Sensory Processing: It only matters in everyday life Winnie Dunn PhD OTR FAOTA Distinguished Professor University of Missouri Thanks so much for honoring.

Sensory Processing: It only matters in everyday life Winnie Dunn PhD OTR FAOTA Distinguished Professor University of Missouri Thanks so much for honoring me with this invitation to your conference. I am Winnie Dunn, Distinguished Professor at the University of Missouri. Today we will talk about the critical importance of considering sensory processing in everyday life. Let’s get started.

Prevalence of Sensory Processing Patterns in the General Population
In the last couple of years, my colleagues and I taken a step back from thinking only about sensory patterns in children and adults with conditions such as autism, schizophrenia and anxiety. We noticed in our discussions and when we talked with all of you and the families we serve, that everyone has stories about themselves, their other children, their partners and how these individuals respond to sensory events in their otherwise not notable everyday lives. So we asked ourselves whether some of our findings in the literature might also be true for everyone. When we only test people with disabilities, we might assume what we find is about their diagnosis, when in fact also be true for some other people without that diagnosis. We decided to look at ALL the children and see what we found using the same statistical strategies people had been using with disability groups. Winnie Dunn PhD OTR FAOTA, University of Missouri Lauren Little PhD OTR, Rush University Evan Dean PhD OTR, University of Kansas Scott Tomchek PhD OTR FAOTA, University of Louisville

Less & much less than others Just like the majority of others
More & much more than others If you think about it, the way the bell curve works lets us know this. We created cut scores for “just like others” [the fat part of the bell curve], “more than others” and “less than others” based on the Standard Deviations from the center of the bell curve. This means that about 15% of the population of the general population will have ‘more than others’ scores and another 15% of the population will have ‘less than others’ scores. So we cannot automatically assume that a ‘more than others’ score means a disability…. So let’s see what we found…..

Distribution of scores on CSP2
1,065 61 85 This is a graph of the number of children who have scores in the different categories. The BLUE bars show how many children have all their Sensory Pattern scores [seeking, avoiding, sensitivity, registration] in the ‘just like others’ range. The YELLOW bars show how many children have at least 1 score in the ‘less than others’ range The GREEN bars show how many children have at least 1 score in the ‘more than others’ range Children in the standardization sample are closer to the BELL curve distribution… Probably there are more MORE THAN OTHERS because we attend to and understand this behavioral repertoire better Proportionally, children with ASD are much more likely to have ‘more than others’ scores. But there are also children with ASD and ADHD who have scores in the ‘just like others’ range. Let’s look at the distributions in more detail

Distribution for typical, ASD, ADHD
So we see here that 32% of children with ADHD and 18% of children with ASD have all their scores in the ‘just like others’ range. We also see that some children in the general population have more than others scores. So scores on the Sensory Profile 2 cannot logically mean a child has a ‘disorder’ in sensory processing

Use of the Bell Curve So lets examine the BELL curve from this point of view….. Retrieved from Google images march 22, 2016

“This brings us to the question of the moment – can we use statistics in some simple and precise way to define mental normality? Can the bell curve provide a scientific guide in deciding who is mentally normal and who is not? Conceptually, the answer is ‘why not,’ but practically the answer is ‘hell no.’ … There are just too many statistical, contextual, and value judgments that perplex a simple statistical solution.” (p. 7) [Frances, 2013, Saving Normal]

Use of the Bell Curve Winnie Dunn’s Characteristics BROWN EYES
This is a bell curve of ME. I am in the top 5% of people on height I am in the top 20% of people who are seekers I am dead center on my eye color I am in the bottom 20% of people on Registration, meaning I do not miss things! And I am in the bottom 15% of people on Praxis. I have to work really hard to learn my YOGA poses REGISTRATION SEEKING PRAXIS HEIGHT 5’10” Retrieved from Google images march 22, 2016

