Identifying and Responding to common sensory triggers Elaine Mc - - PowerPoint PPT Presentation

Sensory Processing Disorder and Current Thinking: Identifying and Responding to common sensory triggers

Elaine Mc Mahon & Nicci Paine, Specialist Occupational Therapists

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• f diagnoses.

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Today’s Targets

Review the importance of our sensory systems. Discuss the clinical guidance. Provide strategies and advice. Identify common sensory triggers

Sensory Processing

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Review

Sensory Processing Difficulties

Sensory Processing is the ability to: Take in … Sort out … Process … Make sense of the sensory information from their body and the world around them. For example: Hear a noise … What is the noise … What does it mean … Organise to respond appropriately Sensory Processing is important for us to make the appropriate Adaptive Response to meet the demands placed by the environment.

Review

Our Senses

Review Vision Hearing Smell Taste Touch Proprioception Vestibular NAS

Sensory Processing

Miller, 2006 Review

Sensory Processing Disorder

Review Miller, 2006

HYPOSENSITIVITY (under-sensitive) HYPERSENSITIVITY (over-sensitive) Needs lots

• f sensation

Sensation avoiding

These perceptions may vary during the course of a day or a week

Sensory Differences

Review

Hyper - Reactivity

Hyper reactivity is when a reaction to a stimulus event is out

• f proportion to the intensity. The individual may feel

discomfort, irritability, frustration and fear. They may avoid experiences with offending stimuli This implies a low threshold for incoming information. For example: Aversion to certain smell. Distress with certain sounds Discomfort of certain textures.

Review

Hypo - reactivity

These children have a very high threshold to sensory stimuli

They may disregard salient information in the environment as it has in no way been registered as relevant They often appear passive, disinterested and unaware,

• ften seeking experiences to heighten sensations.

For example: Do not respond to you calling their name. Can be messy after eating and not notice it. They seek excess movement to reach their threshold

Review

CENTRAL NERVOUS SYSTEM

Olfactory Visual Auditory Gustatory Tactile Vestibular Proprioception

Body Scheme Reflex Maturity Ability to Screen Input Postural Awareness of Motor Security Two sides of body Planning

Eye-hand Ocular Motor Postural Co-ordination Control Adjustment

Auditory Visual- Attention Language Spatial Centre Skills Perception Functions Academic Learning Daily Behaviour Living Activities

Cognition Intellect Perceptual Motor Development Sensory Motor Development Sensory Systems

Review

Williams and Shellenberger, 1996

Residential Care Residential Care Environments Making adjustments to the social and physical environment and processes of care Anticipating and preventing behaviour that challenges

Discuss

Sensory Integration problems in Individuals with Autism across the Lifespan

Autism Nice Guidance: Recognition, referral, diagnosis and management of adults

• n the autism spectrum

Hyper & hypo-sensory sensitivities Recommendations:

• 1. During a comprehensive assessment, enquire about and assess the following:

hyper- and hypo-sensory sensitivities and attention to detail.

• 2. To aid more complex diagnosis and assessment: Residential care environments

should have: adaptations to the physical environment for people with hyper- and hypo-sensory sensitivities inside and outside spaces where the person with autism can be alone (for example, if they are over-stimulated).

June 2012 NICE Guidance guidance.nice.org.uk/CG142

Urwin, R, 2013 Discuss

Residential care environments should have: designated areas for different activities that provide visual cues about expected behaviour adaptations to the physical environment for people with hyper- and/or hypo-sensory sensitivities inside and outside spaces where the person with autism can be alone (for example, if they are over-stimulated). Nice, 2012

Residential Environments

Discuss

Assess factors that may increase the risk of behaviour that challenges in routine assessment and care planning in children and young people with autism, including:

impairments in communication that may result in difficulty understanding situations or in expressing needs and wishes coexisting physical disorders, such as pain or gastrointestinal disorders coexisting mental health problems such as anxiety or depression and other neurodevelopmental conditions such as ADHD inadvertent reinforcement of behaviour that challenges

NICE 2013

Anticipating and preventing behaviour that challenges

Discuss

Environmental changes

The physical environment, such as lighting and noise levels the social environment, including home, school and leisure activities changes to routines or personal circumstances developmental change, including puberty the absence of predictability and structure.

