This feature article was written by Claire Smith, one of the first UK OT’s to deliver Sensory Integration alongside Dialectical Behaviour Therapy (DBT). I am delighted to introduce Claire to you, as she was one of the first people I ever lectured about how to apply Sensory Integration’s in Mental Health. That was way back in 2004 and tonight she features on a BBC Documentary – Girls on the Edge.
Here is what Claire would like to add about how Ayres’ Sensory Integration can be used when we work with adults who have trauma and related sensory integration challenges.
As a DBT therapist and SI Practioner I am fortunate to be able to deliver a full DBT programme, alongside an inter-disciplinary DBT team, provide ASI intervention and use sensory strategies that I believe make a real difference to people’s lives.
We combine sensory strategies with DBT skills that support young people to self-regulate and reduce high emotional arousal. These are personalised and individualised to each young person forming part of their positive behavioural support care-plan. Sensory strategies are often used to help young people become ‘talking therapy ready’ prior to starting DBT. There is much stigma around mental health and what it means to be in a secure unit.
Three teenage girls and their families will be sharing their stories and lookIng at the impact on families in a documentary on Thu 22nd Feb, Girls on the Edge, at 9pm on BBC2. Their bravery, openness and honesty helps to break some of this stigma.
The programme has footage of some of the activities offered at FitzRoy House and features glimpses of a number of OT’s I work with providing meaningful occupations and supporting young people in their journey to recovery.
Occupational Therapists, Physiotherapists and Speech and Langauge Therapists practicing Ayres SI are frequently asked about eating difficulties; this is a common feature of sensory integration difficulties for many young babies and children.
Sensory and motor based eating issues require a whole child approach, starting with how a child moves and sits. Adequate and stable postural control facilitates a good head position and frees the hands up to help with eating.
Try this little exercise – sit on a low stool or chair, slump forward, with your chin almost on your chest and then try to sip a glass of water and chew and swallow a piece of soft fruit? How easy was it to do?
So how do we know if eating difficulties are more about sensory hyper or hypo-reactivity or poor oral sensory discrimination affecting the child’s motor skills? We have a range of tools in our toolbox. For older children, the SIPT Assessment provides excellent information about oral praxis, tactile reactivity and tactile discrimination, vestibular processing and proprioception. The Sensory Processing Measure can provide information for school-aged children, but also younger toddlers from 2.
Clinical Observations and parent report, as well as hypothesis testing through early intervention allows a therapist to test and confirm an early hypothesis through play with toys and games.
Therapy activities used might include a rice tub, play dough, messy paint play, kinetic sand, water play, shaving foam, play on balls, in tunnels, on swings and over foam rollers and with lots of textured surfaces. Careful observation will all help confirm why sensory differences may be contributing to tricky eating.
Then we also need to consider the child’s level of alertness, are they very tired, under-responsive and sleepy, or whizzing and fizzing – neither of these states is right for a task that needs focus and attention.
Do you feel like eating immediately after you wake up, or while trying to concentrate on a difficult task? Or while learning to walk a tight rope? Clear focus and attention is required for success at the table.
I really love this table from this amazing book, which provides an outline of questions to shape your parent interview and to use to inform your clinical reasoning during unstructured clinical observations.
from Arvedson, JC., Brodsky, L. (2002) – Pediatric Swallowing and Feeding: Assessment and Management
Addressing the underlying sensory or motor issues, whether this is an under -responsive vestibular system, over responsive tactile system, poor oral discrimination or poor proprioception and related motor muscle skills required for chewing does not have to be with food. And often it helps if initially, it is not about food. This is because when families first come for assessment and therapy food may already be an emotive subject. Helping our children to eat is key to helping them survive – and when for whatever reason they struggle with eating, Mum’s and Dad’s can feel sad, scared and even desperate. Growing and developing the postural, motor and sensory especially tactile discrimination skills needed for eating through play is fun and allows everyone to relax and new learning to occur without pressure.
Education about family mealtimes is also important, especially for younger children who may need to watch and observe, to model eating skills and see others trying new foods. For slightly older children, sometimes doing this with friends, at friends houses and even at school, cooking groups can allow a child to take risks, modelling peers. It is however essential that there is never pressure applied!
Other information and resources to support eating can be found here, and we will be posting again on eating and feeding difficulties.
Many children may have difficulties with self-regulation, especially those who have had tricky starts; including from traumatic illness, accident, trauma or neglect.
Increasingly OT’s are using Ayres’ Sensory Integration in combination with CBT( Cognitive Behavioural Therapy), adapted DBT (Dialectical Behavioural Therapy) and Attachment-based approaches in CAMHS (Child and Adolescent Mental health Services) and other paediatric roles to assess and provide intervention.
These two books are valuable additions to the bookshelf, with great ideas to inform practice and support time between therapy sessions.
The study Sensory Processing in Children with Autism Spectrum Disorder and/or Attention Deficit Hyperactivity Disorder in the Home and Classroom Contexts was undertaken in Spain. It explored the use of the SPM asking if it could identify sensory processing deficits and patterns on both the home and school forms. A useful study for therapists working in schools, where assessment may be limited to the use of reporting by others. The study includes helpful summaries of some of the literature supporting the use of Ayres’ SI with children with ASD and ADHD.
Sanz-Cervera P, Pastor-Cerezuela G, González-Sala F, Tárraga-Mínguez R, Fernández-Andrés M-I. Sensory Processing in Children with Autism Spectrum Disorder and/or Attention Deficit Hyperactivity Disorder in the Home and Classroom Contexts Frontiers in Psychology. 2017;8:1772. doi:10.3389/fpsyg.2017.01772.
Abstract: Children with neurodevelopmental disorders often show impairments in sensory processing (SP) and higher functions. The main objective of this study was to compare SP, praxis and social participation (SOC) in four groups of children: ASD Group (n = 21), ADHD Group (n = 21), ASD+ADHD Group (n = 21), and Comparison Group (n = 27). Participants were the parents and teachers of these children who were 5–8 years old (M = 6.32). They completed the Sensory Processing Measure (SPM) to evaluate the sensory profile, praxis and SOC of the children in both the home and classroom contexts. In the home context, the most affected was the ASD+ADHD group. The ADHD group obtained higher scores than the ASD group on the Body Awareness (BOD) subscale, indicating a higher level of dysfunction. The ASD group, however, did not obtain higher scores than the ADHD group on any subscale. In the classroom context, the most affected were the two ASD groups: the ASD+ADHD group obtained higher scores than the ADHD group on the Hearing (HEA) and Social Participation (SOC) subscales, and the ASD group obtained higher scores than the ADHD group on the SOC subscale. Regarding sensory modalities, difficulties in proprioception seem to be more characteristic to the ADHD condition. As for higher-level functioning, social difficulties seem to be more characteristic to the ASD condition. Differences between the two contexts were only found in the ASD group, which could be related to contextual hyperselectivity, an inherent autistic feature. Despite possible individual differences, specific intervention programs should be developed to improve the sensory challenges faced by children with different diagnoses.
Click here to read this article, and on the last day of OT Week! OT has so much to offer mental health care – we have a unique role using Ayres’ work to inform current practice in inpatient care – proud to be an OT owning the sensory integration frame of reference!
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