Frances wrote a book called SAVING NORMAL
“We must reconcile to there not being any simple standard to decide the question of how many of us are abnormal. The normal curve tells us a great deal about the distribution of everything from quarks to koalas, but it doesn’t dictate to us where normal ends and abnormal begins.” (p. 8) [Frances, 2013, Saving Normal] Frances wrote a book called SAVING NORMAL “We must reconcile to there not being any simple standard to decide the question of how many of us are abnormal. The normal curve tells us a great deal about the distribution of everything from quarks to koalas, but it doesn’t dictate to us where normal ends and abnormal begins.” (p. 8)

The bell curve is not meant to identify
Use of the Bell Curve People are adaptable no matter where their skills and characteristics fall on the bell curve… People are adaptable no matter where their skills and characteristics fall on the bell curve… People are adaptable no matter where their skills and characteristics fall on the bell curve… People are adaptable no matter where their skills and characteristics fall on the bell curve… People are adaptable no matter where their skills and characteristics fall on the bell curve… The bell curve is not meant to identify dys-function So people can be adaptable from any place on the bell curve The bell curve is not meant to identify DYS function Retrieved from Google images march 22, 2016

“Human difference was never meant to be reducible to an exhaustive list of diagnoses…it takes all types to make a successful tribe and a full palette of emotions to make a fully lived life. We shouldn’t medicalize difference and attempt to treat it away…” [Frances, 2013, Saving Normal] “Human difference was never meant to be reducible to an exhaustive list of diagnoses…it takes all types to make a successful tribe and a full palette of emotions to make a fully lived life. We shouldn’t medicalize difference and attempt to treat it away…”

Adults with ASD have same patterns of sensory processing
Crane, Goddard and Pring showed that Adults with ASD have the same sensory patterns that they had as children and as other children with ASD display ‘more than others’ scores Avoiding Sensitivity Registration (Crane, Goddard & Pring, 2009)

repetitive behaviors & sensory processing[18]
There is a relationship between repetitive/ SIB and stereotypies and patterns of sensory processing Sensory based interventions have not been successful at consistently changing repetitive behavior patterns Related to repetitive behaviors researchers have found that there is a relationship between repetitive, self injurious behaviors and stereotypies and patterns and sensory processing. This has led people to consider using sensory processing method to manage or reduce repetitive behaviors. However sensory-based interventions have not been successful at consistently changing repetitive behavior patterns so we will need to investigate this further

Pain Experience & Sensory Processing 290 adults ages 18 to 50 years
Sensory Pattern Sign. Rel. to PAIN Seeking NONE Avoiding Moderate Sensitivity Registration Small

Pain experience & Sensory Processing
Adults who are overly sensitive to sensory input continue to experience pain sensations at least 5 minutes after the sensation is over…. What does this ‘residue’ mean for participation? We studied Pain Catastrophizing and sensory processing in 290 adults ages years old. Pain catastrophizing is a person’s tendency to get stuck thinking about one’s pain, making the idea of the pain bigger and feeling helpless about the pain experience. As you can see on the slide, there are NO SIGNIFICANT RELATIONSHIPS between Seeking and Pain Catastrophising. However, there are small to moderate relationships with sensitivity and avoiding, and small relationships with Registration. The sensitivity and avoiding are easy to understand, but why would Registration have these small relationships? I believe that people who are missing cues, may notice a stimulus after it is bigger or potentially more harmful, and then have a BIG response. Other people would have noticed sooner and taken a small action. This pattern among the 4 sensory patterns shows up frequently in adult studies. Bar-Shalita, Vatine, Yarnitsky, Parush & Weissman-Fogel 2014; Bar-Shalita, Vatine, Parush, Deutsch & Seltzer 2012 @ winnie dunn University of Kansas 2011

