SPD

Sensory Processing Disorder:

Facts, Assumptions and Myths

Jacci Siebert

BSc (OT) Hons

Specialist Childrens OT

Advanced SI Practitioner & SI mentor

Sens.ations, Leicester, 7th March 2012

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 peoples 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 is a barrier to engagement in

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

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

Far senses

o Sight (Visual) o Sound (Auditory) o Smell (Olfactory)

Near Senses

Taste (Gustatory)

Touch (Tactile)

Vestibular (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

control

Autonomic Nervous System

Typical Brain

Sound, Sight, Taste

Touch, Smell,

Body Position sense,

Movement Sense

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

What are the results of

Sensory Integration?

Self Regulation

The nervous systems 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).

SPD Brain

Sensory Info

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 clients:

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, dont 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

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-Based Motor Disorder (SBMD)

-Dyspraxia -Postural Disorder

Sensory Discrimination Disorder (SDD)

-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 Modulation Disorder

Sensory Over-

responsivity (Sensory Avoider)

Sensory Under-

responsivity (Sensory

Disregarder)

Sensory Seeking

(Sensory Craver)

Sensory Discrimination

Disorder (Sensory Jumbler)

Sensory based Motor

Disorder

Postural Disorder (Sensory Slumper)

Dyspraxia (Sensory Fumbler)

Sensory Profile by Winnie Dunn PhD, OTR , FAOTA

This is a standardised

caregiver

questionnaire

which seeks

to identify the

nature of the

childs sensory

processing

difficulties. Mainly looks

at sensory

modulation

Neurological

Threshold

Continuum

Behavioural Response Continuum

Acting in ACCORDANCE

with Threshold

Acting to COUNTERACT

Threshold

HIGH

(habituation)

Poor Registration Uninterested, Apathetic

Dull affect

Withdrawn

Overly tired

Self-absorbed

Sensory Seeking Active

Continuously engaging

Fidgety

Excitable

LOW

(sensitization)

Distractible

Hyperactive

Sensitivity to Stimuli

Resistant to change

Reliant on rigid rituals

Sensation Avoiding

Neurological

Threshold

Continuum

Behavioural Response Continuum

Acting in ACCORDANCE

with Threshold

Acting to COUNTERACT

Threshold

HIGH

(habituation) Bystander Easy-going and not easily ruffled,

have to be called several times to

get their attention, miss signposts,

may leave dirt on their face or

hands, find scratches and bruises

and dont know how they got them, dont notice clutter until someone points it out.

Seeker Enjoy going to firework displays,

make noises such as humming and

whistling, order or cook spicy food,

tend to touch people when talking to

them, walk around barefoot, change

daily routines to keep them

interesting.

LOW

(sensitization)

Distracted by sounds, startle easily,

are bothered by fast changing

images on TV, have precise ideas

about clothing textures, repeatedly

pick the same food in restaurants,

prefer clean design in the home,

select only a few chosen rides at

amusement parks.

Sensor

Leave the room when a crowd starts

to gather, like their surroundings

clean and tidy, keep curtains or

blinds drawn or partially drawn,

make narrow food choices, dont like getting their hands mucky, select

solitary leisure activities

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 childs 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 (Willbargers) 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

Sensory Integration

Treatment Principles

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 childs 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 childs 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 childs success

Ensure physical safety

Arrange room to engage child

Foster therapeutic alliance

Recent OT-SI Effectiveness

Studies Author Design Subjects Age range

(years)

Intervention Outcome

Smith

2005

ABAB

OT-SI vs

tabletop

activities

7 PDD or

Mental retardation

8-19 5 sessions

per week of

30 minutes

Significant reduction in

self stimulatory

behaviour

Miller

2007

OT-SI vs

activity

protocol

vs no

treatment

24 SMD

(15 ADHD,

1 Anxiety)

3-11 20 x 1 hour

sessions

over 10

weeks

Significant gains in

individualised GAS,

Attention,

Cognitive/social and

reduced electrodermal

responsivity ampitude

Pfeiffer

2011

OT-SI vs

fine-motor

37 ASD 6-12 18 x 45 min

sessions

over 6

weeks

Significant positive

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

Therapy

Space

Russet House School, Enfield (2005)

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

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

Websites www.sensoryintegration.org.uk

www.spdfoundation.net

www.thespiralfoundation.org

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

Independent Occupational Therapists www.cotss-ip.org.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. 2nd 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.

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Therapy, 61 (2), 239-246.

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families. Child: Care, Health and Development, 34 (3), 335-343.

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:

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:

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:

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