susanne smith roley otd, otr/l, faota 2014 - sity

Susanne Smith Roley OTD, OTR/L, FAOTA

2014

Acknowledgements

Dr. Ayres designed SI intervention in the 1960’s – since then…

OT’s working in pediatrics commonly report using sensory integration methods

95-99% OT’s working with children with autism reported using sensory integration methods (Case-Smith, 1999)

8,000 parents reported

the following therapies worked best for their child

rank-ordered by percent of mentions

1. Occupational Therapy – 39%

2. Speech Therapy – 27%

3. ABA Therapy – 15%

4. Social Skills Classes – 8%...

Restricted repetitive activity to patterns of behavior, interests, and activities

(at least two of the following) Stereotyped repetitive movements,

use of objects, speech

Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior

Highly restricted, fixated interests that are abnormal in intensity or focus

Hyper-hypo reactivity to sensation or unusual interests in sensory aspects of the environment

Baker, Lane, Angley, & Young, 2010

Baranek, David, Poe, Stone & Watson, 2006

Dawson & Watling 2000; Kientz & Dunn, 1997

Lane, Young, O’Neill & Jones 1997

Tomcheck & Dunn, 2007

Liss, Saulnier, Fein, & Kinsbourne, 2006)

children

Crane, Goddard, & Pring, 2009

(Dept of Psychology,

University of London)

Adults

self-report on Sensory Profile

adults with ASD

experience very different, severe

sensory processing abnormalities that

warrants intervention

Reynolds, Millette, & Devine, 2012

Rodent

atypical auditory sensory gating

impairments in motor

speed and performance

hyposensitivity & hypersensitivity

How do individuals with autism perform on all of the identified sensory integration patterns?

sensory reactivity

Tactile defensiveness

(1965, 1966, 1969, 1972; 2011)

Visual perception + visual praxis problems

(1965, 1966, 1969,1972,1977 & 1989; 1998; 2011)

Vestibular, postural & bilateral problems

(1965, 1966, 1969,1972,1977 & 1989; 1998; 2011)

Somatosensory perception problems

(1969, 1972, 1977, 1989, 1998)

Motor planning problems

(1965, 1966, 1969,1972,1977 & 1989; 1998; 2011)

Ayres & Tickle, 1980

Ben-Sasson et al., 2009

Dunn, Myles, Orr, 2002

Crane, Goddard, & Pring, 2009

Lane, Young, Baker, & Angley, 2010

Liss et al. 2006

Schoen, Miller, Brett-Green, & Nielsen, 2009

Tomchek & Dunn, 2007

Watson et al., 2011

Woodard et al., 2012


(1965, 1966, 1969, 1972; 2011)


(1965, 1966, 1969,1972,1977 & 1989; 1998; 2011)


(1965, 1966, 1969,1972,1977 & 1989; 1998; 2011)


(1969, 1972, 1977, 1989, 1998)


(1965, 1966, 1969,1972,1977 & 1989; 1998; 2011)

Ayres, 1989

Iarocci & McDonald, p.81

Gowen and Hamilton, 2012


(1965, 1966, 1969, 1972; 2011)


(1965, 1966, 1969,1972,1977 & 1989; 1998; 2011)


(1965, 1966, 1969,1972,1977 & 1989; 1998; 2011)


(1969, 1972, 1977, 1989, 1998)


(1965, 1966, 1969,1972,1977 & 1989; 1998; 2011)

Mostofsky et al., 2006

Dzuik et al., 2007

Ben-Sasson, Fluss, & Cermak, 2008

Dziuk et al., 2007

Marco, Hinkley, Hill, & Magarajan, 2011

Mostofsky et al., 2006

Siaperas, Ring & McAllister, 2011

To characterize sensory integration and praxis patterns of children with ASD

and discern whether these patterns relate to social participation.

121 children with ASD ages 4 – 11 years received OT evaluation 69 (57%) completed 11 or more tests of the SIPT 52 (43%) completed less than 11 tests

Is the SIPT

a feasible

assessment

N=89 children with ASD and SIPT

4 to 11-years (mean=7 years)

Subset of these 89 children also contained

Sensory Processing Measure (SPM) Home Form (N=48).