Positive & Negative affect & SP Engel-Yeger & Dunn in press CJOT
290 adults years old Positive & Negative Affect Scale [PANAS} With these same adults, we checked their positive and negative affect. There was a low relationship between Positive Affect and Seeking. There was a moderate relationship between Sensitivity and Avoiding and Negative Affect. There was also a small relationship between Registration and Negative affect. You see, the same pattern again. THE Key messages from this study are: Positive/negative affect related to sensory processing patterns. Additional studies needed to examine the relationship between affect and sensory processing Therapists should include affect and sensory processing patterns in the evaluation and intervention process, to enhance adaptive behavior and participation in natural environment, enhance positive affective reactions, and thus elevate health status and well-being. The rest here are my notes only: NA items Low Registration Sensitivity Avoiding in distress .212(**) .301(**) .295(**) Upset .199(**) .423(**) .396(**) Guilty .228(**) .324(**) .312(**) Scared .199(**) .269(**) .284(**) Hostile NS .162(*) .143(*) Irritable NS .262(**) .264(**) Ashamed .175(*) .220(**) .263(**) Nervous NS .245(**) .220(**) Jittery .167(*) .342(**) .336(**) Afraid .257(**) .309(**) .291(**) Positive SEEK AVOID SENS REG .14 negative SEEK AVOID SENS REG .39 .41 .24 ‘UPSET’ and ‘JITTERY’ had the highest relationship to Sensitivity & Avoiding @ winnie dunn University of Kansas 2011

Sensory Processing & Participation
So let's turn our attention to sensory processing and its links to participation

The state of the science on sensory factors and their impact on daily life for children: A SCOPING REVIEW In our Scoping Review of the impact of sensory processing on children’s everyday lives, we examined the relationship of sensory processing and participation….. Evan Dean, Lauren Little, Ben Evans. Sara Robertson our librarian is not here today. Dunn, W., Little, L., Dean, E., Robertson, S. & Evans, B. (2016). The state of the science on sensory factors and their impact on daily life for children: a SCOPING review. OTJR: Occupation, Participation & Health, p

No. of Studies by Year It's interesting that across the 10 years there is an increasing number of articles about sensory processing and participation 2014 is incomplete because the journals weren't all indexed for us to gain access to them I think that this graph speaks to the increasing interest in an area that occupational therapists generated interest in we are not obscure anymore I also want to remind you that there has been significant work prior to this 10 years that is not reflected in this review.

SP & DAILY LIFE: School [19]
Auditory and visual processing most often studied at school; associated with reading performance Children with dyslexia recognize the “NOISE” better than the speech sounds…?filtering For children with ASD, modulation, auditory filtering and touch associated with inattention; Related to school participation Auditory and visual processing was most often studied at school and does have a strong association with reading performance Children with dyslexia recognize the noise better than the speech sounds which suggests that there are some sensory filtering factors that we might consider and supporting them And for children with autism, modulation, auditory filtering and touch were associated with inattention at school

SENSORY PROCESSING and DAILY LIFE cont.
Correlations between home and school sensory patterns are moderate, suggesting that there are both universal and context specific features In a study looking at sensory processing at school and home together researchers found Moderate correlations between home and school sensory patterns which suggests that in these two important context for children there are both universal truths and context specific truths when looking at sensory processing behaviors

SP & DAILY LIFE: eating [7]
Children responsive to visually familiar foods [adults use touch to decide] Children with sensitivity to taste and smell reject Fruits & Vegetables; other children’s profiles align with parents Touch sensitivity and unfamiliarity are not a factor Related to sensory processing and eating we found a couple of really interesting articles One article compared children to their parents and found that when deciding whether to try a new food children are more responsive to the visual features of food while adults use touch more frequently This suggest that when we are working with families we might consider the familiarity of visual aspects of new foods we wan to introduce. In another study on the authors found that children who are sensitive to taste and smell are more likely to reject fruits and vegetables other children are more likely to have a profile of food choices that match their parents

Lower proprioception: sedentary play
SP & DAILY LIFE: Play [6] Lower proprioception: sedentary play Children with ADHD and ASD have fewer play choices Regarding play researchers found that children who have lower scores in proprioceptive features are more likely to pick sedentary play And children with ADHD and ASD have fewer play choices

