Sensory Processing Disorder in Children Diagnosed with ASD

1. Sensory Processing Disorder in Children Diagnosed with ASD Presented By Candice Mullendore, MS, OTR/L Kristan Pilakowski, OTD, OTR/L Pediatric Therapy Center

2. Course Objectives • Understand and recognize common fine motor and gross motor disturbances associated with an ASD diagnosis • Understand and recognize motor planning issues in children diagnosed with ASD • Understand and recognize the signs and behaviors associated with sensory processing differences and ASDs • Understand the unique sensory needs and challenges of a child diagnosed with ASD • Understand the principles of intervention for sensory and motor disturbances and the role of occupational and physical therapy

3. Since 1993 there has been a 7,000% increase in children with a diagnosis of autism in the state of NE that are served by IDEA (http://whale.to/a/autism_increase.html) Nationally, approximately 1.5 million people are affected by autism

4. Symptoms Associated with an ASD Diagnosis • Social Interaction Disturbance • Speech, language, and/or communication impairments or deficits • Stereotyped or repetitive behaviors • Cognitive skills • What’s missing?

5. Motor Disturbances and ASD • Wide range of motor deficits and impairments associated with ASD • Fine Motor Deficits • Gross Motor Deficits • Difficulties with Motor Planning

6. Fine Motor Deficits with ASD • Often have delays in the development of mature grasping patterns • Difficulty with handwriting • Difficulty managing fasteners

7. Gross Motor Disturbances with ASD • Parents commonly report gross motor milestones met early or in typical range • Often have abnormal gait patterns (toe walking) • Clumsy even in familiar environments • Difficulty with more complex or advanced motor patterns • Difficulty with organized sports • Poor body awareness

8. Motor Planning Deficits with ASD • Dyspraxia: impairment of the development of purposeful, voluntary movement • Sometimes called Developmental Coordination Disorder • Difficulty with more complex or multi-step motor plans • Independent dressing • Brushing teeth • Using utensils • Tying shoes • Using scissors • Riding a bike

9. Motor Planning Deficits • Motor deficits are often related to sensory processing differences • Poor body awareness • Poor spatial awareness • Poor tactile processing • Poor vestibular processing • Often overlooked • Not considered priority for treatment • Can and should be treated with occupational and physical therapy

10. Sensory Processing Defined • Sensory processing (sometimes called "sensory integration" or SI) is a term that refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses. Whether you are biting into a hamburger, riding a bicycle, or reading a book, your successful completion of the activity requires processing sensation or "sensory integration." -SPD Foundation

11. Sensory Integration… • This concept originated out of the work of A. Jean Ayers • Her focus was on the role of sensory processing in child development • Proximal senses – vestibular, tactile, and proprioceptive senses • Distal senses – vision and hearing • First defined sensory integration as “the organization of sensation for use”

12. Sensory Integration… • Is an unconscious process of the brain • Organizes information detected by the senses • Gives meaning to what is experienced by sifting through all the incoming information and prioritizing what to focus on • Allows us to act on or respond to the situation we are experiencing in a purposeful manner • Forms the underlying foundation for academic learning and social behavior

13. Sensory Processing Hierarchy

14. Brain Food • Sensory integration is the most important type of sensory processing • Sensations nourish the brain by providing the knowledge to direct the body and mind for functional activities • Without well organized sensory processes, sensations cannot be digested and nourish the brain

15. Directing Traffic • The brain must locate, sort, and organize all incoming sensory input • When sensations flow in a well organized and integrated manner, the brain can use those sensations to form perceptions, behaviors, and learning • When disorganized, everyday life can feel like a traffic jam

16. Sensory Modulation • The nervous system modulates itself by increasing the energy of certain messages and reducing the energy of others • Every sensory and motor process involves facilitory and inhibitory forces to help useful messages along and prevent those that are not useful from getting in the way

17. Modulation • Without sufficient inhibition, sensory impulses would spread rapidly through the nervous system. This would cause the person to become extremely overwhelmed • Sensory modulation is a critical part of sensory integration that should be mastered early in childhood to allow for more advanced sensory processing later in life

18. Hypersensitivity • Sensations are registered too intensely • Sensory information is over stimulating and can be irritating, annoying, or threatening • Unable to screen relevant information • Highly distractible

19. Hyposensitivity • Registers sensations less intensely than normal • Does not get enough input to process sensory information accurately • May seek extra input or be passive and sluggish

20. Combination Hypo-Hypersensitivity • Oversensitive in some ways and under sensitive in others • Poor modulation • May seek certain input at times and avoid it at others • Can vary with each day or with each activity • ADHD diagnosis is common

22. Keep in Mind… • Child with SPD will not have every characteristic • Symptoms can very between or within each day – inconsistency is a hallmark of neurological dysfunction • Children can be both hyper and hyposensitive • No one is well regulated all the time

23. Putting the Pieces Together… • Eating an orange • Use your eyes, nose, mouth, the skin on your hands and fingers, muscles, joints, and tendons inside your fingers, hands, and arms, and your mouth • Sensory integration: all the sensory information comes together to allow us to peel, eat, and enjoy eating an orange

24. Adaptive Responses • A purposeful, goal directed response to a sensory experience • Mastering a challenge and learning something new • Examples: • Waving arms vs. reaching for an object • Perceiving that a toy is too far away and crawling to get it • Learning to tie your shoe

