Slide 1 CPRI - Child and Parent Resource Institute · 2016-05-03 · Slide 1 CHILD & PARENT CPRI RESOURCE INSTITUTE MINISTRY OF CHILDREN AND YOUTH SERVICES Sensory Integration Issues

Slide 1 CHILD & PARENTRESOURCE INSTITUTECPRI MINISTRY OF CHILDREN

AND YOUTH SERVICES

Sensory Integration Issues in Children with Mental Health and Behavior Concerns

Authors: Kathryn Harris OT Reg.(Ont.) ², Laurie Francis OT Reg.(Ont.)², Lisa Hoyland OT Reg.(Ont.) ² Contributors: Dr. Ajit Ninan F.R.C.P.(C)²'³ , Stefanie Bodison OTD, OTR/L¹

'University of Southern California, Los Angeles, California ²Child and Parent Resource Institute, London, Ontario ³Schulich School of Medicine and Dentistry at Western University, London, Ontario

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Slide 2 CHILD & PARENTRESOURCE INSTITUTECPRI

Who are we? ServicesWe provide highly specialized, trauma-informed mental health and developmental services:

AssessmentConsultationTreatmentResearchEducationOur services are:

AccessibleInclusive

Culturally-sensitiveIndividualizedEvidence-informed

Our mission is to support children and youth with complex mental health or developmental challenges in reaching their full potential and enhancing their quality of life.

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Slide 3 CHILD & PARENTRESOURCE INSTITUTECPRI

LEARNING OBJECTIVES

• Understand the principles of Sensory Integration Theory

• Identify behavioural and daily functioning challenges that may be related to sensory integration issues

• Screening for sensory integration challenges and making appropriate referrals

• Integrate sensory based strategies into home, school, and community settings

• Take away tools and resources3

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Slide 4 CHILD & PARENTRESOURCE INSTITUTECPRI

The 7 Senses Sensations That Tell Us What is Coming From

Outside the Body (Exteroceptors)

1)Sound (or Auditory Sense)

2)Sight (or Visual Sense)

3)Taste (or Gustatory Sense)

4)Smell (or Olfactory Sense)

5)Touch (or Tactile Sense)(The Sensory Gang – Myles, Cook et al 2000)

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Slide 5 CHILD & PARENTRESOURCE INSTITUTECPRI

Sensations That Tell Us Where The Body is in Space and How it is Moving

6) Position, Force, Body movement(Proprioceptive Sense)

7) Gravity, Head Movement and Balance(Vestibular Sense)

(The Sensory Gang – Myles, Cook et al 2000)

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Slide 6 CHILD & PARENTRESOURCE INSTITUTECPRI

ACTIVITY

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What do you do to self regulate ?

(increase alertness or achieve a calm

state)

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Slide 7 CHILD & PARENTRESOURCE INSTITUTECPRI

AYRES SENSORY INTEGRATION®

7Ayres, A. J. (1972). Sensory integration and learning disorders. Los Angeles, CA: Western Psychological Services.Ayres, A. J. (1975). Sensorimotor foundations of academic ability. In W. M. Cruickshank & D. P. Hallahan (Eds.), Perceptual and Learning Disabilities in Children (vol. 2). New York, NY: Syracuse University Press.Authors: Stefanie Bodison OTD, OTR/L, Lisa Hoyland OT Reg.(Ont.), Kathryn Harris OT Reg.(Ont.), Laurie Francis OT Reg.(Ont.), Dr. Ajit Ninan F.R.C.P.(C)

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Slide 8 CHILD & PARENTRESOURCE INSTITUTECPRI

AYRES SENSORY INTEGRATION®

Sensory Modulation

Over-responsivity Under-responsivity

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• Tactile Defensiveness

• Gravitational Insecurity

• Intolerance to movement

• Under-responsiveness to movement

Ayres, A. J. (1972). Sensory integration and learning disorders. Los Angeles, CA: Western Psychological Services.Ayres, A. J. (1975). Sensorimotor foundations of academic ability. In W. M. Cruickshank & D. P. Hallahan (Eds.), Perceptual and Learning Disabilities in Children (vol. 2). New York, NY: Syracuse University Press.