SP & DAILY LIFE: adaptive behavior [5]
In FASD sensory processing differences are associated w/ adaptive behavior [unrelated to IQ] Children with ASD/ ADHD: low thresholds: low autonomy in self care Low registration: less involved in self care & daily living Regarding adaptive behavior One study found that for children with FASD their sensory processing patterns were associated with their adaptive behavior and it was unrelated to their level of IQ For children with ADHD and/or ASD, lower sensory thresholds were related to lower autonomy in self care and motor skills. When children had low registration they were less involved in self care and daily living skills

SP & DAILY LIFE: Activity Participation [7]
Other studies looked at activity participation When children have lower sensory thresholds they also show lower competence in activity participation Children with and without ADHD who respond more frequently to sensory events showed no differences in participation from each other. This suggests that it's not the ADHD but the sensory processing differences that reflect participation patterns Other studies demonstrated that children with autism have lower participation along with their differences and sensory processing Low thresholds SP: lower competence Children w/wo ADHD with differences in SP: no differences in participation Children with ASD: SP + lower participation

SP & DAILY LIFE: continence [2]
In 2 studies, researchers concluded that sensory processing informs incontinence and can be helpful in resolving this challenge for families There were two studies of about continence The researchers concluded that sensory processing information informs the incontinence problems that families face and can be helpful in resolving this challenge

SP & DAILY LIFE: sleep For children with FASD
sensitivity—shorter sleeping Seeking—less total sleep Avoiding—more wakefulness Regarding sleep, children with fetal alcohol syndrome who are more sensitive to sensory events have shorter sleeping patterns seekers have less total sleep and Avoiders have more wakefulness The researchers hypothesize that once awake distractibility occurs, keeping the child awake, and activating more anxiety which create cycles of no sleeping Once awake, distracted ? More anxiety?

SP & PARTICIPATION: Social Participation [10]
when sensory processing is different children have the same levels of enjoyment when they are with their family or small number of friends but there social participation deteriorates in larger groups children in the general population who are sensitive also have differences in their social participation. This suggests that the sensory processing patterns are key factors in identifying a child's ability to participate socially When SP is different, same levels of enjoyment with family and small no. of friends Children in gen pop with sensitivities have differences in social interactions

SP & FAMILY INTERACTIONS [16]
researchers have investigated the relationship between sensory processing and family interactions. When children have more frequent responses to sensory input their parents report a lower sense of competence in their skills as parents. As a method to respond to this other researchers have investigated coaching practices using sensory processing information to support parents to identify ways to navigate in their everyday lives. in these studies parents competence went up significantly while children's goals were being met and parents said they could provide less support after the coaching practices. More frequent SP responses Associated with Lower sense of competence For parents Coaching interventions Increase parental competence And less parental support needed

Leisure participation
ATYOPIC DERMATITIS Another researcher found that in adults who have ATOPIC DERMATITIS They also have higher sensitivity and more avoidance They also participate in less leisure activities Higher Sensitivity More Avoidance Lower Leisure participation @ winnie dunn University of Kansas 2011

HANDWRITING SEEKING predicts handwriting pressure, time and spatial organization SENSITIVITY predicts velocity Seeking predicts handwriting pressure, time and spatial organization Sensitivity predicts velocity of writing Sensitivity correlates with poorer quality of sleeping Engel-Yeger, Hus & Rosenblum 2012; Engel-Yeger & Shocat 2012

Women who have higher sensitivity:
WOMEN & CHOCOLATE! Women who have higher sensitivity: Eat more emotionally Eat more chocolate And for WOMEN When we are more sensitive we eat more CHOCOLATE Naish & Harris 2012

Findings from Intervention Studies
IMBEDDING IDEAS INTO ROUTINES IS EFFECTIVE Coaching with sensory processing info supports increases parental competence and children’s participation Parents want information for everyday life Tele-health was effective FIVE studies incorporated sensory processing as a component of a comprehensive intervention targeted enhancing family interactions. A contextually relevant coaching intervention that considered children’s sensory processing was effective at increasing parental competence and increasing children's participation. Other studies have indicated that parents feel more empowered when they have strategies to implement during daily activities. And other others have found that an education program increased parental sensitivity but the SI approach for the control group showed no difference. One study illustrated that telehealth was an effective method for intervention using sensory information for families that have a child with autism.

