Understanding Sensory Processing Disorders

1. Understanding Sensory Processing Disorders Developed by Connie Ortman, OTR Presented by Kim Denny-Newkirk, OTR Outreach Services of Indiana http://www.in.gov/fssa/disability/services/seoutreach/index.html

2. Course Objectives • Understand that all people process information differently and have individual preferences • Recognize symptoms of sensory processing disorders • Identify where to go to for evaluation and treatment • Be informed about the types of services available and strategies to help individuals with sensory processing disorders.

3. How does this apply to me? • If you know the behavior has a sensory basis, you are less likely to take it personally and more likely to be empathetic. • If you understand the underlying problem it may help to identify solutions and take action. • Everyone’s nervous system is plastic, it can be changed throughout their lifetime, both positively and negatively.

4. What is Sensory Processing? • Definition: Sensory processing is the method the nervous system uses to recognize, organize and make sense of incoming sensory input. It includes both information coming from the external environment and input from the body in order to create an “adaptive response”.

5. Neurology 101

6. External Senses • Hearing (Auditory) • Vision (Ocular) • Smell (Olfactory) • Touch (Tactile) • Taste (Gustatory)

7. Vestibular System detects movement Tells us we are moving, surrounded by something that is moving or on something moving Receptors located in inner ear Tells up from down Influences concept of outside space Proprioceptive System body awareness Tells us where the body parts are without having to look at them Receptors are located in muscles, tendons, and ligament around joints Provides sense of the contents of the body Internal Sensations

8. What is Sensory Processing? • Definition: Sensory processing is the method the nervous system uses to recognize, organize and make sense of incoming sensory input. It includes both information coming from the external environment and input from the body in order to create an “adaptive response”.

9. An adaptive response .…. • is an appropriate action taken from the synthesis of incoming sensory information received through the central nervous system. • can be conscious or unconscious but it is not a reflex. • is a result of adequate sensory integration and assists in improving sensory integration.

10. Conscious vs. Unconscious Sensory Processing

11. Normal sensory processing includes: *Dysfunction can occur at any stage of the process. • Receiving input from the sensory receptors. • Relaying information to the brain. • Identifying what information is important. • Blocking information that is not important. • Comparing information with past experience or other types of sensory experience to form a plan of action if needed. • Developing a plan • Sending the message to the parts of the body needed to execute the plan. • Carrying out movements as planned. (adaptive response).

12. Normal Sensory Processing

13. Sometimes an individual’s brain does not process the incoming information from the senses (vision, hearing, taste, smell, touch or movement) normally. These individuals are said to have a Sensory Processing Disorder (SPD) or in some literature Sensory Integrative Dysfunction (SID).

14. SPD are caused by • Problems getting the impulse to the brain • Problem within the brain stem (filter) • Communication between centers of the brain For more information go to:http://www.sinetwork.org/aboutspd/whatisspd.html

15. Types of Sensory Processing Disorders How do they respond to each type of sensory input? Can they maintain an appropriate level of awareness to meet environmental demands? Can they use their body effectively?

16. Do they respond normally to sensory input? Symptoms of hypersentivity, defensiveness or sensory avoiding • Has a narrow or limited interests • Fear of movement and heights, or get sick from exposure to movement or heights • Be very cautious and unwilling to take risks or try new things • Respond to being touched with aggression or withdrawal • Responds negatively to certain sounds • Be very picky eaters and/or overly sensitive to food smells • Will only wear certain kinds of clothes, sensitive to tags.

17. What are they thinking about?

18. Can they maintain an appropriate level of awareness to meet environmental demands? (Regulation or Modulation)

19. Normal Regulation/Modulation

20. "Everyone has some sensory integration problems now and then, because no one is well regulated all the time. All kinds of stimuli can temporarily disrupt normal functioning of the brain, either by overloading it with, or by depriving it of, sensory stimulation." Carol Stock Kranowitz "The Out-Of-Sync Child" (1995)from http://www.sensory-processing-disorder.com/sensory-processing-disorder-checklist.html

21. Normal Development of Self Regulation

22. Impaired Regulation/Modulation

23. Symptoms of poor modulation/ regulation • Difficulty tolerating or adjusting to even minor changes in routine • Disregard or impaired ability to interact with others • Disrupted sleep and wake cycles • Attention problems: either easily distracted, or fixated on one activity with difficulty shifting focus • Feel uncomfortable in busy environments, such as sports events, malls

24. What are they thinking about?

25. Can they use their body effectively?Good Integration of “Power Sensations” (internal sensations) is essential for later growth and development Body Aware-ness Move-ment Touch

26. Hyposensitivity (under registration) • Handles people or objects roughly • Under-awareness of touch or pain, or touching others too often or too hard (which may seem like aggressive behavior) • Taking part in unsafe activities, such as climbing too high • Fatigues easily and appears unmotivated

27. The senses are the building blocks for future learning. Thinking Hearing Vision Body Awareness Move-ment Touch

28. Poor Integration or discrimination • Has difficulty with fine motor tasks such as handwriting, cutting, tooth brushing, clothing fasteners, or assembly tasks • Trouble maintaining balance or coordinating movements for activities such as kicking, throwing, dressing, in/out of showers or tubs, negotiating stairs

29. For more detailed symptom checklists go to: http://www.kidfoundation.org/spdchecklist/ or http://www.sensory-processing-disorder.com/sensory-processing-disorder-checklist.html

30. Checklists can be helpful, but .... Ask yourself: How much does this interfere with the quality of life or ability to function?