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Slide 9 CHILD & PARENTRESOURCE INSTITUTECPRI

AYRES SENSORY INTEGRATION®

Sensorimotor Integration

Postural Related Praxis / Motor Planning

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• Postural Responses• Vestibular-ocular

control• Vestibular-bilateral

integration

• Body Schema• Somatodyspraxia• Ideation

Ayres, A. J. (1972). Sensory integration and learning disorders. Los Angeles, CA: Western Psychological Services.Ayres, A. J. (1975). Sensorimotor foundations of academic ability. In W. M. Cruickshank & D. P. Hallahan (Eds.), Perceptual and Learning Disabilities in Children (vol. 2). New York, NY: Syracuse University Press.

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Slide 10 CHILD & PARENTRESOURCE INSTITUTECPRI

Authors: Stefanie Bodison OTD, OTR/L, Lisa Hoyland OT Reg.(Ont.), Kathryn Harris OT Reg.(Ont.), Laurie Francis OT Reg.(Ont.), Dr. Ajit Ninan F.R.C.P.(C)10

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Slide 11 CHILD & PARENTRESOURCE INSTITUTECPRI

Does my client have sensory issues?

11Authors: Stefanie Bodison OTD, OTR/L, Lisa Hoyland OT Reg.(Ont.), Kathryn Harris OT Reg.(Ont.), Laurie Francis OT Reg.(Ont.), Dr. Ajit Ninan F.R.C.P.(C)

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Slide 12 CHILD & PARENTRESOURCE INSTITUTECPRI

DEMOGRAPHICS OF THE SAMPLE• 135 clients admitted over 3 calendar years 2010 – 2013• 2 female / 133 male

• 83 children met criteria for chart review (61 % of those admitted)

• N=30 (agreed to participate in retrospective chart review)• Within this group all were male• Age range of sample 6.6 years to 12.5 years • Mean Age (Standard Deviation) 9.63 years (1.47)

12Authors: Stefanie Bodison OTD, OTR/L, Lisa Hoyland OT Reg.(Ont.), Kathryn Harris OT Reg.(Ont.), Laurie Francis OT Reg.(Ont.), Dr. Ajit Ninan F.R.C.P.(C)

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Slide 13 CHILD & PARENTRESOURCE INSTITUTECPRI

DSM - IV Diagnosesn = 30

0 50 100

Mood Disorder (NOS)

Learning Disorder (NOS)

Expressive LanguageDisorder

Tourette Syndrome

Obsessive CompulsiveDisorder

Anxiety Disorder (NOS)

ADHD Combined Type

% of sample

23.3 %

12.5 %

9.4 %

9.4 %

9.4 %

13

56.7 %

36.7 %

Authors: Stefanie Bodison OTD, OTR/L, Lisa Hoyland OT Reg.(Ont.), Kathryn Harris OT Reg.(Ont.), Laurie Francis OT Reg.(Ont.), Dr. Ajit Ninan F.R.C.P.(C)

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Slide 14 CHILD & PARENTRESOURCE INSTITUTECPRI

Primary Caregiver Priority Concernsn = 30

0 20 40 60 80 100

* Other

Suicidal Ideation

Sexualized Behaviors

Anxiety

Theft

Safety

Self-Injurious Behavior

Elopement

Property Destruction

Verbal Aggression

Physical Aggression

% of sample

90.6 %

62.5 %

40.6 %

37.5 %

15.6 %

15.6 %

12.5 %

9.4 %

9.4 %

9.4 %

46.67 %

14• Other includes (n): refuses to do school work (2), alcohol consumption (1), anhedonic tendencies (1), chewing holes in clothes (1), cutting tags off clothes (1), excessive eating (1), impulsivity (1), inattention (1), minimal frustration tolerance (1), non-compliance (1), problems with social skills (1), risky behaviors (1).

