practical suggestions susanne smith roley otd, otr/l, faota, arts and autism conference ohio state...
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Practical Suggestions
Susanne Smith Roley OTD, OTR/L, FAOTA, Arts and Autism ConferenceOhio State University, 2015
Positions Held:•Collaborative for Leadership in Ayres Sensory Integration® Founding Member•Ayres Sensory Integration 2020 Vision, Founder•Course Originator, past Project Director and Current Instructor for the Sensory Integration Certification Program, sponsored by USC/WPS•University of Ulster, United Kingdom, Guest Faculty
Occupational Therapist (OT)Private Practice, Orange County, CA.
Over 35 years of experience Evaluation and Advocacy for Children, Young Adults and Families
Dr. Susanne Smith Roley
AWARDS• AOTF A. JEAN AYRES AWARD, 2009
•AOTF VIRGINIA SCARDINA AWARD OF EXCELLENCE, 2004
•AOTA ROSTER OF FELLOWS, 2004•AOTA SERVICE AWARDS:
1996,1999, 2002, 2005, 2006, 2007, 2008
Publications on SI: Co-editor of 2 booksSeveral booklets &Over 35 published
articles
A health and rehabilitation profession
Whose aim is to support health, well-being and participation through engagement inoccupation (activities) and co-occupations (shared activities).
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
A neurobiological process ◦ Modulates the intensity of information◦ Discriminates the detailed sensory
information ◦ Supports motor control, planning and
organization
Ayres Sensory Integration®◦ theory and intervention method ◦ used primarily in occupational
therapy practice ◦ designed originally by A. Jean
Ayres Ph.D., OT◦ with ongoing research
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%...
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)
Crane, Goddard, & Pring, 2009
(Dept of Psychology,
University of London)
Reynolds, Millette, & Devine, 2012
Ben-Sasson, Fluss, & Cermak, 2008
Dziuk et al., 2007 Marco, Hinkley, Hill,
& Magarajan, 2011 Mostofsky et al.,
2006 Siaperas, Ring &
McAllister, 2011
Characterize sensory integration and praxis patterns of children with ASDDiscern whether these patterns relate to social participation
121 children with ASD ages 4 – 11 yearsreceived OT evaluation
69 (57%) completed at least 11/17 SIPT
45 completed SPM-H 23 completed SPM-C
SMITH ROLEY ET AL., 2015SMITH ROLEY ET AL., 2015
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.
SMITH ROLEY ET AL., 2015SMITH ROLEY ET AL., 2015
Motor planning problems (1965, 1966, 1969,1972,1977 & 1989; 1998; 2011, 2015) Visual perception + visual praxis problems (1965, 1966, 1969,1972,1977 & 1989; 1998; 2011, 2015) Vestibular, postural & bilateral problems (1965, 1966, 1969,1972,1977 & 1989; 1998; 2011, 2015) Tactile defensiveness (sensory reactivity/modulation) (1965, 1966, 1969, 1972; 2011) Somatosensory perception problems (1969, 1972, 1977, 1989, 1998, 2011, 2015)
Relative strengths ◦Visual Perception
& Visual Praxis
Significantly low mean scores
1) Imitation Praxis 2) Vestibular Bilateral
Integration and Sequencing 3) Somatosensory
with Tactile and Kinesthetic
Discrimination 4) Praxis on Verbal
Command
SMITH ROLEY , ET AL 2015SMITH ROLEY , ET AL 2015
SPM - Home◦ Definite
Differences in Social Participation
◦ Some Problems in Total Sensory Ideas and
Planning
SPM – Classroom◦ Some Problems in
Social Participation
Total Sensory Ideas and
Planning
SMITH ROLEY ET AL., 2015SMITH ROLEY ET AL., 2015
SPMH-HomeC-Main Classroom
SIPTVis
PercVis
PraxisImitation
PraxisVestib
Bilateral
SomatoSensory
PraxisVerbal 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
•Sample of convenience•Retrospective chart review
•Diagnoses are via parent report
Critical Finding:
Praxis, vestibular and somatosensory functionsbetter predictor of social participation than sensory reactivity
Includes: Relating to and interacting with peersMeals, bedtime, grooming & hygiene, getting ready to go somewhereFamily engagement in neighborhood and community events
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
Adaptability during daily routines Remains organized during structured and unstructured
tasks Ability to divide attention between two or more focused
tasks Ability to monitor own behavior before it becomes a
