dyspraxia. asd and adhd slides mh3 · 2021. 1. 8. · and mental health. “ caçola2016 6(1625 ......
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Sensory integration...the ability to organize sensory information for use, results in perception and… synthesis of sensory data that enables man to interact effectively with the environment. Jean. A. Ayres (1972
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“…those with an underactive vestibular system feel propelled to move. Bill Gates is well known for rocking back and forth while he works or talks to people and he uses a home trampoline for extra up-and-down movement.” Heller 2002
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Praxis
“the ability by which we figure out how to use our hands and body in skilled tasks like playing with toys; using tools, including a pencil or fork; building a structure, whether a toy block tower or a house; straightening up a room; or engaging in many occupations.”
A Jean Ayres 1985
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Praxis and ASD
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Developmental Apraxia
“a disorder of sensory integration interfering with ability to plan and execute skilled or non-habitual motor task”
Ayres 1972
“ability to perform skilled movement impaired despite normal intellect and normal neurological findings”.
Gubbay in 1975 and 1979
“Problems in motor planning, clumsiness in execution, inappropriate actions, and difficulty in motor learning have been associated with apraxia in adults and developmental dyspraxia in children. Separate terms for adults and children are used to describe a disturbance of praxis-the ability to plan and execute a skilled movement - because the etiology and neurophysiology, behavioral manifestations, and evaluation and treatment of problems in praxis differ for the two groups.”
Goodgold-Edwards and Cermak in 1990
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Praxis and Sensory Integration
“the neurological processes by which cognition directs motor action” Ayres 1985
“Praxis is the ability of the brain to conceive of, organise, and carry out a sequence of unfamiliar actions.” Ayres, 1973
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The history dyspraxia within the theory of sensory integration to now
Ideation
Action planningIncluding planning and sequencing
Execution
“the neurological processes by which cognition directs motor action” Ayres 1985
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Dyspraxia and Autistic traits in adults with and without ASC
Dyspraxia is significantly more prevalent in adults with ASC ; motor coordination difficulties commonly co-occur with ASCDyspraxia was associated with significantly higher autistic traits and lower empathy in those without ASC. The results suggest that motor coordination skills are important for effective social skills and empathyCassidy et al 2016
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Praxis and LanguageLong-standing speculations and more recent hypotheses propose a variety of possible evolutionary connections between language, gesture and tool use. These arguments have received important new support from neuroscientific research on praxis, observational action understanding and vocal language demonstrating substantial functional/anatomical overlap between these behaviours.Stout and Chaminade 2012https://www.youtube.com/watch?v=s-b8KY4Y8-M
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DCD and Dyspraxia – the terms we use…
“In reality, the definition of DCD is very similar to dyspraxia. A survey of health and educational professionals showed widespread uncertainty about the definitions of, and distinction between, DCD and dyspraxia. Furthermore, the rationale for using one or the other term in the literature has been unclear.Therefore, DCD and dyspraxia should be regarded as synonymous.”
Gibbs et al 2007
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Dyspraxia, DCD and Mental Health
“Dyspraxia/DCD are considered to be one of the major health problems among school-aged children worldwide, with unique consequences to physical and mental health.“Caçola 2016
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A little quiz:
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Adolescents, Adults and Dyspraxia
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ASD
70% SMD Adamson et al. 2006
90 % of children with ASD have motor difficulties: this does not necessarily relate to functional impairment Green 2006
80-90% atypical responsivity Rogers & Ozonoff 2005, Tomchek & Dunn 2007
Developmental Dyspraxia and Sensory Responsivity Buitendag & Aronstam 2010
Pain and hearing: most commonly affected modality Klintwall 2010
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ASD
Christopher Gillberg’s team (Klintwall 2010) used informal assessment methods to identify abnormal sensory reactions in children with ASD and found high and consistent levels of impairing sensory problems from childhood to adulthood in almost all individuals diagnosed with classic autism
Pain and hearing were the most commonly affected modalities
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ASD and Social Interaction
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This work has been brought into the clinical arena by Barenak(2012) who was working on early intervention to address praxic skills in the context of social development
Mostofsky (2006) and colleagues have looked at the relationship between praxis and social skills and suggest that praxic difficulties in those with ASD directly impact on the ability to develop appropriate social interaction.
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ASD
Children with ASD present with proprioceptive processing difficulties that are different to TP and those with developmental disabilities Blanche et al, 2012
Associations between sensory processing patterns and developmental domains such as adaptive behaviour and language Tomcheck, Little & Dunn, 2015
Classification of Children With Autism Spectrum Disorder suggests 2 categories: • Sensory hyper reactivity• difficulties with multisensory processing Lane A, Malloy C & Bishop S, 2014
Difficulties in maintaining postural control in infancy, persisting in later years Memari et al, 2014
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ASD with MABC and SIPT – Clusters; proprioception and vestibular deficits, visual strength Siaperas, 2014
SI & Praxis patterns in children with Autism Roley et al 2015
Strengths in visuopraxis and difficulties with somatopraxis and vestibular functions, greatly affect participation.
Play skills in Autism affected by imitation praxis & ideation Bodison S 2015
Abnormal Pain, Touch Sensitivity, Proprioception and Manual Dexterity in Children with ASD
Riquelme et al 2016
Importance of multisensory processing in building perceptual and cognitive representations, and how deficits in multisensory integration may also be a core characteristic of ASD
Bauma et al 2016
ASD and Praxis
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ASD Adults
Narratives and reports of significant sensory differences – Temple Grandin, Sharon Heffer, Donna Williams.
