​#5K – SENSORY INTEGRATION    (a. Sensory Room, b. Sensory Activities)
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Classic Sensory Integration Therapy (SIT), according to the meta-analysis reported on by Leong, et al. (2014), delivers intervention for an individual in a small group session. Various forms of sensory stimulation are used, such as the individual being rubbed with brushes or other textured items. Or, being swung or spun in a hammock, being rocked back and forth while lying on a gym ball; or being moved on a scooter board. There could be joint compression from wrist weights. Different practices, interpretations and theories have been explored since the A. Jean Ayres’ Sensory Integration strategies began to be known in 1972.
 
< My Thoughts >       “…Various forms of sensory stimulation are used.”
 
The sensory stimulations being used are determined from the various forms of sensory information derived from the person’s ‘sensory profile’. From there, the therapist develops a ‘sensory diet’ of sensory-based activities for home and for school. For instance, some integration activities might be developed to help the person with sensory seeking stimulation needs, sensory avoidance or aversion situations, and/or sensory balance requirements.
 
Thompson (2012) tells us that the Ayers’ method of satisfying sensory needs through sensory integration ranged from the calming input of massage and weighted vests, to listening to music to which massages the middle ear hair cells in the cochlea. These various sensory-based stimulation techniques are incorporated into programs or used in isolation.
 
< My Thoughts >       “…incorporated into programs or used in isolation.”
 
One of A.Jean Ayers' early publications was Improving Academic Scores Through Sensory Integration; Journal of Learning Disabilities (1972). This article described her idea that ‘identifiable types of sensory integrative dysfunction’ could be included in a remedial program. Thus improving a students’ learning and academic performance by changing unwanted sensory responses. The Ayers’ method  is well known among therapists and teachers alike.
 
Others, such as Winnie Dunn, with her ‘Sensory Profile’, added to the development of a child’s sensory processing abilities and/or disabilities. Dunn felt that these undesirable sensory responses, plus the individual’s temperament, may negatively impact their daily life as well as their academic learning.

The Dunn Sensory Profile is intended to create a comprehensive picture of the person’s sensory performance; thus combined with other data will help with diagnostic and intervention planning. You can have a look at one assessment portfolio on this website – Retrieved from – https://otforchildrenassessmentportfolio.blogspot.com/2013/04/sensory-profile.html
 
Sensory integration, according to a study made through the University of Belfast, Northern Ireland, and explained by Doumas, et al. (2015) saying that sensi-motor control processes affect the person with Autism Spectrum Disorder. We receive sensory information from three main channels, our eyes, our ears, and our touch. These authors state that control in a task does not rely equally on all three channels simultaneously, but rather on information from the channel relied upon most for information.

For instance, one uses their sight to see where they are going, until it becomes dark. Then the other two sensory channels of hearing and touch are relied upon, or needed the most for sensory information because there is no longer reliable visual information available in the dark.

< My Thoughts >       “We receive sensory information from three main channels.”
 
Sensory information impairments are now part of the Diagnostic & Statistical Manual of Mental Disorders, 5th Edition (DSM-5). This includes ‘hyper’ or ‘hypo’ reactivity to sensory input or unusual interest in sensory aspects of the environment. It is known that impaired sensory processing or deficits in sensory channels make it difficult for children with ASD to perform ordinary tasks. Considerably more difficult than for those typically developing (TD) children and adults.

Author Amelia Tiedemann tell us that the A. Jean Ayres' definition of ‘sensory integration’ as the neurological process that organizes sensations from one's body and from the environment. In order to thrive within the environment, one’s body must make the appropriate adaptive responses. To direct the body, the brain must register, select, interpret, compare, and associate sensory information in a flexible, constantly-changing pattern,” Ayres (1989).