problem Ability to filter and adjust the intensity and duration of
sensation in order to cope in a busy environment Ability to sustain homeostasis under varying
environmental demands.Schaaf, R. and Smith Roley, S. (2006)
Difficulty forming attachments Feeding and nutrition problems Delayed play and environmental exploration Aggressive outbursts / Withdrawal Caregiver feeling of incompetence due to
unresponsiveness or excessive irritability of child Sleep deprivation interferes with daytime functioning Restricts lifestyle of caregivers Schaaf, R. and Smith Roley, S. (2006)
Sensory Perceptual and
Motor Concerns in ASD
“We must be able to internally represent objects and events before play ability, language, and stable emotional relations can develop. Ayres, 1985”
Decoding information to know what is going on within the person and in the environment
Improves motor control with increase sensory feedback
Initiates engagement in new and novel materials, setting, activity, people
Imitates others Times and sequences interactions
muscle toneeye hand body coordinationbalance & equilibriumsitting still and uprightattentionspeech & language
Attachment/AffectionEating/feedingRefined touch during fine motor activitiesExploration of environmentsAttentionHygiene/toileting
Strength & enduranceGraded force and direction of movements without running into things or breaking somethingUsing appropriate force with hand grip or graspGross motor coordination
Slow to respond Inaccurate responses Poor awareness of
body, self, others Confusion Errors such as
mistaking words
Disinterest in fine motor activities
Does not engage in active play during recess
Tends to engage in running or physical play to the exclusion of more organized games or ball play
Tires easily Falls often Hits head Poor sitting – falls out
of chair Leans on people or
desk
“If one has to think about actions, one is probably motor planning” Ayres,
1985
Iarocci & McDonald, p.81
Use of body as a tool◦ Anticipation◦ Use of hands◦ Imitation - Body◦ Imitation Facial gestures
Use of Objects◦ Creative use of objects◦ Construction◦ Organization
Following directions Creative ideas
Isolation from peers Poor organization Poor safety awareness /
increased injuries Decreased initiation of
activities Poor material
management Messy with clothing and
personal belongings Repetitive play / Less
challenging play
• Increased need for control
• Decreased flexibility and adaptability
• “Wandering”
• Fearful reactions to new/novel situations and activities
• Decreased participation and occupational engagement
Copyright Schaaf, R. and Smith Roley, S. (2006)
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 0.55Figure-Ground Perc. -0.06
Man. Form Perception 0.75
Kinesthesia -2.13Finger Identification -1.62
Graphethesia -2.08Loc. Tactile Stimuli -3.00
Praxis Verb. Command -1.60Design Copying -2.10
Constructional Praxis 0.16Postural Praxis -1.50
Oral Praxis -1.46Sequencing Praxis -1.56
Bilateral Motor Coord -1.70
Stand & Walk Balance -2.60Motor Accuracy -1.79
Postrotary Nystagmus -2.35
4 year 7 mo boy
Autism 1 –16 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1362361313517762 aut.sagepub.com
Day 2 – exhausted, slept well Day 3 – had such a good time, wanted to
come back to OT Day 4 – had a good week at preschool, more
compliant, better transitions, sleeping well Day 5 – so much better organized, improved
language, seems like he understands better, gets himself dressed without much help
Smith Roley, 2015
REPORTED BY FAMILIES OF CHILDREN WITH AN
AUTISM DISORDER
2009 survey sent to all PTN families 210 total parent responses 57 indicated child’s diagnosis autism
spectrum and received OT in past year
Response Percent
Response Count
19.1% 921.3% 1038.3% 184.3% 227.7% 1338.3% 1819.1% 936.2% 1740.4% 19
4710skipped question
feeding
grooming
Answer Options
allergies
answered question
bowel and bladder patterns
bathing
If your child has significant difficulties within any of the areas listed below, please check all that apply.
digestion
dressing
sleep patterns
emotional state/mood
Has your child’s participation in our programs had a positive impact on your family life?
Yes
No
Has your child’s participation in our program had a positive impact on your child’s life?
