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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About Leap… We are a private Occupational Therapy practice with 3 Specialist Occupational Therapists in High Wycombe Buckinghamshire. We see children, young people and adults with a variety of diagnoses. We provide a range of services including assessment, individual and group treatment, holiday activities, training, advice and parent support groups.
Today’s Targets Review the importance of our sensory systems. Discuss the clinical guidance. Identify common sensory triggers Provide strategies and advice.
Review Sensory Processing http://www.paranormalpeopleonline.com/wp-content/uploads/2011/10/2008_09_Synesthesia490X513.jpg
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.
Our Senses Review Vision Hearing Smell Taste Touch Proprioception Vestibular NAS
Sensory Review Processing Miller, 2006
Sensory Processing Review Disorder Miller, 2006
Sensory Review Differences HYPO SENSITIVITY HYPER SENSITIVITY (under-sensitive) (over-sensitive) Sensation Needs lots avoiding of sensation These perceptions may vary during the course of a day or a week
Hyper - Reactivity Review Hyper reactivity is when a reaction to a stimulus event is out of 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.
Hypo - reactivity Review 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, often 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 Academic Learning Cognition Intellect Daily Behaviour Living Activities Auditory Visual- Attention Language Spatial Centre Skills Perception Functions Perceptual Motor Development Eye-hand Ocular Motor Postural Co-ordination Control Adjustment Body Scheme Reflex Maturity Ability to Screen Input Sensory Motor Development Postural Awareness of Motor Security Two sides of body Planning Sensory Olfactory Visual Auditory Gustatory Systems Tactile Vestibular Proprioception CENTRAL NERVOUS SYSTEM Williams and Shellenberger, 1996
Discuss Residential Care Residential Care Environments Making adjustments to the social and physical environment and processes of care Anticipating and preventing behaviour that challenges
Sensory Integration problems in Individuals with Autism Discuss across the Lifespan Autism Nice Guidance : Recognition, referral, diagnosis and management of adults on 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
Residential Discuss Environments 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
Anticipating and preventing behaviour that challenges 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
Winterbourne, Discuss 2012 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
Sensory Identify Triggers Stress Anxiety Sound/ noise Lack of Light movement Tastes Sensory Smell Over load
Identify Behaviours Heighten Increased voice Challenging Fidgeting behaviour Seeking Aggression movement Disengage Change in ment mood Fear
Causes of Stress Identify in ASC Emotional Overload Not Understanding Speech Changes in Programme Choices Not Understanding Time Not Knowing What is Happening Hypersensitivities
Add Stress to Identify 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
Autonomic Provide Response
Provide Considerations 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
Provide Considerations 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
Provide Considerations 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
Provide Strategies 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
Provide Strategies 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
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