10/19/2022 Sensory Processing & Autism Melinda Cooper Senior Product Manager – Occupational Therapy October 19, 2022 1 1 Introducing our presenters and panelists Shelley Hughes, OTR Director, Portfolio Management & Delivery - Therapeutics Melinda Cooper, OT Senior Product Manager - Occupational Therapy Liz Grose, SSP, NCSP Senior Assessment Consultant & Regional Manager, East Becky Whalen, MA CCC-SLP Assessment Consultant 2 2 Disclosure Financial: Shelley Hughes and Melinda Cooper are employed by Pearson Clinical Assessment. Non‐financial disclosure: There are no relevant non‐financial relationships to disclose. The Pearson Assessment Division, the sponsor of this webinar, develops and distributes assessments and intervention tools for speech‐language pathologists, occupational therapists, and psychologists. This webinar will address appropriate use of the Sensory Profile 2 and Adolescent/Adult Sensory Profile. These assessments are published by Pearson. 3 3 Copyright © 2021 NCS Pearson, Inc. or its affiliates. All rights reserved. 1 10/19/2022 Requirements to receive AOTA CE credit Pearson will provide attendees with a certificate of continuing education if you: • Attend the entire 60 minutes of the live session (confirmed by our verification report) • Participate in the knowledge check questions in the post webinar survey (participation is audited) Pearson can NOT provide a certificate of continuing education credit if you: • Didn't attend the live presentation in its entirety. • Request “Partial credit” [not available] • View the webinar recording after the live event Questions about CEUs? Contact Darlene Davis at: ClinicalTraining@pearson.com 4 4 Learner Outcomes Based on the content of the workshop, participants will be able to: 1. List three reasons why sensory differences may impact participation for individuals with autism. 2. Identify three strategies which can be employed to support the sensory needs of individuals with autism. 3. Explain how an atypical sensory processing pattern can be used as a strength. 4. Describe two standardized assessment tools available for the identification of sensory preferences of people with autism. 5 5 Agenda 10:30 – 10:55 Introduction to sensory processing and Dunn’s sensory processing framework 10:55 – 11:00 Overview of the Sensory Profile 2 and Adolescent/Adult Sensory Profile 11:00 – 11:15 Implications of sensory processing differences for participation at school, and interventions to assist 11:15 – 11:25 Review of recent research on sensory processing and autism 11:25 – 11:30 Questions and Answers 6 6 Copyright © 2021 NCS Pearson, Inc. or its affiliates. All rights reserved. 2 10/19/2022 Introduction to sensory processing and Dunn's sensory processing framework 7 7 Sensory Processing • The process of detecting information via internal and external sensory receptors, then receiving and organizing it in the brain to shape a response. DSM-5 diagnostic criteria for autism include • Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement). American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013. 8 8 "The experience of being human is embedded in the sensory events of everyday life" (Dunn, 2001) Dunn, W. (2001). The sensations of everyday life: Empirical, theoretical, and pragmatic considerations, 2001 Eleanor Clarke Slagle lecture. American journal of Occupational Therapy, 55, 608‐620. 9 9 Copyright © 2021 NCS Pearson, Inc. or its affiliates. All rights reserved. 3 10/19/2022 Dunn’s Sensory Processing Framework (Dunn, 2014) 10 10 Registration More than others • ‘Miss’ sensory information • I don’t smell things that other people say they smell • Easygoing Less than others • Notices things others would miss • Eye for small detail • “Sherlock Holmes” 11 Seeking More than others • Continually adding sensory input to tasks • I add spice to my food • Curious, engaged with sensation • Consider function/purpose of the seeking behavior Less than others • Not overly interested in sensory experiences • Comfortable in low-stimulus environments 12 Copyright © 2021 NCS Pearson, Inc. or its affiliates. All rights reserved. 