25. SPD and Autism • Three common problems in children with Autism and SPD • Sensory input is not being “registered” correctly – leads to paying little attention to some things and at times overreacting • Inaccurate or poor modulation of sensory input – especially vestibular and tactile sensations leading to gravitational insecurity and tactile defensiveness • The part of the brain that motivates interest in new and different activities is not operating correctly causing little or no interest in purposeful or constructive tasks

26. SPD and Autism • Other common behaviors and signs • Little or no registration of odors • Little sense of taste • Poor body awareness • Poor pain perception • Intense awareness of tactile stimuli – light touch defensiveness • Restricted diets • Movement seeking or “on-the go”

27. SPD and Autism • Poor registration leads to inaccurate integration • Impacts the ability to form a clear perception of space and a child’s relationship to space • Trouble registering spatial elements of their environment often leads to great difficulty when things within their environment change • Poor registration from skin, muscles, joints, and vestibular system impact body awareness and motor planning – impair ability to interact with the world

28. SPD and Autism • Difficulty with postural responses • Although not well developed, they are better than most children with a diagnoses of only SPD • Indicates the brain stem is processing proprioceptive and vestibular input needed for postural responses • Dyspraxia • Difficulty locating tactile stimuli • Difficulty knowing where their hands are if they cannot see them

29. SPD and Autism • Differences in the Limbic System • Leads to inaccurate registration of sensory information and failing to register and record input • Sorting through relevant and irrelevant visual input, may fail to visually attend to facial expressions but will pay unusual attention to a small detail such as a spot on the floor

30. SPD and Autism • Other common behaviors and signs • Little or no registration of odors • Little sense of taste • Poor body awareness • Poor pain perception • Intense awareness of tactile stimuli – light touch defensiveness • Restricted diets

31. SPD and Autism • “I want to do it” • Many children with autism are missing this internal motivator or desire to initiate behavior • The outcome of sensory input is deciding to respond or ignore sensory stimuli • Impacts purposeful and/or functional play and actions • Properly registering and integrating sensory input provides information for interaction with the environment

32. SELF CHECK Are you chewing gum? Are you wiggling your foot or leg? Have you been snacking during the session? Are you tapping your pen on the table? Have you ever turned down the radio in the car when it is dark and raining and you are lost?

33. The 5 Senses • Exteroceptors – sensations that tell us what is going on outside of the body • Sight • Sound • Taste • Smell • Touch

34. Beyond the 5 Senses • Proprioceptors – sensations that tell us where the body is in space and how it is moving • Proprioception – position and movement • Vestibular sense – gravity, head movement, and balance

36. Signs of SPD - Auditory • Under-responsive: • Hums or makes other noises constantly • Misses oral instructions more often than other students • Appears to ignore instructions frequently • Seems oblivious within an active environment • Over-responsive: • Avoidance behaviors before he/she has to go to Music, PE, or lunch • Comments about the fire engine or plane outside that no one else has noticed • Overly scared of fire alarm during fire drills • Frequently tells others to be quiet

37. Auditory Treatment Ideas • Earplugs • Headphones without the music • Gradual exposure to louder items • Quiet place to retreat to when items are loud

38. Use of Therapeutic Listening™ for auditory regulation

39. Signs of SPD - Proprioceptive • Under-responsive: • Sits on other children by accident when trying to sit on the floor • Trips over own feet frequently • Seeks out rough and tumble play • Pushes too hard through pencil • Frequently rips paper when trying to writeor erase • Seeks out hugs • Does not seem aware of own strength • Sprawls across chairs and/or slouches • Over-responsive • Does not push hard enough through pencil when writing • Does not climb on playground equipment due to apparent fear of heights • Moves arms and legs slowly or stiffly • Hesitant to participate in physical games

40. Proprioceptive Treatment Ideas • Hanging from monkey or pull up bar • Crash into pillows • Carrying, pushing & pulling heavy items • Theraband around legs of chair • Brushing program • Pushing/pulling heavy items • Carrying heaving items • Weighted vest or blanket

41. Proprioceptive Treatment IdeasContinued… • Wrist and/or ankle weights • Climbing • Jumping • Animal walks • Crawling over dynamic surfaces • Cuddle/hug vests

42. Proprioceptive Treatment IdeasContinued… • “Hermit crab” – let your child crawl around with a heavy backpack • Tug of war • Bear hugs • Wall/chair push ups • Weighted vests and/or lap pads

43. Crawling through a tunnel and over cushions for proprioceptive input

44. Weight Bearing and Handwriting for proprioceptive input

45. Dynamic walking

46. Proprioceptive and tactile input via body sock

47. Signs of SPD - Vestibular • Under-responsive: • Wiggles in chair constantly • Bumps into desks when walking through the room • “Busy” or “on the go” all the time • Falls frequently • Shakes head frequently • Climbs on furniture • Hangs head upside down • Over-responsive: • Hesitant to participate in active or fast games/activities • Intentionally withdraws from active environments or situations • Doesn’t play on playground equipment, especially swings • Moves slowly and cautiously • Holds head/neck very stiffly

48. Vestibular Treatment Ideas • Sitting on exercise ball • Swing inside or outside • Slide • Jumping • Animal Walks • Rocking • Move n sit cushions • Head upside down between legs

49. Vestibular Treatment IdeasContinued… • Swings • Scooter board • Trampoline • Rocking chair • Sit n spin • Bicycle • Car rides • Wagon rides • Walking on dynamic surfaces (pillow, mattresses) • Running • Therapy balls

50. Addressing multiple sensory components