occupational therapy & speech and language therapy lenses on assessment jenny jones occupational...
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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 hypothesis
1949 – 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
SensorimotorPlay
Social 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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