4 10/19/2022 Sensitivity More than others • Continually detecting sensory input • I startle easily • Heightened awareness to sensation Less than others • Filters out sensations • Less likely to be distracted by extraneous input 13 13 Avoiding More than others • Withdraws from overwhelming sensory input • I only eat familiar foods • Thrives on routine, familiarity, control Less than others • Thrives on spontaneity, change, lack of routine 14 14 Overview of the Sensory Profile 2 and Adolescent/Adult Sensory Profile 15 15 Copyright © 2021 NCS Pearson, Inc. or its affiliates. All rights reserved. 5 10/19/2022 Sensory Profile 2 • Standardized sensory processing questionnaire • Measures sensory processing patterns as reported by caregiver or teacher • Ages birth – 14:11 •Infant •Toddler •Child •School •Short 16 16 Adolescent / Adult Sensory Profile • Standardized sensory processing questionnaire • Measures sensory processing patterns via self report • Ages 11:0 – 65+ years 17 17 There is no "right" or "wrong" Sensory Profile • Neither the SP-2 nor the AASP seek to label or diagnose dysfunction • Help gain a holistic picture of the person • Understand the level of fit between sensory preferences and sensory stimuli in environment • Identify and remediate barriers to participation • Not designed as outcome measures 18 18 Copyright © 2021 NCS Pearson, Inc. or its affiliates. All rights reserved. 6 10/19/2022 Implications of sensory processing differences for participation at school, and interventions to assist 19 19 Participation Physical Environment • Building design • Sensory qualities of the environment • Furniture and materials • Weather Social Environment • Proximity of adult support • Attitudes of others • Group / peer culture • Rules Appropriate Services • Difficulty accessing needed services • Services not individualized • Transportation Task Demands • Physical • Sensory • Motor • Cognitive • Social What are the barriers to participation for the individual? (Coster et al., 2013) 20 20 Participation challenges for high threshold At risk of under-stimulation • Being seated for long periods • May miss verbal / auditory instructions • May miss visual social / nonverbal communication cues • Limited opportunities to gain additional stimulation within constraints of class schedule / environment • May be labelled as disruptive / distracting due to seeking behavior • Difficulty switching between sensory modalities (e.g. visual/auditory) 21 21 Copyright © 2021 NCS Pearson, Inc. or its affiliates. All rights reserved. 7 10/19/2022 Participation strengths for high threshold Tolerance for input is a "superpower" • Enthusiastic, curious and willing to try new things (seekers) • Less likely to be bothered by highly stimulating environments • Easygoing, less likely to be disruptive (bystanders) • Seekers' seeking behavior may facilitate their engagement and show you what they need more of 22 22 Principles for Intervention – high threshold 23 23 Participation challenges for low threshold At risk of over-stimulation • May have difficulty with change / novelty • May have fight/flight responses to certain environments • May be seen as distractible and have difficulty completing work on time • Need for control may impact on social abilities • School is a "one size fits most" environment 24 24 Copyright © 2021 NCS Pearson, Inc. or its affiliates. All rights reserved. 8 10/19/2022 Participation strengths for low threshold Heightened awareness is a "superpower" • May excel at creative/arts • Some autistic individuals show enhanced visual processing, particularly in visual search activities • Observant and aware of subtle changes • Responds well to sameness and routine • May work well in self-directed or solitary activities 25 25 Principles for Intervention – low threshold 26 26 Common Sensory Supports Movement (Proprioceptive and Vestibular) • Classroom errands • Brain breaks, movement breaks, yoga • Multi-sensory learning Visual • Changing lighting to more natural light • Reduce visual stimuli on walls • Preferential seating Auditory • Alerting feature e.g.bell • Preferential seating • Noise reducing headphones or ear plugs (Asher, 2017; Bodison & Parham, 2018; Dunn, 2014) Tactile • Permitted "fidgets" • Adjust physical environment to minimize unexpected touch 27 27 Copyright © 2021 NCS Pearson, Inc. or its affiliates. All rights reserved. 