Of which 25 also contained scores for the SPM Main Classroom Form.

SIPT and SPM standard scores used to describe sensory integration and praxis patterns.

Correlation coefficients were generated to discern relationships among sensory integration and praxis scores,

and associations with SPM Social Participation scores.

SIPT

Relative strengths

~ Visuopraxis

Visual Perception & Visual Praxis

Significantly low mean scores

~Somatopraxis

Imitation Praxis

Vestibular Bilateral Integration

Somatosensory

Praxis on Verbal Command

SPM At Home At School

N M SD N M SD

Soc

Part

48 70 7.2 26 67 8.0

Plan

&

Ideas

46 68 8.6 26 63 6.8

Total

Sens

46 69 7.1 26 62 7.2

T-score: 0 - 59 = typical; 60-69 probable dysfunction; T= 70-80

definite dysfunction

SPM H-Home

C-Main Classroom

SIPT

Vis

Perc

Vis

Praxis

Imitation

Praxis

Vestib

Bilateral

Somato

Sensory

Praxis

Verbal

Com

Social – H ** * *

Social – C *** ** * Planning-Idea-H

Planning-Idea-C *

Total Sensory–H

Total Sensory-C **

*p<0.05, **p<0.01, ***p<0.0001

Visual Praxis – Strength in motor free visual perception and visual construction Somatodyspraxia Somatosensory processing of tactile and proprioception Dyspraxia including poor imitation, sequencing, and following unfamiliar instructions Vestibular-related challenges Standing Walking Balance below average, oftentimes low postrotary nystagmus and poor postural control Atypical Sensory Reactivity Heightened responses to a variety of stimuli, atypical pain responses with under-responsiveness to body-centered sensations *Dyspraxia more predictive of Social Participation Deficits than sensory reactivity

4 years 7 month male autism introverted, sensitive and

intelligent avoids being in the spotlight lacks social play skills with

peers good at visualizing how things

are put together teacher reports concerns re:

speech and language, behavior and social skills

parent concerns are attention to task, communication, and social abilities

-3 -2 -1 0 1 2 3

0.5 1 5 10 25 50 75 90 95 99 99.5

AVERAGE

Percentile

SD LOW HIGH

Space Visualization 0.55

Figure-Ground Perc. -0.06

Man. Form Perception 0.75

Kinesthesia -2.13

Finger Identification -1.62

Graphethesia -2.08

Loc. Tactile Stimuli -3.00

Praxis Verb. Command -1.60

Design Copying -2.10

Constructional Praxis 0.16

Postural Praxis -1.50

Oral Praxis -1.46

Sequencing Praxis -1.56

Bilateral Motor Coord -1.70

Stand & Walk Balance -2.60

Motor Accuracy -1.79

Postrotary Nystagmus -2.35

4 year 7 mo boy

2. How often do the following daily household routines run smoothly for your child and family? a. getting ready to go somewhere

b. leaving the house in the morning

c. meal preparation and cleanup d. mealtimes e. getting ready for and going to bed

f. bathing and grooming activities

1. Does your child: a. play with friends?

b. make and keep friends?

c. relate to being part of the family?

3. How often do the following experiences go smoothly for your child and family? a. running errands

b. leaving to go out on overnight trips

c. shopping trips for groceries or clothes

d. dining out e. birthday parties

f. recreational activities such as bike riding or ball games

4. Considering your child’s special needs, is your family able to: d. stay involved with the community?

e. participate in the neighborhood?