NICE 2013

Anticipating and preventing behaviour that challenges

Discuss

Key Recommendations: Listen to people with learning disabilities and their family carers in developing person-centred approaches Commission the right model of care to focus on the needs of individual people, Avoid the factors which might distress people and make behaviours more challenging, building positive relationships Focus on early detection, prevention, crisis support and specialist long term support

Winterbourne, 2012

Discuss

Sensory Triggers

Smell Lack of movement Sound/ noise Light Anxiety Stress Tastes Sensory Over load Identify

Behaviours

Change in mood Disengage ment Seeking movement Aggression Challenging behaviour Increased Fidgeting Fear Heighten voice Identify

Causes of Stress in ASC

Emotional Overload Not Understanding Speech Changes in Programme Choices Not Understanding Time Not Knowing What is Happening Hypersensitivities

Identify

Add Stress to the Mix

Chicken or Egg? Sensitivities can raise anxiety levels in everyday situations and the general environment is much more overwhelming. If you are already stressed or anxious, anyone of us can become more sensitive than usual. We therefore can all experience sensory overload at stressful times. Our Thresholds for response is lower, it takes much less to push us over the edge. Flight or Flight Response is triggered easily. Just because we think the response is out of proportion to the stimulus, it doesn’t mean the response isn’t real.

Identify

Behaviour & Anxiety

Is it sensory or is it behaviour? Be a SENSORY DETECTIVE Environment and consistency Fight or flight response – can happen several times a day Time out cards and chill out zones

Identify

Autonomic Response

Provide

Medical / Physical Pain or discomfort Hunger or Thirst Illness or beginning to feel unwell Medication response or side effects Lack of sleep Action Seek appropriate medical advice

Considerations

Provide

Communication Attention New social situation or unexpected event/action Personal need or want Choice Action Establish communication Set up method of communication Use Consistently In all environments

Considerations

Provide

Task Demand The nature of the task:

Task being too easy/difficult A transitioning difficulty Lack of confidence / self esteem Action: Modify - to increase/decrease demand; Establish systems and routines Modify the environmental demands Provide emotional support

Considerations

Provide

Postural Control Underlying factors may include: Poor core strength Poor stamina Increased effort Action: Include opportunities for exercise and strength Build in a daily and/or weekly routine, e.g. gym, yoga, pilates

Strategies

Provide

Praxis Underlying factors may include: Knowing how to do a task Difficulty creating ideas for actions Difficulty sequencing and organising tasks Action: Helping to break down tasks into smaller parts and working towards accomplishing small steps at a time Providing support to create the ideas for and ‘recipe’ to complete tasks Practice, practice, practice

Strategies

Provide

Sensory Systems Underlying factors may include:

Poor sensory processing Over responsive sensory systems Under responsive sensory systems

Action: 1. Sensory awareness of the individual’s needs

• 2. Environmental Considerations
• 3. Sensory Based Activities
• 4. Purposeful Occupation

Strategies

Provide

Action Consult with the OT for an assessment and consideration of the individual’s sensory needs. Identify strengths and weaknesses Consider whether the person may be over- sensitive (hyper-sensitive) or under-sensitive (hypo-sensitive) to sound, light, colour, smell or taste, which can cause anxiety or even pain in a person with autism. (NICE, 2011) Think about: What is the sensory need, how will it be met? Are there ways of modifying or increasing/decreasing the sensory input? Guide and work with the individual to implement sensory strategies Are strategies able to be carried out consistently in all environments

Sensory Awareness

Provide

Environmental Considerations

Personal Space Breaks Colours Lighting Noise levels Visual Supports Provide At least an arm’s length Less Fluorescent, Black out curtains Dark glasses Natural light Reduce external sounds; Ear plugs Ear defenders Labels – words/symbols Visual cues about expected behaviour Avoid patterns Involve individuals in choosing colours Adapt/adjust Duration Regular breaks

Proprioceptive Activities Active heavy muscle work Resistive movement opportunities can provide increased feedback to the body and result in a calming and organising. Hobbies e.g. swimming, martial arts; Karate, going to the gym, Yoga, Pilates.

