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Slide 1 CHILD & PARENTRESOURCE INSTITUTECPRI MINISTRY OF CHILDREN
AND YOUTH SERVICES
Sensory Integration Issues in Children with Mental Health and Behavior Concerns
Authors: Kathryn Harris OT Reg.(Ont.) ², Laurie Francis OT Reg.(Ont.)², Lisa Hoyland OT Reg.(Ont.) ² Contributors: Dr. Ajit Ninan F.R.C.P.(C)²'³ , Stefanie Bodison OTD, OTR/L¹
'University of Southern California, Los Angeles, California ²Child and Parent Resource Institute, London, Ontario ³Schulich School of Medicine and Dentistry at Western University, London, Ontario
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Slide 2 CHILD & PARENTRESOURCE INSTITUTECPRI
Who are we? ServicesWe provide highly specialized, trauma-informed mental health and developmental services:
AssessmentConsultationTreatmentResearchEducationOur services are:
AccessibleInclusive
Culturally-sensitiveIndividualizedEvidence-informed
Our mission is to support children and youth with complex mental health or developmental challenges in reaching their full potential and enhancing their quality of life.
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Slide 3 CHILD & PARENTRESOURCE INSTITUTECPRI
LEARNING OBJECTIVES
• Understand the principles of Sensory Integration Theory
• Identify behavioural and daily functioning challenges that may be related to sensory integration issues
• Screening for sensory integration challenges and making appropriate referrals
• Integrate sensory based strategies into home, school, and community settings
• Take away tools and resources3
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Slide 4 CHILD & PARENTRESOURCE INSTITUTECPRI
The 7 Senses Sensations That Tell Us What is Coming From
Outside the Body (Exteroceptors)
1)Sound (or Auditory Sense)
2)Sight (or Visual Sense)
3)Taste (or Gustatory Sense)
4)Smell (or Olfactory Sense)
5)Touch (or Tactile Sense)(The Sensory Gang – Myles, Cook et al 2000)
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Slide 5 CHILD & PARENTRESOURCE INSTITUTECPRI
Sensations That Tell Us Where The Body is in Space and How it is Moving
6) Position, Force, Body movement(Proprioceptive Sense)
7) Gravity, Head Movement and Balance(Vestibular Sense)
(The Sensory Gang – Myles, Cook et al 2000)
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Slide 6 CHILD & PARENTRESOURCE INSTITUTECPRI
ACTIVITY
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What do you do to self regulate ?
(increase alertness or achieve a calm
state)
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Slide 7 CHILD & PARENTRESOURCE INSTITUTECPRI
AYRES SENSORY INTEGRATION®
7Ayres, A. J. (1972). Sensory integration and learning disorders. Los Angeles, CA: Western Psychological Services.Ayres, A. J. (1975). Sensorimotor foundations of academic ability. In W. M. Cruickshank & D. P. Hallahan (Eds.), Perceptual and Learning Disabilities in Children (vol. 2). New York, NY: Syracuse University Press.Authors: Stefanie Bodison OTD, OTR/L, Lisa Hoyland OT Reg.(Ont.), Kathryn Harris OT Reg.(Ont.), Laurie Francis OT Reg.(Ont.), Dr. Ajit Ninan F.R.C.P.(C)
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Slide 8 CHILD & PARENTRESOURCE INSTITUTECPRI
AYRES SENSORY INTEGRATION®
Sensory Modulation
Over-responsivity Under-responsivity
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• Tactile Defensiveness
• Gravitational Insecurity
• Intolerance to movement
• Under-responsiveness to movement
Ayres, A. J. (1972). Sensory integration and learning disorders. Los Angeles, CA: Western Psychological Services.Ayres, A. J. (1975). Sensorimotor foundations of academic ability. In W. M. Cruickshank & D. P. Hallahan (Eds.), Perceptual and Learning Disabilities in Children (vol. 2). New York, NY: Syracuse University Press.
