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What is the evidence? Why does it matter? Sue Allen Clinical Specialist Occupational Therapist Royal Berkshire Hospital, Reading. Chair, Sensory Integration Network (UK and Ireland). 3 SAllen NAS 2011
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high and consistent levels of impairing sensory problems from childhood to adulthood in almost all individuals diagnosed with classic autism Klintwall 2010 5 SAllen NAS 2011
5-15 % general population (Miller 2006) 70% incidence of Sensory Modulation Disorder (Adamson and O Hare 2006) 6 SAllen NAS 2011
Sensory Modulation Difficulties 70 to 90 % Adamson 2006 7 SAllen NAS 2011
Sensory Processing and Integration issues Pain and hearing were the most commonly affected modalities (Klintwall 2010) Adults with Autism report more sensory sensitivity to touch, vision, sound, smell, taste and movement (Tavossoli 2010) 8 SAllen NAS 2011
Sensory Processing and Integration issues Children with ASD demonstrate low scores on all tests of praxis compared with typically developing children (Siaperas 2011) 90% Motor Difficulties (Green 2010) 9 SAllen NAS 2011
Neuroscience Multisensory enriched environments, contextualised with cognitive demand facilitate neuroplasticity and thus growth, development and behaviour (Lane and Schaaf 2010) 10 SAllen NAS 2011
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How do sensory processing and integration difficulties impact on every day life? 12 SAllen NAS 2011
Sensory processing impacts on Occupation Adapted from Koenig and Rudney 2010, Jasmin 2009 13 SAllen NAS 2011
Assessment may include: Questionnaires e.g. Sensory Profile, Sensory Processing Measure Observation of motor skills and response to sensation Standardised Assessment e.g. Sensory Integration and Praxis Tests 14 SAllen NAS 2011
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Approaches to Intervention 1. Sensory Integration Therapy 2. Provide consultation including education and activity planning with carers, identification of sensory strategies for daily life 16 SAllen NAS 2011
1. Sensory Integration Therapy Parham 2011 1:1 treatment with an Occupational Therapist, Physiotherapist or Speech and Language Therapist who has received post graduate training in Sensory Integration Treatment sessions meet specific criteria including multiple sensory experiences, novelty in the environment, active engagement in challenging cognitive, sensory and motor tasks 17 SAllen NAS 2011
Treatment Space 18 SAllen NAS 2011
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1. Sensory Integration Therapy Greater changes than active control group in Cognitive/ Social and electrodermal activity Changes in self stimulatory behaviour Changes in Individualised goals Changes in sensory behaviours Miller 2010, Pfeffer 2012 20 SAllen NAS 2011
Author Design Subjects Age range (years) Smith 2005 ABAB OT-SI vs Table Top 7 PDD or Severe mental Retardation Summary OT/SI Autistic Spectrum Intervention 8-19 Mixed 5 sessions per week of 30 minutes Outcome Significant Reduction in Self Stimulatory Behaviour Miller 2007 OT-SI vs Activity vs No Rx 24 (15 with ADHD, 1 Anxiety) 3-11 NO 20 x 1 hour sessions over 10 weeks Significant gains in individualised GAS, Attention, Cognitive/ social and reduced Electrodermal responsivity amplitude Pfeiffer 2011 OT-SI vs Fine Motor 37 6-12 All 18 X 45 mins over 6 weeks Significant positive changes in GAS (Sensory processing, motor skills and social functioning) 21 Sue Allen and Sue Delport Nov 2011
OT/ SI Adult Population Urwin and Ballinger s (2005) study conducted with adults with learning disabilities indicate that there are changes in behaviours associated with sensory processing difficulties after Sensory Integration assessment and intervention. Further studies are needed to confirm and support these findings. 22 SAllen NAS 2011