Yes
No
Response Percent
Response Count
53.6% 3042.9% 2475.0% 4244.6% 2558.9% 3337.5% 2142.9% 2446.4% 2633.9% 1933.9% 19
561
Contributed to feeling hopeful about my child’s future
Helped me explain my child’s behaviors & needs to
Answer Options
Increased my understanding of my child
Assisted me in developing realistic expectations for
Contributed to my greater enjoyment of my child
skipped question
If yes, please check all that apply:
Provided ideas for modifying our home environment to
Decreased my family stress
Provided strategies for managing my child’s behavior
Made it easier to take my child into the community
answered questionMade parenting my child easier
Has your child’s participation in occupational therapy had a positive impact on your family life?
Response Percent
Response Count
35.7% 2057.1% 3248.2% 2741.1% 2328.6% 1646.4% 2650.0% 2826.8% 1526.8% 1542.9% 24
561
My child is more willing to take risks and try new things
My child is less irritable
Answer Options
My child spends more time engaged in positive
My child has increased confidence
My child is more accepting of variety of textures,
skipped question
If yes, check all that apply:
My child spends more time engaged in positive
My child receives better reports from his or her teacher
My child is more a part of family activities
It is easier for my child to make transitions in his or her
answered questionMy child is improving in his or her school performance
Has your child’s participation in occupational therapy had an impact on your child’s abilities or skills?
Response Percent
Response Count
42.6% 2351.9% 2835.2% 1951.9% 2831.5% 1746.3% 2535.2% 1925.9% 14
543
My child's handwriting is better
My child has an easier time making and playing with
Answer Options
My child is more organized
My child is doing better at school
If yes, please check all that apply:
My child has increased attention
answered question
My child has improved balance
My child’s language has improved
skipped question
My child has improved coordination
Has your child’s participation in occupational therapy had an impact on your child’s abilities or skills?
Response Percent
Response Count
13.0% 641.3% 1919.6% 941.3% 1934.8% 164.3% 2
4611
More explanation (rationale) for selection of
Other (please specify)
Increased participation in actual treatment sessions
skipped question
Answer Options
No additional information needed
On-going consultation with therapist to monitor and
answered question
What, if any, additional information would assist you in helping your child appropriately participate and cope with every day activities at home and
Provide written schedule of recommended activities
Try to understand the sensory contribution to behavior
Reduce extraneous sounds and visual clutter in the home & classroom
Infuse body-centered sensory motor activities into daily routine
Refer to an Occupational Therapist Certified in Sensory Integration evaluation & intervention
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While at school, recess is a critical part of the day and must not be taken away due to missed work or other consequence. Vigorous physical activity such as jumping jacks or push-ups will be a better consequence and help regain energy and focus on her work. During breaks, encourage your student to participate in physically active games with other children.
Mobile seating devices such as a peanut ball, ball chair, sit-n-move cushion or therapy ball
Visual and kinesthetic supports for all learning activities in addition to language
Opportunities to do her work in various positions such as standing, in bean bag chair, on large pillows
Zones of Regulation or the Alert Program for Self-Regulation
Positive behavior support strategies Providing chew or fidget toys such as rubber erasers
and stress-balls. Heavy work activities such as scooter board, pushing
book carts, performing errands such as carrying boxes or supplies, playing “tug-of-war,” and climbing on playground equipment.
Frequently scheduled activity or callisthenic breaks Prepare student in advance for transitions and
expectations in new circumstances such as classroom changes or social requirements during field trips or assemblies. Preparation may include understanding where she needs to go, what will happen, what other people will be doing, what she is expected to do, how long it will last, and what happens when it is finished.
Become involved in physical activities during socially appropriate times, before, during and after school and through each and every day. This will enable him to feel like he is solidly in his body, raise his energy level, and increase his attention and ability to focus.
Swinging, moving, and spinning are all advised. If he is having difficulty sitting still, or prior to this demand, it may help to have him go out and swing for 5 minutes or run around the building. Allow him to swing and spin as long as he can stay organized.
Encourage tactile play with a variety of textures and temperatures and wrestling play with a lot of deep pressure. He may enjoy being sandwiched in pillows, wrapped up in a blanket and rolled out, or held snugly while reading a book, which may feel good to him and help him increase his body awareness.
Create spaces that he can burrow into such as a tent with pillows and blankets. He may enjoy playing with a 4 yard length of 60 inch wide Lycra spandex fabric. He could wrap up in it or use it as a hammock to swing in. Provide heavy bean bag chairs that he can crawl between and jump into.