Steve McGuinness, NAS Trustee & Autism Consultant:https://www.behance.net/gallery/4064791/msituA-raising-awareness
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ASD Adults
Autism Research Centre (Cambridge) study of sensory processing and perception in adults with ASC compared self reported sensory experiences in adults with and without SPD and found :
Adults ASC showed differences on all Dunn’s subscales:
• with more sensitivity to and avoidance of sensory stimuli
• lower registration and less sensation seeking
Adults ASC report more sensory sensitivity to touch, vision, sound, smell, taste and movement
Tavisolli (2010) Sensory Processing in Autism
www.autismresearchcentre.com21
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A Case Study
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A Case Study
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A Case Study Group Activity
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ADHD• 54% ADHD Sensory Over Responsivity
Lane, 2010
• 37 children with ADHD were compared with 37 controls using Sensory Profile
ADHD showed significant impairments in 11 out of 14 sections and 6 out of 9 factors
Shimizu V , Bueno O, Miranda M, 2014
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ADHD
OT-SI vs Activity vs No Rx24 (15 with ADHD, 1 Anxiety)
Ages: 3-11
20 x 1 hour sessions over 10 weeks
SI - Significant gains in individualised GAS, Attention, Cognitive/ social and reduced electrodermal responsivity amplitude
Miller 2007
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ADHD and Praxis• Comorbidities of praxis and sensory integration dysfunction• Learning Disabilities• ADHD• Autism Spectrum Disorder• Mental Health Disorders (e.g. anxiety, depression)
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Prevalence of ADHD and Motor Skills Problems• ADHD in children 6-18 is 8 – 11.4%
• ADHD in adults is approximately 5%
• Over 50% of children with ADHD meet criteria for Developmental Coordination Disorder.
• Exact prevalence of specific praxis disorders is unknown as it has not been examined
• Prevalence of sensory integration dysfunction in adults is 5 –11%
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What do we know about ADHD and Praxis Deficits in Adults?• Little if any literature on praxis and adults with ADHD
• Links between ADHD and DCD in adults accepted
• Motor persistence and impulsivity primary problems
• Problems with dimensions of impulsivity including attentional, non-planning & motor impulsivity (Malloy-Diniz, et al, 2007)
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What do we know about ADHD and Praxis in Children ?
Children with ADHD tend to demonstrate deficits in motor control aspects of movementExcessive variability in movement speed (Izawa, et al, 2012)
Reaction time, variability of movement speed, timing, aiming in complex motor coordination tasks, motor fluency in complex letter formation (Kaiser, et al, 2015)
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ADHD and Praxis• ADHD & SIPT (Mulligan, 1996)
• Relative strengths in non-motor visual perception & localizing tactile input• Weakness in vestibular processing and most areas of praxis
• ADHD & Gesture Use (Dewey, Cantell, Crawford, 2007; MacNeil & Mostofsky, 2012)• Children with ADHD had decreased basic motor control but not gesture use
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Ideation• May-Benson, 2005
• Children with ideational praxis problems demonstrated poorer attention and increased impulsivity
• Pfeiffer, et al, 2014• Social Participation (r = .50) and Planning and
Ideas (r = .73) subtests of the Sensory Processing Measure significantly associated with hyperactivity/impulsivity
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Intervention: Coaching
• SAMPLE: 20 Parents of children with ASD
• FREQUENCY: 10 x 1 hour sessions over 12 to 15 weeks
• OUTCOME: COPM, GAS, PSI
• RESULTS: Parents felt more competent and children significantly increased participation in everyday life, suggesting that this approach is an effective occupational therapy intervention.
(Dunn,2013)
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Collaborative Consultation • Is particularly effective in situations where creating a
more supportive environment will make a big difference to the child’s functioning
• When clients feel competent, are actively engaged, and understand the whole process, they are more likely to acquire the skills to analyze and solve future problems
• Bretnall and Bundy, 2012
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Achieving a balance: integration and processing of sensation for a balanced
lifestyle
Smith, K 2000
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Sensory input • Ball Chairs
Positive effect on in seat behaviour for the children who had the most extreme vestibular-proprioceptive seeking behaviour, those with poor postural stability where less engaged on therapy ball (Bagatelle, 2010)
Improved on task behaviour due to increased vestibular system engagement (Burgoyne & Ketcham, 2015)
• Chewing Gum – significant positive effect on concentration performance (Tanzer,2009)
• Touch – massage or touch therapy (4 studies): some encouraging evidence that improvements in target behaviours noted
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Weighted ItemsWeighted Blanket - No impact found on sleep
Green et al, 2014
Weighted Blanked - Anxiety reduced
Champagne, 2007
Vest - Effect of a therapeutic climbing activities wearing a weighted vest on a child with ADHD: A Case Study (2015) positive effect on brain waves and their attention span
Lee 2015
Vayu Vest
Deep pressure stimulation is capable of eliciting changes in autonomic arousal
Reynolds, Lane & Mullen, 2015
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Recommendations• ADHD DX often includes motor coordination and
praxis problems
• Screen for Dyspraxia (motor coordination and praxis problems)
• Refer for more comprehensive assessment with SIPT/EASI as needed
Intervention for praxis problems is important if someone is to be able to successfully participate and do in everyday life
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Sensory EnvironmentsImproved attention, response time and decrease in self stimulatory behaviour in a room with improve acoustics and reduced visual stimuliMostafa, 2008
Improved attention to task following installation of sound-absorbing walls and halogen lighting Kinnealey et al, 2012
Noise reduction headphones- effective in enhancing attention to task during independent classroom work Rowe, Candler & Neville, 2011
Comfort rooms to support sensory modulation supports reduction in seclusion and restraint in an inpatients Psychiatric Setting Blair et al, 2016
Classroom Sensory Environment Assessment (CSEA) Kuhaneck H & Kelleher J, 2016
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