9 10/19/2022 What about when all four quadrants are atypical? This Photo by Unknown author is licensed under CC BY‐SA. 28 28 Interpretation in context • It's not uncommon to see a score profile where all quadrants show a difference • Scores by themselves are not that meaningful • Focus on a specific goal or problem • Use Sensory Profile data to formulate evidence-based recommendations • Recommendations should be linked to the goal or problem 29 29 "Everyone is a genius. But if you judge a fish by its ability to climb a tree, it will live its whole life believing that it is stupid.” (Unknown) 30 30 Copyright © 2021 NCS Pearson, Inc. or its affiliates. All rights reserved. 10 10/19/2022 Strengths-Based Approach • Build on an individual's strengths • Shift away from thinking how an individual can "fit in" • Shift away from deficit-based focus • Aligns with WHO ICF Model (2007) • Encourages self-advocacy • Improves self-determination • Closing the gap between capabilities and expectations (Dunn et al., 2017, p. 240) 31 31 Recent research 32 32 Executive Functioning: A Mediator Between Sensory Processing and Behaviour in Autism Spectrum Disorder (Fernandez-Prieto et al. 2021) • Hypothesized that executive function deficits are associated with greater behavioral problems and sensory processing impairments • n =79 (65 male) with ASD diagnosis aged 4-16 years • Sensory Profile 2 Child form, Child Behavior Checklist • Increased reactivity to touch or body movement may be linked to emotion regulation difficulties in children with ASD • Executive functions at the emotion regulation and control level mediated the relationship between sensory processing differences and behavioral problems • Possible that autistic children/adolescents with atypical sensory profiles more likely to show decreased emotion regulation and control • No mediation effects of working memory found Journal of Autism and Developmental Disorders (2021) 51:2091–2103 https://doi.org/10.1007/s10803‐020‐04648‐4 33 33 Copyright © 2021 NCS Pearson, Inc. or its affiliates. All rights reserved. 11 10/19/2022 The impact of atypical sensory processing on social impairments in autism spectrum disorder (Thye et al. 2018) • Reviewed behavioral and neurobiological studies on social and sensory processing in ASD to explore the relationship between the two • Sensory atypicalities are one of the earliest emerging markers of infants later diagnosed with ASD • Atypical sensory processing in ASD can interfere with obtaining an accurate assessment of skills, progression of therapy, and intervention outcomes • Sensory hyposensitivity can impact selective attention to social stimuli, decoding intentions, social reciprocity, and adherence to social norms of behavior. • Oversensitivity to sensory features can come at the expense of inability to filter out extraneous information Developmental Cognitive Neuroscience 29 (2018) 151–167 https://doi.org/10.1016/j.dcn.2017.04.010 34 34 Sensory Processing Patterns in Autism, Attention Deficit Hyperactivity Disorder, and Typical Development (Little et al. 2018) • Examine sensory processing in children ages 3–14 years with ASD, ADHD, and typical development (TD) using the Sensory Profile 2 • n = 239 (ASD = 77; ADHD = 78; TD = 84) • Both ASD and ADHD groups had higher scores on the SP-2 than TD but no distinctive diagnostic profile • ASD group showed the highest rate of oral processing differences • ADHD group had more visual processing differences than ASD and TD • Sensory features may be an area of overlap of behaviors in ASD and ADHD, which may have implications for intervention approaches for these groups Little, L. M., Dean, E., Tomchek, S., & Dunn, W. (2018). Sensory processing patterns in autism, attention deficit hyperactivity disorder, and typical development. Physical & Occupational Therapy in Pediatrics, 38(3), 243–254. https://doi.org/10.1080/01942638.2017.1390809 35 35 Classifying sensory profiles of children in the general population (Little et al. 2017) • Aim to subtype groups of children with and without developmental conditions, based on sensory processing patterns • SP-2 administered to n=1132, aged 3–14 with typical development (70%) and conditions including ASD, ADHD and LD • Profile 1 - “Balanced” (typical scores on all 4 quadrants) • n=890 (79% of total sample) 88.6% of TD, 35% of ASD • Profile 2 - “Interested” (higher scores on Seeking) • n = 83 (7% of total sample) 6.1% of TD, 9.1% of ASD Little LM, Dean E, Tomchek SD, Dunn W. Classifying sensory profiles of children in the general population. Child Care Health Dev. 2017 Jan;43(1):81‐88. doi: 10.1111/cch.12391. 