Consultation To parent, teachers or careers to support understanding and shared development of support strategies e.g. Warm ups before seated activities 23 SAllen NAS 2011
Consultation What are my own sensory needs? What strategies are available to me? How can I use the environment or myself for self regulation? How will my choice of daily activity influence my ability to develop? 24 SAllen NAS 2011
Sensory Strategies/ Techniques 1) Touch based treatments e.g. Massage led to changes in touch aversion, joint attention and initiating behaviour also reduction in autistic behaviours 2) Weighted Vests mixed evidence 3) Therapy balls as a seating alternative substantial improvement on in seat behaviour 25 SAllen NAS 2011
Adamson A, O'Hare A and Graham C. (2006) Impairments in Sensory Modulation in Children with Autistic Spectrum Disorder. BJOT 69(8)357-364 AOTA (2011) Occupational therapy Practice Guidelines for Children and Adolescents with Challenges in Sensory Procesing and Sensory Integration Ayres AJ (1979) Sensory Integration and the Child Bagatelle N (2010) Effectiveness of therapy ball chairs on classroom participation in children with autism spectrum disorder. American Journal of Occupational Therapy 64(6)p.895-903 Ben Sasson A et al(2008) A Meta-analysis of Sensory Modulation Symptoms in Individuals with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders 39(1)1-11. Bundy AC, Lane SJ, Murray EA (2002) Sensory Integration: Theory and Intervention Cosby J, Johnston SS (2010) Sensory Processing Disorders and Social Participation AJOT May/June 2010 64(3) 462-473 Jasmin E et al (2009) Sensori-motor and Daily Living Skills of Preschool Children with Autism Spectrum Disorders Jasmin et al (2009) Sensori-motor and daily living skills of preschool children with autistic spectrum disorder. Journal of Autism and Developmental Disorders39/2(231-241) 26 SAllen NAS 2011
Klintwall L et al (2010) Sensory Abnormalities in Autism. Research In Developmental Disabilities doi:10.1016/j.ridd.2010.10.021 Koenig KP, Rudney SG (2010) Performance Challenges for Children And Adolescents with Difficulty Processing and Integrating Sensory information: A Systematic Review. American Journal of Occupational Therapy 64(3) p430-442 Lane SJ and Schaaf RC (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) pp.375-390 May Benson TA, Koomar J (2010) Systematic Review of he Research Evidence Examining the Effectiveness of Interventions Using a Sensory Integrative Approach for Children American Journal of Occupational Therapy 64(3) p403-414. Miller LJ (2007) Sensational Kids Mullen.B, Champagne,T. Krishnamurty,S. Dickson,D. Gao, R. (2008) Exploring the Safety and Therapeutic effects of Deep Pressure Stimulation Using a Weighted Blanket. Parham LD et al (2011) Development of a Fidelity Measure for Research on the Effectiveness of the Ayres Sensory Integration Intervention. American Journal of Occupational Therapy. 65(2) p133-142 27 SAllen NAS 2011
Pfeiffer BA et al (2011) Effectiveness of Sensory Integration Interventions in Children with Autism Spectrum Disorders: A Pilot Study. American Journal of Occupational Therapy 65(1) p76-85 Schaaf R (2011) Interventions That Address Sensory Dysfunction in Individuals with Autism Spectrum Disorders: preliminary Evidence for the Superiority of Sensory Integration Compared to Other Sensory Approaches. In Kazdin AE Evidenced-based Practices for Children with Autism Schaaf R, Davies P.L., (2010) The Evolution of Sensory Integration Frame of Reference.AJOT64(3) 363-367. Smith Roley S (2001) Understanding the Nature of Sensory Integration with Diverse Populations Tanzer U (2009) Chewing Gum and concentration performance. Psychological Reports 105(2)p372-4 Tavisolli (2010) Sensory Processing in Autism www.autismresearchcentre.com Urwin, R, Ballinger, C (2005) The Effectiveness of Sensory Integration Therapy to improve Functional Behaviour in Adults with Learning Disabilities: Five Single-Case Experimental Designs, B.J.O.T., 68(2) 28 SAllen NAS 2011