​Pediatric Occupational Therapist, Cara Koscinski asks you to close your eyes and imagine yourself swinging on a warm sunny day. Feel the breeze blowing past you and the fluttering butterflies in your stomach as the swing reaches its highest point. The freedom of flying sensation is why swings continue to be used by therapists, and remain the staple in backyards and playgrounds all over the world. Retrieved online from: https://harkla.co/blogs/special-needs/sensory-swings-autism

Yet another explanation of Sensory Integration refers to how people use the information provided by all the sensations coming from within and from outside the body and from the external environment. We usually think of the senses as separate channels of information, but they actually work together to give us a reliable picture of the world and our place in it. Your senses integrate to form a complete understanding of who you are, where you are, and what is happening around you. Because your brain uses information about sights, sounds, textures, smells, tastes, and movement in an organized way, you assign meaning to your sensory experiences. Retrieved from: https://www.familyeducation.com/school/sensory-integration-dysfunction/what-sensory-integration
 
< My Thoughts >             “…assign meaning to your sensory experiences…”
 
Thompson (2012) states that there is no consistent evidence that sensory-based treatments have specific lasting effects on the behavior of children or adults with ASD. But, he says the lack of evidence does not necessarily prove that a treatment is ineffective…
 
While Leong, et al (2014) thinks that the problem of authenticating the value of Sensory Integration Therapy may lie with the integrity of the trials, or with ‘pre’ and ‘post’ test validity. They point out that the difference could also be with the state of brain ‘plasticity’ of the child/adult receiving the therapy.
 
Just as there are hundreds of thousands of educators trying to make a difference in the world, there are just as many therapists trying to do the same. Some students are lifelong learners, while some just want to attain a certain level to get by. Those on the Autism Spectrum may feel the same way, according to their personality, temperament, and abilities. I applaud the teachers and therapists who continue to find ways to give those in their path the opportunity to move toward greater independence. Just saying.
 
< My Thoughts >             “…the opportunity to move toward greater independence.”
 
Ever wonder why your child does the things s/he does? How many times have you said in frustration – “Why in the world did you just do that?” Seems that some of us have five thumbs, while others have green thumbs. It all may be about our sensory perception of the world. Some of us are destined to take a chance, those are the risk-takers.

​While others of us spend life on the sidelines, observing from afar. Take this one step farther and think about what it must be like to have Sensory Processing Disorder. Either your world is filled with exciting opportunities… or, your world if filled with one terrifying event after another. Just saying…
 
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BLOG #5F – SENSORY IMPAIRMENTS
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In the May 2013 Edition of DSM 5th Edition (DSM-5), the realm of restricted, repetitive patterns of SENSORY behavior, interests, or activities has been expanded to include abnormalities in ‘sensory processing impairments.’ The objective of adding this to the behavioral domain was to help clinicians perform diagnosis more accurately, thus identifying cases requiring treatment with greater accuracy.

The DSM-5 is a living document which provides a common language for clinicians, patients, and researchers to communicate information about symptoms, as well as to accurately diagnose mental, behavioral, and personality disorders. Retrieved from: https://www.steppingstonesca.com/single-post/2016/09/22/A-Quick-Guide-To-The-DSM-5-Criteria

< My Thoughts >       “perform diagnosis more accurately, thus identifying cases requiring treatment with greater accuracy.”

As a parent and/or teacher, you will become a trained observer, learning to recognize ‘sensory impairments’ in your child or student. This in turn, will help clinicians find just the right diagnosis, treatment, and intervention for that child.

Remember that the DSM-5 is a ‘living document’, that is because the ‘bar’ gauging ‘severity’ is forever changing. Your child, student, or patient is also forever changing. As observers, you are identifying the ‘current’ pattern, behavioral crisis, or behavioral activity. Just saying.

The National Institute of Health (NIH) website tells us that maladaptive behaviors such as ‘stereotyped behaviors’, i.e. sensory impairments, are predictable as a ‘severe sensory feature’ of autism. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3727194/

Banda, et al. (2014) in a review studies of individuals with Autism and Sensory Impairments, having the overlapping condition/characteristics of sensory impairments. These impairments varied in the levels of severity, as well as the number of impairments; to include – vision, hearing, and/or communication. In addition, four of the studies targeted problem co-existing behaviors such as self-injury, aggression, vocal disruption, and self-stimulatory activity.