Everyone has sensory processing patterns
Those sensory patterns manifest in everyday life behaviors and responses Sensory patterns seem to continue across time Everyone has sensory processing patterns Those sensory patterns manifest in everyday life behaviors and responses Sensory patterns seem to continue across time

What’s GREAT about everyone’s sensory patterns?
How do sensory patterns make you who you are? How do your sensory patterns show up in YOUR life? So as you go through your day ask yourself and others Whats GREAT about everyone’s sensory patterns? How do your sensory patterns show up in your life? How do sensory patterns make you who you are? THANKS!

Sensory Processing: It only matters in everyday life
Occupational Therapy has been fascinated with sensory processing for decades since Dr. Ayres pointed out its importance for understanding particular behaviors. Sometimes sensory processing has become the focus of our work. As families and colleagues have come to rely on us for sensory processing expertise, it is more important than ever to characterize sensory processing as a key factor in participation goals rather than the goal itself. In this session we will examine the critical link between sensory processing and how people live satisfying lives on their own terms.

Findings from Intervention Studies
Effectiveness of sensory based approaches A few showed effectiveness Many show NOT effective Equal outcomes to alternative interventions Different outcomes for comparison groups Variable outcomes across the study Promising new ideas I will refer to ‘sensory based approaches’ since people used methods that some might argue do not qualify as SI therapy even though this is the term many used. EFFECTIVENESS Researchers found that sensory based approaches were helpful for improving toileting behaviors and fine motor behaviors. However, other studies reported that sensory based approaches were not effective. One group of researchers found that ABA was more effective than SBA for challenging behaviors in children with ASD. another group found that a behavioral approach is more effective than an SB approach on eating behaviors for toddlers. The brushing protocol, weighted vest, SI were not effective at improving problem behaviors or engagement for children with autism. Some studies show equal outcomes from comparison interventions. In one study there was no significant differences between fine motor and SI groups. Another study found that there were positive changes in play behavior for children receiving SI or sensorimotor activities. Children with down syndrome had improvements in gross motor skills whether they had OT in a traditional sense or OT plus sensory stimulation Other researchers have shown that there are specific outcomes related to the group placement for example an SI group increased motor skills while the comparison playgroup increased in play skills. one study explored use of therapy balls in classrooms for attention. Children with ASD attended better UNLESS they had postural instability A number of studies reported variable results within their studies, making conclusions difficult In the promising category, another study showed that SI could be implemented in a virtual reality situation for children with autism.

IMPLICATIONS FOR STAKEHOLDERS
Evaluate sensory processing as part of comprehensive assessment PAIRED with participation and activity analysis Employ sensory processing knowledge as a therapeutic medium So what are the implications for stakeholders? in this case our stakeholders are the people we serve, ourselves as researchers, practitioners ourselves as educators The evidence from the studies suggest that we need to evaluate sensory processing as part of comprehensive assessment paired with participation and activity analysis to document the significant contribution sensory processing makes to children's lives. Second we need to employ sensory processing knowledge as a therapeutic medium on its own right. When providers understand meaning of behaviors from a sensory processing point of view their ability to manage everyday life successfully increases. We need to also emphasize the links to participation in all the aspects of our work. This is the core function of occupational therapy. IMPLICATIONS FOR STAKEHOLDERS

Sensory Processing: It only matters in everyday life Winnie Dunn PhD OTR FAOTA Distinguished Professor University of Missouri Thanks so much for honoring.

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Sensory Processing: It only matters in everyday life Winnie Dunn PhD OTR FAOTA Distinguished Professor University of Missouri Thanks so much for honoring.

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Presentation on theme: "Sensory Processing: It only matters in everyday life Winnie Dunn PhD OTR FAOTA Distinguished Professor University of Missouri Thanks so much for honoring."— Presentation transcript:

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