Authors: Stefanie Bodison OTD, OTR/L, Lisa Hoyland OT Reg.(Ont.), Kathryn Harris OT Reg.(Ont.), Laurie Francis OT Reg.(Ont.), Dr. Ajit Ninan F.R.C.P.(C)

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Slide 15 CHILD & PARENTRESOURCE INSTITUTECPRI

Scores on the Sensory Processing Measure Indicating Some Problems or Definite Dysfunction

0 20 40 60 80 100

Total SPM Score

Social

Vision

Hearing

Touch

Body Awareness

Balance

Planning & Ideas

School SPM Scores(n=28)Home SPM Scores(n=29)

15% of sampleAuthors: Stefanie Bodison OTD, OTR/L, Lisa Hoyland OT Reg.(Ont.), Kathryn Harris OT Reg.(Ont.), Laurie Francis OT Reg.(Ont.), Dr. Ajit Ninan F.R.C.P.(C)

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Slide 16 CHILD & PARENTRESOURCE INSTITUTECPRI

Sensory Modulation Issues Identified During OT Evaluation

Overall 84.4 % of sample

Auditory Sensitivity 75%

Tactile Defensiveness 56.3 %

Intolerance to Movement 40.6 %

16Authors: Stefanie Bodison OTD, OTR/L, Lisa Hoyland OT Reg.(Ont.), Kathryn Harris OT Reg.(Ont.), Laurie Francis OT Reg.(Ont.), Dr. Ajit Ninan F.R.C.P.(C)

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Slide 17 CHILD & PARENTRESOURCE INSTITUTECPRI

Sensorimotor Integration Issues Identified During OT Evaluation

Overall 50 % of sample

Postural Control 37.5 %

Praxis 43.8 %

17Authors: Stefanie Bodison OTD, OTR/L, Lisa Hoyland OT Reg.(Ont.), Kathryn Harris OT Reg.(Ont.), Laurie Francis OT Reg.(Ont.), Dr. Ajit Ninan F.R.C.P.(C)

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Slide 18 CHILD & PARENTRESOURCE INSTITUTECPRI

RELATIONSHIP BETWEEN DIAGNOSES & SENSORY PROCESSING CONCERNS

0102030405060708090

100

SensoryModulation

Issues

SensorimotorIntegration Issues

ADHD Combined TypeOCDAnxiety

94.1 %

85.7 % 81.8 %

52.9 % 42.9 % 54.5 %

18Authors: Stefanie Bodison OTD, OTR/L, Lisa Hoyland OT Reg.(Ont.), Kathryn Harris OT Reg.(Ont.), Laurie Francis OT Reg.(Ont.), Dr. Ajit Ninan F.R.C.P.(C)

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Slide 19 CHILD & PARENTRESOURCE INSTITUTECPRI

Pathways.org Resources

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• Printable Developmental Milestone Checklists

• Printable Sensory Motor Checklists

• Printable Brochures (e.g. Play; Tummy Time; Intro to Sensory Integration)

• On line Videos

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Slide 20 CHILD & PARENTRESOURCE INSTITUTECPRI

Providers of Occupational Therapy Service

• Infant Development Services• Children’s Treatment Centers • School Health Support Services (consultative for

school based issues)• Children’s Mental Health Services (may have

occupational therapy services)• Tertiary Level Mental Health & Developmental Service

Provider (e.g. Child & Parent Resource Institute)• Private Practice Occupational Therapy

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Slide 21 CHILD & PARENTRESOURCE INSTITUTECPRI

Direct versus Consultative Occupational Therapy

Direct Therapy One-on-One (e.g. sensory rich

therapy space)

School & Home

Consultation(e.g. sensory

diet)

Environmental Modification

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Slide 22 CHILD & PARENTRESOURCE INSTITUTECPRI

SELF REGULATION

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Just Right Level of

Alertness

• Optimum Band of Alertness• Signs of Difficulty with Self-Regulation

• Strategies: co-regulation; scan the environment; pre-plan; abandon the activity; the just-right challenge; follow the child’s lead; celebrate success

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Slide 23 CHILD & PARENTRESOURCE INSTITUTECPRI

Sensory Strategies for Self Regulation

Sensory Based Cognitive Strategies e.g. Alert Program

Preventative Sensory Diet Activities

Equipment to help maintain optimal level of alertness

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Slide 24 CHILD & PARENTRESOURCE INSTITUTECPRI