Fuentes, et al. (2010) talk about studies using questionnaires which revealed general differences in sensory experience of auditory, visual, tactile, and movement processing in those children with and without Autism. This study noted that there was no significant difference in IQ between the groups.

They found that the sense of position and movement of parts of the body, proprioception, played a crucial role in successfully interacting with the environment. The general tone of responses from study participants was conveyed in these two statements –

“I could not point at objects for many reasons. The most important reason is that I had very little sensation of my body.” (Tito Mukhopadhyay), And, “ In childhood I had real problems in knowing exactly where my connectional limbs and trunk were… where they would move to next, and even more frighteningly, where they had last been positioned.” (Lucy Blackman).

Sensory impairments in the ASD group were significantly worse than those in the group without an autism diagnosis. Researchers said that successful ‘skill’ performance on the PANESS assessment involved good sensory processing and rapid execution of finely controlled movements; such as tool use and skill imitation.

< My Thoughts >       “the PANESS assessment…”

​The official title of the PANESS assessment is Positive And Negative Syndrome Scale; Positive meaning ‘productive’ symptoms, and Negative to mean showing ‘deficit’ features. According to an online interview with Lewis Alan Opler, Long Island University, one of the co-authors of PANESS, said that their PANESS assessment is still valid, reliable, and user friendly instrument. An accompanying comment by Bajouco, Hospitais da Universidade de Coimbra, stated that for another assessment of negative symptoms of diminished emotional expression, and motivation/pleasure one could use is the Brief Negative Symptoms Scale (BNSS). Retrieved from: https://www.researchgate.net/post/What_is_the_best_alternative_to_PANNS_in_assessing_psychosis
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 BLOG #5J – SENSORY DIET
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Nancy Penske may surprise us by saying that the Sensory Diet is actually NOT about food, but about sensory enriched activities to fulfill a person’s sensory needs. Occupational Therapist, Patricia Wilbarger devised a personalized activity plan which was soon called a Sensory Diet Plan. The purpose of this individualized plan, when followed for 10-20 minutes per day, would help to assist with adaptive, positive responses to environmental stimuli. Retrieved from:https://www.sensorysmartparent.com/sensory-diet

These activities are designed to keep the brain’s neuro-chemicals flowing steadily throughout the day to improve learning. But before you can create a Sensory Diet, it helps to know what sensory issues are at risk. Enter the ‘Sensory Profile’ devised by Winnie Dunn. Gay & Baranek (2008) draw the conclusion that Dr. Dunn believed we are ‘seekers’ of sensations in our environment. Dunn believing that understanding how bodies differ, allows for respect and even embracing of those differences in ourselves and others. (The Sensory Profile was discussed in BLOG #5I.)

Sensory enriched activities, aka Sensory Diets help those with Autism Spectrum Disorder which are somewhat predisposed to anxiety created by their many sensory avoidance and arousal issues, according to Rosen, et al. (2016). They feel that anxiety seems to be mostly associated with higher intellectual function and higher social functioning persons. And, that deficits in these areas can be difficult to detect in those with limited verbal ability, as well.

They found that behavioral intervention targeting anxiety should be evidence-based and provided by well-established treatments. Experienced professionals, they say, will be able to distinguish the individual’s current functioning levels and create an affective Sensory Diet.

< My Thoughts >       “…Experienced professionals…”

Some of us have a high threshold when sensation seeking, while others of us have a low threshold. How can you tell the difference, or how can you tell if your child is having sensory processing problems? Really, it takes a clinician or team of people in the field to make that diagnosis. Parents can look online for examples of Sensory Profile questionnaires to get some idea of how data collection works for developing a Sensory Diet.

In an article on Sensory Defensiveness – Sensory Processing Disorder (Copyright 2004), author Michelle Morris tells us some of the following about the types of

Sensory Defensiveness –

• Oral Defensiveness
• Gravitational Insecurity
• Postural insecurity
• Visual Defensiveness
• Auditory Defensiveness
• Olfactory Defensiveness

Retrieved from: https://www.sensory-processing-disorder.com/sensory-defensiveness.html

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