Sensory Based Activities

Provide

Vestibular Activities Challenges to movement, balance and postural control Activities include:

Swinging back and forth e.g. on a garden swing/therapy ball Rocking back and forth e.g. rocking chair Hobbies: horse-riding, trampolining, fitness classes, cycling.

Sensory Based Activities

Provide

Tactile Based Activities Deep pressure Accessing varying texture within the environment, e.g. sheets, towels, sponges, box of tactile fidgets and toys Use of weighted items such as blankets, jackets, ankle/wrist weights. Traditional massage, hand massage Use of vibration – massagers Oral motor activities,

e.g. chewing on gum, blow bubbles

Sensory Based Activities

Provide

Tactile Based Activities Personal care opportunities:

Bathing / Showering Towelling with heavy pressure Bath products – scents that are relaxing, invigorating or neutral Varying textures of products, scrubs and creams Use of sponges; loofahs; brushes Moisturisers cream / sprays Independently applying products

Sensory Based Activities

Provide

Auditory Based Activities Use of music in different situations Classical can be calming and organising Music with rhythm and beat can be alerting and organising Listening programmes available e.g. Therapeutic Listening Programme (www.vitallinks.net)

Sensory Based Activities

Provide

Visual Based Activities Increasing or decreasing visual stimulation can affect arousal levels

A clear organised workspace may be calming and

• rganising for some and too limiting for others.

Options for different types of visual activities e.g. appropriate use of items with varying lights and movement

Sensory Based Activities

Provide

Participation in meaningful activities

Leisure / Hobbies / Play opportunities

Music, reading. Painting, art Walking Cycling or tricycle Gardening Exercise, sports, going to the gym, yoga, Pilates Natural outdoor areas- parks and gym areas

In the community – shopping, using the post office, employment

Purposeful Occupation

Provide

Participation in meaningful activities

Self care – washing, dressing, eating, sleeping Jobs

Shopping: making lists, going to/from the shops; shopping and carrying shopping bags Cooking – making drinks, snacks, baking bread, making pizza Washing up, washing windows, laundry, hanging up wet washing Cleaning, dusting, tidying, organising, sorting, changing sheets Filling the dishwasher, taking out bins

Purposeful Occupation

Provide

Access to purposeful occupations Resistive, movement and calming activities available within the environment. Quiet space Access to sensory rooms, with appropriate stimulation and goals for use - too much or too little stimulation Monitoring screen time – computer/TV Individual design of workspaces

In-House Solutions

Provide

Individualised daily schedule of a enriched “sensory lifestyle” Sensory based activities Resistive, movement and tactile activities Calming activities such as relaxation, listening to music Tactile activities

In-House Solutions

Provide

Ensure there is a specific assessment of the individual’s sensory processing (OT or professional trained in SI). Be aware of the individual’s likes and dislikes, strengths and weaknesses. Be aware of the individual’s sensory thresholds (over/under responsive). Work alongside the individual to identify warning signs of sensory overload and to create strategies to cope with situations Create a log of effective sensory based activities which the individual responds to. Guide the individual to utilise calming or organising activities when needed Integrate sensory based movement, calming and organising activities as part of the daily routine.

In Summary

Provide

Miller, L. 2006. Sensational Kids, Hope and Help for Children with Sensory Processing Disorder. Murray-Slutsky, C and Paris, B. 2005.Is It Sensory or Is It Behavior?: Behavior Problem Identification, Assessment, and Intervention. PsychCorp. National Autistic Society www.autism.org.uk NICE August 2013: Autism - management of autism in children and young people, http://www.nice.org.uk/nicemedia/live/14257/64946/64946.pdf NICE June 2012: Autism: recognition, referral, diagnosis and management of adults on the autism spectrum, http://www.nice.org.uk/nicemedia/live/13774/59685/59685.pdf NICE September 2011: Autism diagnosis in children and young people, http://www.nice.org.uk/nicemedia/live/13572/56428/56428.pdf Williams and Shellenberger, 1996; How does your engine run? Leader's Guide to the Alert Program for Self Regulation Winterbourne View December 2012: Key Findings and Recommendations, http://www.dudley.gov.uk/resident/care-health/dudley-social-services/whats- new/winterbourne-view-key-findings-and-recommendations/

References