Seating Providing Movement Input• Caution: Provide only if recommended by OT

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Slide 25 CHILD & PARENTRESOURCE INSTITUTECPRI

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Items Providing Input into Muscles and Joints and Deep Pressure Touch (caution: provide only if recommended by OT)

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Slide 26 CHILD & PARENTRESOURCE INSTITUTECPRI

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Fine Motor/Handwriting Strategies (caution: provide only if recommended by OT)

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Slide 27 CHILD & PARENTRESOURCE INSTITUTECPRI

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Fidget Items and Chewable Items (caution: provide only if recommended by OT)

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Slide 28 CHILD & PARENTRESOURCE INSTITUTECPRI

INTERVENTION STRATEGIES FOR SENSORY SENSITIVITIES

Remove noxious stimuli

Restorative niche

Movement / Alternate seating

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Slide 29 CHILD & PARENTRESOURCE INSTITUTECPRI

SENSORY DIETUSE OF SENSORY INPUT TO PROMOTE CHANGE

INHIBITORY• Slow deep pressure, neutral warmth, slow rhythmic

movement• Vibration, soft music

EXCITATORY • Light intermittent touch, cold, irregular or fast movement, loud

sounds

ORGANIZING• Reduce visual & auditory stimuli, regular tempo• Heavy work, resistive exercise, push/pull, weight bearing• Oral motor chewing, blowing

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Slide 30 CHILD & PARENTRESOURCE INSTITUTECPRI

INTERVENTION STRATEGIES FOR MOTOR PLANNING AND MOTOR COORDINATION ISSUES

Increase the level of “helper”

Reduce social demands

Alter task or activity

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Slide 31 CHILD & PARENTRESOURCE INSTITUTECPRIJUST RIGHT CHALLENGE

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Slide 32 CHILD & PARENTRESOURCE INSTITUTECPRI

HEAVY WORK STRATEGIES

HouseholdActivities

School Helper

Leisure Community

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Slide 33 CHILD & PARENTRESOURCE INSTITUTECPRI

HEAVY WORK - Break Away Activity

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Gross Motor Equipment

Hand Held Items

SeatingLifting/ Carrying

Pushing / Pulling

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Slide 34 CHILD & PARENTRESOURCE INSTITUTECPRI

ORGANIZING & CALMING HEAVY WORK STRATEGIES

FEEDBACK FROM GROUPS

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Pushing / Pulling

Lifting/ Carrying

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Slide 35 CHILD & PARENTRESOURCE INSTITUTECPRI

QUESTIONS

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Slide 36 CHILD & PARENTRESOURCE INSTITUTECPRI

References/Resources• Some parts of presentation “Based on material

developed by Pediatric Therapy Network, 2011”• Sensory Integration – Answers for Teachers; Sensory

Integration – Answers for Parents (Susanne Smith Roley, Zoe Mailloux and Gina Geppert Coleman)

• Sensory Integration and Praxis Tests Course 1 and 4 notebooks 2012

• Sensory Integration and the Child – 25th Anniversary Edition – By A. Jean Ayres

• www.pathways.org• “How Does Your Engine Run?” A Leader’s Guide to the

Alert Program for Self-Regulation, Mary Sue Williams, Sherry Shellenberger (1996)

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Slide 37 CHILD & PARENTRESOURCE INSTITUTECPRI

References/Resources• Asperger Syndrome and Sensory Issues, Practical Solutions for

Making Sense of the World, Brenda Smith Myles et. al. (2000)• Take Five! Staying Alert at Home and School, Mary Sue Williams,

Sherry Shellenberger (2001)• Sensory Integration, Answers for Teachers, Gina G. Coleman, Zoe

Mailloux, Susanne Smith Roley (2006)• Sensory Integration, Answers for Parents, Gina G. Coleman, Zoe

Mailloux, Susanne Smith Roley (2004)• The Out-of-Sync Child Has Fun, Activities for Kids with Sensory

Integration Dysfunction, Carol Stock Kranowitz (2003)• The Sensory Team Handbook, Nancy Mucklow (2009)

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