sensory processing disorder 101 - wv early childhood€¦ · sensory processing disorder 101...

Sensory Processing Disorder 101 Celebrating Connections 2019

Ingrid M. Kanics, OTR/L, FAOTA [email protected] 1

Sensory Processing Disorder

101Ingrid M. Kanics, OTR/L, FAOTA

[email protected]

☼ What is Sensory Processing?

☼ What is Sensory Regulation?

☼ What is Sensory Processing Disorder?

Objectives



BackgroundA. Jean Ayres, Occupational Therapist

Neuroscience

Better explains the relationship between behavior and neural functioning.

Organization of sensory information for daily use.

Sensory Processing

ThroughputWhere input is organized and

reorganized

Sensory Input

BehavioralMotor Output

Normal sensory input becomes organized to produce normal motor/behavioral

output with accurate feedback

Sensory Processing



1. Typical Development

2.Dysfunction of Sensory Integration (Sensory Processing Disorder)

3.Guide to intervention and treatment

Three Overarching Postulants

Sensory Processing

1. Neural Plasticity: the brain physically changes as we learn

Typical Development AssumptionsSensory Processing



2. Sensory development follows a sequence.

Sensory ProcessingTypical Development Assumptions

3. Nervous system hierarchy

Central Nervous System

Tactile Proprioceptive Vestibular

Smell TasteAuditoryVisual

Motor PlanningAwareness of two sides of bodyPostural Security

Ability to Screen Input

Reflex MaturityBody Scheme

Postural Adjustment

ADL Behavior

Learning

Ocular Motor Control

Eye-hand coordination

ALS VSP ACF

Cognition Intellect

Perceptual Motor

Development

Sensory Motor Development

Sensory Systems

Williams, Shellenberger 1994




4. Adaptive behavior is the result of registration of sensory input.


5. Input to one sensory system can be used to support another.




☼ First Order – Reticular Formation (Brain stem)

☼ Second Order –Limbic System

☼ Third Order – Cerebral Cortex

LIMBIC SYSTEM


Sensory RegulationDevelopment of Self Regulation

☼ Brainstem - Reticular Formation

☼Monitor survival

☼Autonomic functions☼ Temperature☼ Respiration☼ Heart rate☼ Sleep/wake cycles☼Muscle tone

LIMBIC SYSTEM

Sensory RegulationFirst Order




☼ Limbic System – next to brainstem

☼ Fight, Flight, Freeze when brainstem sense danger

☼ Emotion

☼ Learning

☼Memory

LIMBIC SYSTEM

Sensory Regulation


Second Order

☼Cerebral Cortex – gray matter

☼Corpus Callosum –bridge of the brain

☼ Sensation☼ Perception☼Voluntary Movement☼ Learning ☼ Speech☼Cognition

LIMBIC SYSTEM

Sensory Regulation


Third Order



LIMBIC SYSTEMLIMBIC SYSTEM

Bottom up approach

Stimulation of Cerebellum with

heavy work

Top down using thought to overcome feeling of a threat

Brainstem tells brain to pay

attention

Sensory Regulation


Perceived Threat

☼Difficulty with processing sensory input☼ Ineffective interactions☼ Significant difficulties in daily routines and tasks

Sensory Processing DisordersDefinition



SPD

Autism Spectrum Disorder

Baranek, et al, 2006,Tomchek & Dunn 2007Schoen, et al 2009

ASD prevalence ~1:58 SPD prevalence ~1:20

Sensory Processing DisordersRelationship of ASD and SPD

STAR Institute, 2016

ADHD Only32%(57)

SPDOnly28%(50)

Overlap40%(74)

Sensory Processing DisordersRelationship of SPD and ADHD


Co-occurrence of SPD and ADHD in a national sample. These data sets were derived from a national stratified sample of 2,410 children, tested during the

standardization of the Leiter International Performance Scale, Revised



1. Social Participation2. Self sensory regulation3. Self esteem

Sensory Processing DisordersImpact of SPD

☼ Sensory Modulation Disorder☼ Sensory Over-responsive☼ Sensory Under-responsive☼ Sensory Craving

☼ Sensory-based Motor Disorder☼ Postural Disorder☼ Dyspraxia

☼ Sensory Discrimination Disorder☼ One or more sensory systems

Sensational Kids, Lucy Jane Miller , 2006

Sensory Processing DisordersTypes



Sensory Processing DisordersSensory Modulation Disorder: Sensory Over-responsive


Sensory Modulation Disorder: Sensory Over-responsiveSensory Processing Disorders

• Responds too much, too frequently, or for too long to sensory stimuli

• Aggressive or impulsive when overwhelmed by sensory stimulation

• Irritable, fussy, moody

• Unsociable; avoids group activities and has trouble forming relationships

• Excessively cautious and afraid to try new things

• Upset by transitions and unexpected changes

• Often labeled a “fussy baby”, “difficult”, or “out of control”

Sensory Processing Disorder Foundation, 2011



Sensory Processing DisordersSensory Modulation Disorder: Sensory Under-responsive


Sensory Modulation Disorder: Sensory Under-responsive

• Poor inner drive, uninterested in exploring games or objects or world around him/her

• Passive, quiet, withdrawn

• Difficult to engage in conversation or other social interactions

• Easily lost in his own fantasy world

• Apathetic and easily exhausted

• Excessively slow to respond to directions or complete assignments

• Often labeled “loner” or “lame”