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Slide 9 CHILD & PARENTRESOURCE INSTITUTECPRI
AYRES SENSORY INTEGRATION®
Sensorimotor Integration
Postural Related Praxis / Motor Planning
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• Postural Responses• Vestibular-ocular
control• Vestibular-bilateral
integration
• Body Schema• Somatodyspraxia• Ideation
Ayres, A. J. (1972). Sensory integration and learning disorders. Los Angeles, CA: Western Psychological Services.Ayres, A. J. (1975). Sensorimotor foundations of academic ability. In W. M. Cruickshank & D. P. Hallahan (Eds.), Perceptual and Learning Disabilities in Children (vol. 2). New York, NY: Syracuse University Press.
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Slide 10 CHILD & PARENTRESOURCE INSTITUTECPRI
Authors: Stefanie Bodison OTD, OTR/L, Lisa Hoyland OT Reg.(Ont.), Kathryn Harris OT Reg.(Ont.), Laurie Francis OT Reg.(Ont.), Dr. Ajit Ninan F.R.C.P.(C)10
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Slide 11 CHILD & PARENTRESOURCE INSTITUTECPRI
Does my client have sensory issues?
11Authors: Stefanie Bodison OTD, OTR/L, Lisa Hoyland OT Reg.(Ont.), Kathryn Harris OT Reg.(Ont.), Laurie Francis OT Reg.(Ont.), Dr. Ajit Ninan F.R.C.P.(C)
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Slide 12 CHILD & PARENTRESOURCE INSTITUTECPRI
DEMOGRAPHICS OF THE SAMPLE• 135 clients admitted over 3 calendar years 2010 – 2013• 2 female / 133 male
• 83 children met criteria for chart review (61 % of those admitted)
• N=30 (agreed to participate in retrospective chart review)• Within this group all were male• Age range of sample 6.6 years to 12.5 years • Mean Age (Standard Deviation) 9.63 years (1.47)
12Authors: Stefanie Bodison OTD, OTR/L, Lisa Hoyland OT Reg.(Ont.), Kathryn Harris OT Reg.(Ont.), Laurie Francis OT Reg.(Ont.), Dr. Ajit Ninan F.R.C.P.(C)
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Slide 13 CHILD & PARENTRESOURCE INSTITUTECPRI
DSM - IV Diagnosesn = 30
0 50 100
Mood Disorder (NOS)
Learning Disorder (NOS)
Expressive LanguageDisorder
Tourette Syndrome
Obsessive CompulsiveDisorder
Anxiety Disorder (NOS)
ADHD Combined Type
% of sample
23.3 %
12.5 %
9.4 %
9.4 %
9.4 %
13
56.7 %
36.7 %
Authors: Stefanie Bodison OTD, OTR/L, Lisa Hoyland OT Reg.(Ont.), Kathryn Harris OT Reg.(Ont.), Laurie Francis OT Reg.(Ont.), Dr. Ajit Ninan F.R.C.P.(C)
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Slide 14 CHILD & PARENTRESOURCE INSTITUTECPRI
Primary Caregiver Priority Concernsn = 30
0 20 40 60 80 100
* Other
Suicidal Ideation
Sexualized Behaviors
Anxiety
Theft
Safety
Self-Injurious Behavior
Elopement
Property Destruction
Verbal Aggression
Physical Aggression
% of sample
90.6 %
62.5 %
40.6 %
37.5 %
15.6 %
15.6 %
12.5 %
9.4 %
9.4 %
9.4 %
46.67 %
14• Other includes (n): refuses to do school work (2), alcohol consumption (1), anhedonic tendencies (1), chewing holes in clothes (1), cutting tags off clothes (1), excessive eating (1), impulsivity (1), inattention (1), minimal frustration tolerance (1), non-compliance (1), problems with social skills (1), risky behaviors (1).
