 2005 by Carol Stock Kranowitz (Author) Raising a Sensory Smart Child: The Definitive Handbook for Helping Your Child with Sensory Processing Issues, Revised Edition Paperback – 1 Aug 2009 by Lindsey Biel (Author) Too Loud Too Bright Too Fast Too Tight Paperback – 2 Dec 2003 by Sharon Heller (Author)
Answers to Questions Teachers Ask About Sensory Integration: Forms, Checklists, and Practical Tools Paperback – 30 Jan 2001 by Jane Koomar (Author), Carol Kranowitz (Author), Stacey Szklut (Author), Lynn Balzer-Martin (Author) Sensational Kids: Hope and Help for Children with Sensory Processing Disorder (SPD) Paperback – 6 May 2014 by Lucy Jane Miller PhD Otr (Author) Living Sensationally: Understanding Your Senses Paperback – 15 May 2009 by Winnie Dunn (Author) Sensory Integration and the Child Paperback – 1 Apr 2005 by A Jean Ayres (Author) Clinician’s Guide for Implementing Ayres Sensory Integration®: Promoting Participation for Children With Autism Paperback – 30 Apr 2015 by Roseann Schaaf (Author), Zoe Mailloux (Author)
