1. Occupational Therapy & Speech and language Therapy Lenses on Assessment
Jenny Jones Occupational Therapist
Julie Mullis Speech and Language Therapist
Clinical leads for ASD Services
Cardiff 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 children
To 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%
ASD
Synaesthesia
Sensory distortions
Sensory tune outs
Sensory overload
Overselectivity
Perceptual dysfunction
Sensory modulation

5. What are Sensory Processing Disorders?
SENSORY INTEGRATION THEORY
SENSORY PROCESSING
DISORDERS
REGISTRATION
Perception of intensity
of stimuli & the
orientation to it
MODULATION
Under reactive
Over reactive
Fluctuating in response
DISCRIMINATION
Praxis
Perceptual function
for learning
Postural & Motor Control
SI is a long standing and growing area of practice in Occupational Therapy
In the last 30 years the theory, conceptual constructs, evaluation and principles have been refined and validated by different scientific research studies
The 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 Reactivity
Under-Arousal
i.e. misses non-verbal cues,
slow affective responses
Over-Arousal
i.e. over-reacts to non- verbal
cues, anxious, too alert
Needs large amount of
stimulation for arousal
Impaired Social Behaviour
Must attend to all stimuli as
much as possible
Defective Attending Behaviour
i.e. fails to look, listen, process,
and remember
“Spacey” & “Slow”
Distractible & Fragmented
Learning 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 Baranek
2005 Rogers and Ozonoff
2006 Kern et al
2006 Adamson, O’Hare and Graham
2007 Kern et al
2007 Tomchek and Dunn
2007 Ben-Sasson et al
2010 Tomchek
And 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 functions
Developmental play and interactions with environment
Motor planning/praxis and sequencing
Postural motor control
Bilateral integration
Gross and fine motor skills
Visual motor integration
Prewriting and writing skills
Functional 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 disorders
Sensory integration approach provides an alternative explanation for behaviours
Accurate diagnosis = appropriate intervention
Sensory processing disorders may represent another core diagnostic criterion
ASD-DSM-V

15. Play Observations Observations
SLT Observations
Not turning to name
Not looking to mum for help with clothes discomfort
Developmental delay
No intentional communication – growls
Poor awareness of environment and other toys around him.
No exploratory or object play.
No enjoyment from parental interaction and sharing of toy
OT Observations
Poor registration to the turtle,
Possible dysregulation by the singing and flashing of the toy
Interested 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 head
Distracted/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
Registration
Social Play
Sensorimotor
Play
PLAY
Child’s main
Occupation
Modulation
Praxis ideation
Julie got handwritten notes for OT bit to Inc. in this slide…..
Functional Play
Symbolic Play

17. Principles of Assessment for Speech and Occupational Therapy
On going process
Skilled observations essential
Observed in at least 2 different settings, over several visits and with a variety of people
Assessment of child's sensory profile essential
Detailed understanding of myriad of internal and external mechanisms that will influence child's communication and occupations

18. C A B
Julie 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