31. Sensory processing dysfunction can be classified as MILD • Individual can generally hold it all together while at work or school but tend to loose it when they get home or when under stress • They are generally unhappy, feel different but are unable to pin point why. • May tend to be compulsive and maintain strict routines • May appear to be tightly wound • Have a narrow range of interests/activities

32. Sensory processing dysfunction can be classified as MODERATE • Usually affects all settings of life: home, school, work, and leisure. • The person may avoid situations or sensory input that is aversive. • Not only is the individual’s life affected but it also negatively affects those around them.

33. Sensory processing dysfunction can be classified as SEVERE This person needs the help of others to participate or complete basic self-care needs They are obviously uncomfortable for a significant portion of the day They may engage in stereotypic, aggressive or self injurious behavior. *for more examples of what it feels like to have a SPD go to: http://www.sensory-processing-disorder.com/sensory-processing-disorders.html

34. What can you do? • Report your concerns and the symptoms you observe to your personal care physician or case manager. • Obtain a referral for an occupational therapy evaluation from a practitioner who has experience evaluating sensory processing disorders.

35. Diagnostic Manual for the Interdisciplinary Council on Developmental and Learning Disorders (ICDL)"Regulatory Sensory Processing Disorder" (code #200) www.icdl.com

36. Sensory Processing Evaluation should include: • Interview of individual if possible, parents and/or caregivers. • Observation of individual, if possible in natural setting. • Informal or standardized testing of the individuals response to a variety of sensory input.

37. Be informed • Review evaluation results and ask questions of therapist if you do not understand information presented. • If sensory processing problems are identified and treatment is recommended…ask what things will they be doing, will you be able to observe therapy. • Request suggestions that can be done at home to support therapy such as a “sensory diet.” • Share information with other care providers and across settings ie. home, school, or workshop

38. What is Sensory Integration Therapy? • Active Participation • “Just Right Challenge” • “Adaptive Response” • Self Directed

39. Goals and Outcomes of Sensory Integration Therapy • Improve attention to task, participation and learning • Increase independence in self care tasks • Decrease fear and anxiety • Improve communication • Improve ability to adapt to change/flexibility • Increase socialization • Increase self confidence • Improve ability to explore choices in their environment, community integration

40. Consultation Services • Strategies • Sensory Diet • Home Program * Discuss methods to review or monitor results of sensory diets or home program

41. Sensory Diet vs. Sensory Stimulation • For more information or examples of a sensory diet you can go to: • http://www.sensorysmarts.com/diet.html • http://www.sensorysmarts.com/diet.html#Sample

42. Resource for Sensory Equipment • http://www.southpawenterprises.com • http://www.flaghouse.com • www.abilitations.com • www.sensorycomfort.com

43. Ideas for modifying environment • If easily overwhelmed by change, reduce stress by setting up structured daily routines. • Involve speech therapy to help improve communication strategies. • Provide a calming space when over stimulated. • Establish realistic expectations and adhere to consistent guidelines for intervention. (Behavioral clinician, case manager, social worker or psychologist are good recourses).

44. How to modify environment for Hypersensitivity • Increasing your awareness of environmental stimuli which may cause distress i.e. toilet flushing, vacuum cleaner, dishwasher, fans, bright sunlight, fluorescent lighting. • Reduce the frequency or intensity of problematic stimuli. • Work to develop trust by only providing interaction/input as tolerated.

45. Where can I go to learn more? • American Occupational Therapy Association • Sensory Integration International • Websites, associations or support groups for Autism or Pervasive Development Disorders • Fact sheet for this presentation

46. Alternate Views • SPD often coexist with other conditions. It is possible for SPD to be misdiagnosed. Precautions should be taken so that any other conditions will not be overlooked. • Remember you can not separate mind and body. The effects of stress on the body of a normal nervous system can present similar symptoms of SPD. • Sensory Integrative Therapy often works better in combination with other supports such as speech and behavioral approaches. • Although sensory integration research has been published in peer-reviewed (mostly occupational therapy) journals, most are case studies or have a small sample size. Other professionals have questioned the research design and conclusions/results of these studies. Clearly more research is needed.