Jumping, climbing, hanging, pushing and pulling activities will also be organizing for him. These are particularly useful if your child is feeling anxious, frustrated, sluggish, or inattentive. Provide opportunities for him to play on bouncing equipment such as trampoline, bungy swings, pogo sticks, or jumping boots. Weight bearing games are integrating such as during wheel-barrow walking.
Increase awareness of time through use of clocks and stop watches during fun activities in which he is not required to perform, such as timing how long it takes to make dinner or start the car.
Interactive and cooperative games in which different children can make up and change the directions while maintaining their engagement in the game will be beneficial.
Provide your child opportunities for jumping and skipping during outside play. He may like to draw large circles with chalk either on a blackboard or cement using both hands simultaneously.
Prepare your child for transitions in advance. He may be more independent if there is a visual chart of activities that are necessary in the daily routines such as the elements needed before going to bed or what is involved in meal preparation and table setting. Set a timer to give him the temporal cues about how much time he has to complete independent tasks such as dressing.
In a neutral atmosphere, explain social expectations and how other people react in a variety of circumstances. Prepare him in advance for social situations so that he knows what to expect and how to behave. He may prefer to either be the first or last one to arrive.
Active, physical, community based activities such as swimming, gymnastics, horseback riding, and martial arts are encouraged.
In order for your child to develop optimally and feel healthy and happy, it is important that he maintains an active life-style throughout his life.
Sensory Reactivity◦ Over responsiveness◦ Under responsiveness◦ Fluctuating responsiveness◦ Poorly regulated behaviors
Vestibular-Proprioceptive Processing◦ Security with Movement◦ Seeking rotation and watching
things spin◦ Ocular Control
Head/neck/eye control Gaze shifting
◦ Postural Control – Head lag Asymmetry Righting and Equilibrium
Somatosensory Discrimination◦ Seeking touch◦ Seeking heavy
work/proprioception◦ Body awareness◦ Hand use◦ Graded force and direction of
movements
Praxis◦ Transition Movements◦ Tool use◦ Exploration of novelty◦ Exploration of body in space◦ Imitation◦ Sequencing◦ Ideation and complexity in play◦ Following unfamiliar instructions
Heightened sensitivity to sound, light, touch, smells, and movement, may misinterpret accidental touch by peers
May be fussy or irritable, especially with noise or unexpected events Diminished sensitivity to pain, certain sounds, and pressure; may be
passive, lethargic or unresponsive. May not communicate about pain Peculiar interest in certain sensations like looking at lights, spinning
objects, feeling lint or twirling around. Seeks sensory information which limits awareness of everything else.
Self stimulating behaviors such as head banging or rocking that interfere with social interactions or play, may injure self
Decreased initiation of social contact, making sounds, bringing toys, movements or indicating desire to share excitement
Picky eater, gags with certain textures or smells Difficulty visually following people or objects,
difficulty shifting gaze in the classroom
Difficulty orienting self to a person or objects Diminished anticipation of caregiver interaction Decreased response to someone calling his/her name Preference for looking at forehead or mouth instead of eyes when
looking at people Difficulty maintaining an upright sitting position, often “props up” head
while leaning on arm Poor sitting balance, falls easily, hits head often Decreased tendency to look where others look or to use pointing to
engage others’ interest Difficulty visually following people or objects Difficulty shifting gaze to look where other people are looking
Poor social communication, turn taking and understanding others’ interests and points of view
Decreased imitation of games such as peek a boo or hand gestures in songs
Delayed use of gestures such as waving bye, bye or blowing kisses
Limited repertoire of facial expressions Poor tolerance for two- way, back and forth exchanges Difficulty accomplishing multi-step routines such as
grooming and managing clothing and backpacks Poor tool use such as eating with utensils or drawing with
crayons Decreased speech and language abilities Difficulty with transitions in place or activities
Sensory Integration & the Child by A. Jean Ayres
Sensory Integration: Answers for ParentsSensory Integration: Answers for TeachersSensory Integration: Answers about AutismSensory Integration: Answers for Mealtime SuccessApplying Sensory Integration Principles Where Children Live, Learn & Play (DVD)
◦ www.pediatrictherapynetwork.org