Correlations Between SIPT and FIQ Social Relationships

Visual & Visual Motor not significant

Imitation Group p=<.01

Vestibular Bilateral p=<.01

Somatosensory p=<.01

Praxis on Verbal Command p=<.02

SUMMARY SENSORY INTEGRATION PATTERNS IN ASD

Assessment Strengths Difficulties

Sensory Integration and Praxis Tests (SIPT)

Visual Perception and Visual Praxis

Vestibular Bilateral Somatosensory Imitation/Praxis Praxis on Verbal Command

Sensory Processing Measure SPM-Home SPM-Main Classroom

Atypical sensory responsiveness Social Participation Ideas and Planning

Family Impact (FIQ) Social Daily Routines Community Events

Relating to and interacting with family members Preferred activities

Relating to and interacting with peers Meals, bedtime, grooming & hygiene, getting ready to go somewhere Family engagement in neighborhood and community events

•Retrospective chart review

•Not all children had the SPM

•For children older than 8 years 11 months, data may under-estimate the severity of their difficulties

•Children who could not take the SIPT had even more difficulties

Implications

Early Identification of Sensory Integration and Praxis Deficits

Common in Autism

Roley, S.S., Mailloux, Z. & Coleman, G.G. (2011). Sensory Integration: Answers About Autism. Torrance, CA:

Pediatric Therapy Network.

Early Developmental Concerns Associated with Autism

Possible Related Sensory Integration and Praxis Issues

Potential Difficulties in Daily Life

Heightened sensitivity

to sound, light, touch,

smells, and movement;

may be fussy or

irritable especially with

noise or unexpected

events

Difficulty adjusting to sensory

changes in the environment;

decreased ability to “ignore”

background noise, smells, or

lighting or the feel of clothing;

can lead to fluctuating attention

and alertness

Over-reaction to people,

situations or events leading

to poorly regulated

emotions, alertness or

attention




Self-stimulatory behaviors

such as head-banging or

excessive rocking

Seeking pressure or

movement sensations; may

be response to pain,

indicating an ear infection or

other medical issue

May be self-injurious;

Interferes with typical social

interactions and interactive

play or manipulation of

objects

Peculiar interest in certain

sensations such as

looking at lights, spinning

objects, feeling lint, or

twirling around

Seeks certain kinds of

sensory information which

limits awareness of everything

else

Decreased attention to

caregivers or situations;

limits play and exploration of

age-appropriate toys

Decreased head/neck

control in infancy

Poor processing of

information from movement

and body position senses

Difficulty maintaining an

upright sitting position; often

“props up” head while

leaning on arm




Diminished anticipation of

caregiver interactions

such as reaching or

moving toward adult to be

picked up

Difficulty automatically move his

or her body in preparation for

tasks such as opening mouth for

feeding, lifting legs during

diapering, and holding out arms

for dressing

Caregivers have more

difficulty engaging infant

during daily tasks

Decreased initiation &

continuance of social

contact, making sounds,

movements, bring toys, or

indicating desire to share

excitement

Difficulty tolerating the intensity of

the sensory interaction or

decreased imitation, part of motor

planning

Decreased reciprocal

interactions lead to

decreased time socially

engaging with caregivers

and others

Decreased initiation of

games such as peek-a-

boo or imitation of hand

gestures in songs

Difficulty adjusting and

accommodating to the situation

or decreased imitation and motor

planning

Decreased opportunities

to practice motor skills

needed for playing with

others




Difficulty directing or

shifting visual gaze, and

looking where other

people are looking

Poor processing of

information from movement

and visual senses

Difficulty visually following

moving people or objects

which interferes with

understanding what other

people are seeing and

maintaining positive social

interaction and successful

object manipulation

Preference for looking at

mouths instead of eyes

when looking at people

Difficulty processing visual

movement

Decreased comprehension

of facial gestures

Unusual interest in light

patterns or objects to the

exclusion of interest in

people

Poor processing of multiple

sensations and decreased

motor planning

Decreased learning

opportunities through

complex play with objects

and people

Limited repertoire of facial

expressions

Diminished body awareness

(particularly facial muscles)

Difficulty imitating and

understanding other’s facial

gestures during nonverbal

communication

To all of you who are attending

To families and their children who have contributed to these projects

To my mentors and collaborators

To European Congress organizers for hosting this conference

Thank You

[email protected]

susanne smith roley otd, otr/l, faota 2014 - sity

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