Occupational Therapy

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Occupational Therapy Speech and language
Therapy Lenses on Assessment
Jenny Jones Occupational Therapist Julie
Mullis Speech and Language Therapist Clinical
leads for ASD Services Cardiff and the Vale
University Health Board
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Aims

• To have a greater understanding of Sensory
  Processing and ASD
• To explain the valuable role OT and SLT have in
  the assessment and diagnosis of complex children
• To outline the benefits of joint working

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Sensory Perceptual Atypicalities and ASD

• It is estimated that 90 of individuals with ASD
  have some abnormality of sensory and perceptual
  functioning and considered by some as CORE
  FEATURES
• (Geschwind
  2009)

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How does that look ?
Sensory Processing Disorders 70-80
Atypical Sensory Perceptual 90
ASD

• Synaesthesia
• Sensory distortions
• Sensory tune outs
• Sensory overload
• Overselectivity
• Perceptual dysfunction
• Sensory modulation

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What are Sensory Processing Disorders?
SENSORY INTEGRATION THEORY
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Effects of poor sensory modulation on learning
and behaviour
Under- Normal
Over- Reactivity Sensory Modulation
Reactivity
Under-Arousal i.e. misses non-verbal cues, slow
affective responses
Over-Arousal i.e. over-reacts to non-
verbal cues, anxious, too alert
Impaired Social Behaviour
Needs large amount of stimulation for arousal
Must attend to all stimuli as much as possible
Defective Attending Behaviour i.e. fails to look,
listen, process, and remember
Spacey Slow
Distractible Fragmented
Learning is impaired
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A Sensory hypothesis to Autism..New or just
the in thing ?

• 1943- Kanner rejected a sensory hypothesis
• 1949 Bergman and Escalona offered the first
  version of a sensory hypothesis
• The child's need to protect himself or herself
  from the sensory onslaught resulted in
  developmental distortions that eventually led to
  the symptoms that Kanner had first described

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Main hypotheses concerning Autism .60s and 70s

• Specific sensory dysfunctions and their affects
  on motoric-social and cognitive functioning in
  Autism were recognised and empirical studies
  began..

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Still current today

• Current clinical and treatment literature treats
  sensory dysfunction as an established core
  deficit in autism, with a theoretical focus on
  possible abnormalities in subcortical neural
  systems.
• Rogers Ozonoff 2005

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• The objective of therapy for the autistic child
  is to improve the sensory processing so that more
  sensations will be effectively registered and
  modulated and to encourage the child to form
  simple adaptive responses as a means of helping
  him learn and organise his behaviour
• 
  Ayres 1979

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Native Experts..90s

• Difficulty in registering input in a meaningful
  way can often be felt as painful and confusing
• (Grandin 95)
• Any satisfactory comprehensive theory of autism
  must address sensory symptoms
• ( Grandin 92, ONeill Jones 97, Williams 94)

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The last decadeResearch studies on sensory
processing and ASD

• 2002 Baranek
• 2005 Rogers and Ozonoff
• 2006 Kern et al
• 2006 Adamson, OHare and Graham
• 2007 Kern et al
• 2007 Tomchek and Dunn
• 2007 Ben-Sasson et al
• 2010 Tomchek
• And the list goes on

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Occupational Therapy Assessment

• Sensory processing functions
• Developmental play and interactions with
  environment
• Motor planning/praxis and sequencing
• Postural motor control
• Bilateral integration
• Gross and fine motor skills
• Visual motor integration
• Prewriting and writing skills
• Functional abilities in different daily living
  activities

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Why have an Occupational Therapist on Diagnostic
and Assessment teams?

• A detailed assessment of atypical sensory
  behaviours helps to distinguish whether a child's
  symptoms result from SPD, autism or other
  co-morbid disorders
• Sensory integration approach provides an
  alternative explanation for behaviours
• Accurate diagnosis appropriate intervention
• Sensory processing disorders may represent
  another core diagnostic criterion
• ASD-DSM-V

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Play Observations
Observations

• SLT Observations
• Not turning to name
• Not looking to mum for help with clothes
  discomfort
• Developmental delay
• No intentional communication growls
• Poor awareness of environment and other toys
  around him.
• No exploratory or object play.
• No enjoyment from parental interaction and
  sharing of toy

• OT Observations
• Poor registration to the turtle,
• Possible dysregulation by the singing and
  flashing of the toy
• Interested in string of turtle not the turtle.
• Praxis- not sure what to do with the turtle?
• Clawing at clothes, hands often fisted or
  looking at them flicking tactile defensive?
  visual seeker?
• Biting clothes, hitting head
• Distracted/distressed by fathers video game-
  auditory?

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Relational Play / Constructional
Object / Exploratory Play
Registration
Sensorimotor Play
Social Play
PLAY Childs main Occupation
Modulation
Praxis ideation
Symbolic Play
Functional Play
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Principles of Assessment for Speech and
Occupational Therapy

• On going process
• Skilled observations essential
• Observed in at least 2 different settings, over
  several visits and with a variety of people
• Assessment of child's sensory profile essential
• Detailed understanding of myriad of internal and
  external mechanisms that will influence child's
  communication and occupations

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C
A
B
D