Presentation on theme: "Jenny Jones Occupational Therapist"— Presentation transcript:
1 Occupational Therapy & Speech and language Therapy Lenses on Assessment Jenny Jones Occupational TherapistJulie Mullis Speech and Language TherapistClinical leads for ASD ServicesCardiff and the Vale University Health Board
2 Aims To have a greater understanding of Sensory Processing and ASD To explain the valuable role OT and SLT have in the assessment and diagnosis of complex childrenTo outline the benefits of joint working
3 Sensory – Perceptual Atypicalities and ASD “It is estimated that 90% of individuals with ASD have some abnormality of sensory and perceptual functioning and considered by some as CORE FEATURES”(Geschwind 2009)
4 ASD How does that look ? Sensory Processing Disorders 70-80%Atypical Sensory & Perceptual 90%ASDSynaesthesiaSensory distortionsSensory tune outsSensory overloadOverselectivityPerceptual dysfunctionSensory modulation
5 What are Sensory Processing Disorders? SENSORY INTEGRATION THEORYSENSORY PROCESSINGDISORDERSREGISTRATIONPerception of intensityof stimuli & theorientation to itMODULATIONUnder reactiveOver reactiveFluctuating in responseDISCRIMINATIONPraxisPerceptual functionfor learningPostural & Motor ControlSI is a long standing and growing area of practice in Occupational TherapyIn the last 30 years the theory, conceptual constructs, evaluation and principles have been refined and validated by different scientific research studiesThe theoretical base of SI is unique in that ait deals specifically with the contributions of the subcortical areas of the brain to human behaviour.
6 Effects of poor sensory modulation on learning and behaviour Under Normal Over-Reactivity Sensory Modulation ReactivityUnder-Arousali.e. misses non-verbal cues,slow affective responsesOver-Arousali.e. over-reacts to non- verbalcues, anxious, too alertNeeds large amount ofstimulation for arousalImpaired Social BehaviourMust attend to all stimuli asmuch as possibleDefective Attending Behaviouri.e. fails to look, listen, process,and remember“Spacey” & “Slow”Distractible & FragmentedLearning is impaired
7 A Sensory hypothesis to Autism….. New or just the “in thing” ? 1943- Kanner rejected a sensory hypothesis 1949 – Bergman and Escalona offered the first version of a sensory hypothesis “The child's need to protect himself or herself from the sensory onslaught resulted in developmental distortions that eventually led to the symptoms that Kanner had first described”
8 Main hypotheses concerning Autism ….60s and 70s Specific sensory dysfunctions and their affects on motoric-social and cognitive functioning in Autism were recognised and empirical studies began…..
9 Still current today ……… Current clinical and treatment literature treats sensory dysfunction as an established core deficit in autism, with a theoretical focus on possible abnormalities in subcortical neural systems.Rogers & Ozonoff 2005
10 “The objective of therapy for the autistic child is to improve the sensory processing so that more sensations will be effectively ‘registered’ and modulated and to encourage the child to form simple adaptive responses as a means of helping him learn and organise his behaviour”Ayres 1979
11 Native Experts..90s“Difficulty in registering input in a meaningful way can often be felt as painful and confusing”(Grandin 95)“Any satisfactory comprehensive theory of autism must address sensory symptoms”( Grandin 92, O’Neill &Jones 97, Williams 94)
12 The last decade……Research studies on sensory processing and ASD 2002 Baranek2005 Rogers and Ozonoff2006 Kern et al2006 Adamson, O’Hare and Graham2007 Kern et al2007 Tomchek and Dunn2007 Ben-Sasson et al2010 TomchekAnd the list goes on……………Recently more research studies have been conducted to examine the relationship that exists between brain function and the behavioural manifestations of sensory processing disorder(Mcintosh et al 1999, Mangeot et al 2001, and Davies and Gavin 2007)
13 Occupational Therapy Assessment Sensory processing functionsDevelopmental play and interactions with environmentMotor planning/praxis and sequencingPostural motor controlBilateral integrationGross and fine motor skillsVisual motor integrationPrewriting and writing skillsFunctional abilities in different daily living activities
14 Why have an Occupational Therapist on Diagnostic and Assessment teams? A detailed assessment of atypical sensory behaviours helps to distinguish whether a child's symptoms result from SPD, autism or other co-morbid disordersSensory integration approach provides an alternative explanation for behavioursAccurate diagnosis = appropriate interventionSensory processing disorders may represent another core diagnostic criterionASD-DSM-V
15 Play Observations Observations SLT ObservationsNot turning to nameNot looking to mum for help with clothes discomfortDevelopmental delayNo intentional communication – growlsPoor awareness of environment and other toys around him.No exploratory or object play.No enjoyment from parental interaction and sharing of toyOT ObservationsPoor registration to the turtle,Possible dysregulation by the singing and flashing of the toyInterested in string of turtle not the turtle.Praxis- not sure what to do with the turtle?Clawing at clothes, hands often fisted or looking at them flicking – tactile defensive? visual seeker?Biting clothes, hitting headDistracted/distressed by fathers video game- auditory?Big point to make on this slide is that although it was a very small piece of footage, having two professional lenses on the assessment of play , doubles the observations that can be gathered and analysed and will direct further assessment and investigation.What is interesting about this little chap, is that he was given a diagnosis of developmental delay and SPD at the age of 18months and a diagnosis followed of ASD just before his second birthday. This supports Sassons work in 2007 whose findings point to the early onset of an extreme sensory profile in ASD.
16 Relational Play / Constructional Object / Exploratory Play RegistrationSocial PlaySensorimotorPlayPLAYChild’s mainOccupationModulationPraxis ideationJulie got handwritten notes for OT bit to Inc. in this slide…..Functional PlaySymbolic Play
17 Principles of Assessment for Speech and Occupational Therapy On going processSkilled observations essentialObserved in at least 2 different settings, over several visits and with a variety of peopleAssessment of child's sensory profile essentialDetailed understanding of myriad of internal and external mechanisms that will influence child's communication and occupations
18 CABJulie to summarise, and to outline the importance of a team approach to assessment and diagnosis …all have a very valuable lens! Cant do it with just one pair of glasses!!! !utilising all skills in my experience is best practice.D