Authors: Stefanie Bodison OTD, OTR/L, Lisa Hoyland OT Reg.(Ont.), Kathryn Harris OT Reg.(Ont.), Laurie Francis OT Reg.(Ont.), Dr. Ajit Ninan F.R.C.P.(C)
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Slide 15 CHILD & PARENTRESOURCE INSTITUTECPRI
Scores on the Sensory Processing Measure Indicating Some Problems or Definite Dysfunction
0 20 40 60 80 100
Total SPM Score
Social
Vision
Hearing
Touch
Body Awareness
Balance
Planning & Ideas
School SPM Scores(n=28)Home SPM Scores(n=29)
15% of sampleAuthors: Stefanie Bodison OTD, OTR/L, Lisa Hoyland OT Reg.(Ont.), Kathryn Harris OT Reg.(Ont.), Laurie Francis OT Reg.(Ont.), Dr. Ajit Ninan F.R.C.P.(C)
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Slide 16 CHILD & PARENTRESOURCE INSTITUTECPRI
Sensory Modulation Issues Identified During OT Evaluation
Overall 84.4 % of sample
Auditory Sensitivity 75%
Tactile Defensiveness 56.3 %
Intolerance to Movement 40.6 %
16Authors: Stefanie Bodison OTD, OTR/L, Lisa Hoyland OT Reg.(Ont.), Kathryn Harris OT Reg.(Ont.), Laurie Francis OT Reg.(Ont.), Dr. Ajit Ninan F.R.C.P.(C)
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Slide 17 CHILD & PARENTRESOURCE INSTITUTECPRI
Sensorimotor Integration Issues Identified During OT Evaluation
Overall 50 % of sample
Postural Control 37.5 %
Praxis 43.8 %
17Authors: Stefanie Bodison OTD, OTR/L, Lisa Hoyland OT Reg.(Ont.), Kathryn Harris OT Reg.(Ont.), Laurie Francis OT Reg.(Ont.), Dr. Ajit Ninan F.R.C.P.(C)
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Slide 18 CHILD & PARENTRESOURCE INSTITUTECPRI
RELATIONSHIP BETWEEN DIAGNOSES & SENSORY PROCESSING CONCERNS
0102030405060708090
100
SensoryModulation
Issues
SensorimotorIntegration Issues
ADHD Combined TypeOCDAnxiety
94.1 %
85.7 % 81.8 %
52.9 % 42.9 % 54.5 %
18Authors: Stefanie Bodison OTD, OTR/L, Lisa Hoyland OT Reg.(Ont.), Kathryn Harris OT Reg.(Ont.), Laurie Francis OT Reg.(Ont.), Dr. Ajit Ninan F.R.C.P.(C)
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Slide 19 CHILD & PARENTRESOURCE INSTITUTECPRI
Pathways.org Resources
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• Printable Developmental Milestone Checklists
• Printable Sensory Motor Checklists
• Printable Brochures (e.g. Play; Tummy Time; Intro to Sensory Integration)
• On line Videos
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Slide 20 CHILD & PARENTRESOURCE INSTITUTECPRI
Providers of Occupational Therapy Service
• Infant Development Services• Children’s Treatment Centers • School Health Support Services (consultative for
school based issues)• Children’s Mental Health Services (may have
occupational therapy services)• Tertiary Level Mental Health & Developmental Service
Provider (e.g. Child & Parent Resource Institute)• Private Practice Occupational Therapy
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Slide 21 CHILD & PARENTRESOURCE INSTITUTECPRI
Direct versus Consultative Occupational Therapy
Direct Therapy One-on-One (e.g. sensory rich
therapy space)
School & Home
Consultation(e.g. sensory
diet)
Environmental Modification
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Slide 22 CHILD & PARENTRESOURCE INSTITUTECPRI
SELF REGULATION
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Just Right Level of
Alertness
• Optimum Band of Alertness• Signs of Difficulty with Self-Regulation
• Strategies: co-regulation; scan the environment; pre-plan; abandon the activity; the just-right challenge; follow the child’s lead; celebrate success
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Slide 23 CHILD & PARENTRESOURCE INSTITUTECPRI
Sensory Strategies for Self Regulation
Sensory Based Cognitive Strategies e.g. Alert Program
Preventative Sensory Diet Activities
Equipment to help maintain optimal level of alertness
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Slide 24 CHILD & PARENTRESOURCE INSTITUTECPRI
Seating Providing Movement Input• Caution: Provide only if recommended by OT