Sensory Processing Disorders



Sensory Processing DisordersSensory Modulation Disorder: Sensory Craving


Sensory Processing DisordersSensory Modulation Disorder: Sensory Craving




Sensory Modulation Disorder: Sensory Craving


• Constantly wants control over every situation

• Does not wait turn, interrupts constantly, gets “wound up”

• Angry or even explosive when required to sit still or stop what he is doing –intense

• Creates situations others perceive as dangerous or disruptive

• Excessively affectionate physically

• Discharged from schools due to behavior; often labeled “bad boy” or “bad girl” or “needs better discipline”


Sensory Processing DisordersSensory-based Motor Disorder: Postural Disorder



Sensory-based Motor Disorder: Postural Disorder


• Appears weak and limp

• Tires easily / appears tired most of the time

• Gives up when challenged physically (and often cognitively)

• Difficulty with physical endurance especially in competitive games

• Often labeled “lazy”, “unmotivated” or “indifferent”

• Does not consistently use a dominant hand


Sensory-based Motor Disorder: Dyspraxia


• Ideation• The process of generating new

ideas prior to acting

• Planning and sequencing• The order of actions in time and

space• Used to organize occupation of

daily life routines and activities (getting dressed, doing homework, budgeting time, punctuality etc.)

• Execution of planned idea• Precise, efficient movements of

the body




Sensory Processing DisordersPraxis: Ideation, Planning & Sequencing

Sensory Processing DisordersPraxis: Ideation, Planning & Sequencing, Execution



Sensory Processing DisordersSensory-based Motor Disorder: Dyspraxia


• Prefers fantasy games and talking to doing

• Prefers sedentary activities, not active play

• Messy or sloppy eating and disheveled appearance

• Frustrated when unable to complete tasks due to poor motor skills

• Can be extremely smart

• Often labeled “klutzy”

Sensory Processing DisordersSensory-based Motor Disorder: Dyspraxia



Sensory Discrimination Disorder: One or more sense








• Difficulty following directions

• Gets lost easily

• Aversion to playing with puzzles or other visually detailed games

• Needs directions repeated

• Needs more time than other children to perform many tasks

• Often labeled “slow learner”


Principle 1: Awareness of arousal levels and choose activities to modify as needed

Principle 2: Work on relationships and engagement while engaging the sensory systems

Principle 3: Incorporate function and social participation

Principle 4: Build self-esteem through repeated success and emphasizing activities the child is good at.

Principle 5: Most children with SPD can benefit from a sensory backpack where sensory tools are easily available.

General Support Principles:





Supports for Sensory Modulation Disorder: Sensory Over-responsive


Principle 1: Start with self-application of sensory stimuli.

Principle 2: Gradually introduce new sensations.

Principle 3: Build trust and use predictability.

Principle 4: Anxiety and intensity of responses can be mediated through motivation, attention and cognition.

Principle 5: Engage the parasympathetic NS to counter balance the sympathetic NS.

Principle 6: Structure environment and tasks to minimize over reaction


Supports for Sensory Modulation Disorder: Sensory Under-responsive


Principle 1: Use stimulating sensations

Principle 2: Engage in activities that enhance tactile, proprioception and vestibular stimulation.

Principle 3: Find sensory activities that are motivating.

Principle 4: Use facial expressions and affect to entice child to participate.

Principle 5: Address body awareness and postural components if under respective in proprioception and vestibular senses




Supports for Sensory Modulation Disorder: Sensory Under-responsive



Supports for Sensory Modulation Disorder: Sensory Craving


Principle 1: Create organized movement experiences that have a goal and purpose.

Principle 2: Environment changes can increase attention.

Principle 3: Use sensory and self-regulation programs that use “heavy work”.

Principle 4: Combine movement with proprioceptive, get head out of upright position.

Principle 5: Use start and stop activities

Principle 6: Use Sensory backpacks




Supports for Sensory-based Motor Disorder: Postural Disorder


Principle 1: Strengthen core muscles of trunk.

Principle 2: Work on co-activation of stabilizing muscles.

Principle 3: Use weight bearing, weight shifting and rotation.

Principle 4: Work on shoulder, forearm and wrist stability.

Principle 5: Make sure sitting posture is stable to maximize arm and hand function.

Principle 6: Address strength and endurance.

Principle 7: Work on static and dynamic balance.


Supports for Sensory-based Motor Disorder: Dyspraxia


Principle 1: Sensory feedback enhances motor performance.

Principle 2: Use activities the require timing and spatial organization.

Principle 3: Choose activities that require sequencing of body movements

Principle 4: Practice Ideation (all the time)

Principle 5: Help child develop body maps and spatial maps.

Principle 6: Use words to reinforce sequence of tasks

Principle 7: Have child conceptualize and plan their daily routines




Supports for Sensory Discrimination Disorder: One or more sense


Principle 1: Use fun activities that address properties of the object.

Principle 2: Encourage the child to use visualization and verbalize what they can’t see.

Principle 3: Improve quantitative percepts by playing games that measure ht, wt, etc.

Principle 4: Use activities that require attending to specific sounds.

Principle 5: Use games that relate to specific location of the body and body movement through space

Principle 6: Use games that occlude vision


Questions

Ingrid M. Kanics, OTR/L, [email protected]

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