36 36 Copyright © 2021 NCS Pearson, Inc. or its affiliates. All rights reserved. 12 10/19/2022 Classifying sensory profiles of children in the general population (Little et al. 2017) • Profile 3 - “Intense” (more than others scores on all 4 quadrants) • n= 58 (5% of total sample) 2% of TD, 19.5% of ASD • Profile 4 - “Mellow until...” (higher scores on Registration and Avoiding) • n = 50 (4.4% of total sample) 2.3% of TD, 11.7% of ASD • Profile 5 - “Vigilant” (higher scores on Sensitivity and Avoiding) • n = 51 (4.5% of total sample) 1% of TD, 24.7% of ASD • Children with and without diagnoses presented across subtypes • One subtype was significantly younger in age • Atypical SP patterns are not unique to ASD but rather reflections of children’s abilities to respond to environmental demands Little LM, Dean E, Tomchek SD, Dunn W. Classifying sensory profiles of children in the general population. Child Care Health Dev. 2017 Jan;43(1):81‐88. doi: 10.1111/cch.12391. 37 37 How Sensory Experiences Affect Adolescents with an Autistic Spectrum Condition within the Classroom (Howe & Stagg 2016) • n= 16 (12 male, 4 female) aged 12 - 17 in the UK • Adolescent/Adult SP: 2 participants had one “difference” quadrant, 4 showed differences on two quadrants, 6 on three quadrants and 2 on four quadrants • Also completed a questionnaire asking how much each sense affected them specifically in the classroom • All reported difficulties in at least one sensory domain, with hearing affecting them most (88%), followed by touch (75%), vision (50%) and smell (38%) • Sensory sensitivity affecting concentration and therefore learning • Keywords “anxious”, “uncomfortable”, “frustrated”, “annoyed”, “physical discomfort” • Sensory experiences fluctuate with mental state and context Howe, F.E.J., Stagg, S.D. How Sensory Experiences Affect Adolescents with an Autistic Spectrum Condition within the Classroom. J Autism Dev Disord 46, 1656–1668 (2016). https://doi.org/10.1007/s10803‐015‐2693‐1 38 38 Sensory Processing in Low-Functioning Adults with Autism Spectrum Disorder: Distinct Sensory Profiles and Their Relationships with Behavioral Dysfunction (Gonthier et al. 2016) • Data were collected for a sample of inpatients in autism care centers (n = 148) with severe-profound ID and a non-clinical control group • Adolescent/Adult Sensory Profile completed by the health or social worker who had the most frequent interactions with the participant • ASD group showed more low registration and significantly less seeking, sensitivity and avoiding than control participants • Low registration associated with hypoactivity and apathy, difficulty initiating activities, disinterest and indifference, and self-aggression • Low-functioning adults with ASD are especially vulnerable to sensory mismatches because their low autonomy limits development of coping strategies Gonthier C, Longuépée L, Bouvard M. Sensory Processing in Low‐Functioning Adults with Autism Spectrum Disorder: Distinct Sensory Profiles and Their Relationships with Behavioral Dysfunction. J Autism Dev Disord. 2016 Sep;46(9):3078‐89. doi: 10.1007/s10803‐016‐2850‐1. 39 39 Copyright © 2021 NCS Pearson, Inc. or its affiliates. All rights reserved. 13 10/19/2022 Key Take Aways • Sensory differences are prevalent in children, adolescents and adults with ASD • Key is to identify how well sensory needs are being met and focus on increasing participation • Employ a strengthsbased perspective • Sensory diversity makes the world go round! 40 40 Need help using the Sensory Profile? Convenient on-demand training now available! Visit https://www.pearsonass essments.com/professionalassessments/training.html to find out more 41 41 Questions? 42 42 Copyright © 2021 NCS Pearson, Inc. or its affiliates. All rights reserved. 14 10/19/2022 43 43 Copyright © 2021 NCS Pearson, Inc. or its affiliates. All rights reserved. 15