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Slide 25 CHILD & PARENTRESOURCE INSTITUTECPRI
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Items Providing Input into Muscles and Joints and Deep Pressure Touch (caution: provide only if recommended by OT)
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Slide 26 CHILD & PARENTRESOURCE INSTITUTECPRI
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Fine Motor/Handwriting Strategies (caution: provide only if recommended by OT)
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Slide 27 CHILD & PARENTRESOURCE INSTITUTECPRI
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Fidget Items and Chewable Items (caution: provide only if recommended by OT)
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Slide 28 CHILD & PARENTRESOURCE INSTITUTECPRI
INTERVENTION STRATEGIES FOR SENSORY SENSITIVITIES
Remove noxious stimuli
Restorative niche
Movement / Alternate seating
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Slide 29 CHILD & PARENTRESOURCE INSTITUTECPRI
SENSORY DIETUSE OF SENSORY INPUT TO PROMOTE CHANGE
INHIBITORY• Slow deep pressure, neutral warmth, slow rhythmic
movement• Vibration, soft music
EXCITATORY • Light intermittent touch, cold, irregular or fast movement, loud
sounds
ORGANIZING• Reduce visual & auditory stimuli, regular tempo• Heavy work, resistive exercise, push/pull, weight bearing• Oral motor chewing, blowing
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Slide 30 CHILD & PARENTRESOURCE INSTITUTECPRI
INTERVENTION STRATEGIES FOR MOTOR PLANNING AND MOTOR COORDINATION ISSUES
Increase the level of “helper”
Reduce social demands
Alter task or activity
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Slide 31 CHILD & PARENTRESOURCE INSTITUTECPRIJUST RIGHT CHALLENGE
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Slide 32 CHILD & PARENTRESOURCE INSTITUTECPRI
HEAVY WORK STRATEGIES
HouseholdActivities
School Helper
Leisure Community
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Slide 33 CHILD & PARENTRESOURCE INSTITUTECPRI
HEAVY WORK - Break Away Activity
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Gross Motor Equipment
Hand Held Items
SeatingLifting/ Carrying
Pushing / Pulling
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Slide 34 CHILD & PARENTRESOURCE INSTITUTECPRI
ORGANIZING & CALMING HEAVY WORK STRATEGIES
FEEDBACK FROM GROUPS
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Pushing / Pulling
Lifting/ Carrying
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Slide 35 CHILD & PARENTRESOURCE INSTITUTECPRI
QUESTIONS
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Slide 36 CHILD & PARENTRESOURCE INSTITUTECPRI
References/Resources• Some parts of presentation “Based on material
developed by Pediatric Therapy Network, 2011”• Sensory Integration – Answers for Teachers; Sensory
Integration – Answers for Parents (Susanne Smith Roley, Zoe Mailloux and Gina Geppert Coleman)
• Sensory Integration and Praxis Tests Course 1 and 4 notebooks 2012
• Sensory Integration and the Child – 25th Anniversary Edition – By A. Jean Ayres
• www.pathways.org• “How Does Your Engine Run?” A Leader’s Guide to the
Alert Program for Self-Regulation, Mary Sue Williams, Sherry Shellenberger (1996)
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Slide 37 CHILD & PARENTRESOURCE INSTITUTECPRI
References/Resources• Asperger Syndrome and Sensory Issues, Practical Solutions for
Making Sense of the World, Brenda Smith Myles et. al. (2000)• Take Five! Staying Alert at Home and School, Mary Sue Williams,
Sherry Shellenberger (2001)• Sensory Integration, Answers for Teachers, Gina G. Coleman, Zoe
Mailloux, Susanne Smith Roley (2006)• Sensory Integration, Answers for Parents, Gina G. Coleman, Zoe
Mailloux, Susanne Smith Roley (2004)• The Out-of-Sync Child Has Fun, Activities for Kids with Sensory
Integration Dysfunction, Carol Stock Kranowitz (2003)• The Sensory Team Handbook, Nancy Mucklow (2009)
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