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Occupational Therapy and Trauma 3: A Tool for considering the physical environment in children’s residential homes to address sensory processing issues in trauma-affected children

This article by Clinical Psychologists Christopher Robinson and Alicia Madeleine Brown in the Scottish Journal of Residential Child Care includes a lovely environmental checklist (adapted from Simpson 2009) used in considering the physical environment in three children’s residential homes.

Abstract: Sensory processing issues are generally considered to be clinically significant in children who have suffered abuse and trauma and much has been written about the possible neurological correlates of such sensitivities (De Bellis and Thomas, 2003; van der Kolk, 2014). Comparatively little focus has been given to the functional aspects of these sensitivities, and particularly how these might interact, in context, with a child’s underlying neurological vulnerabilities. In this respect, the environment surrounding the child is a neglected area of significant, perhaps critical, importance. In terms of potential hypersensitivity to environmental stimuli, children with Autistic Spectrum Conditions (ASC), although with different aetiological correlates to trauma affected children, are known to face profound environmental challenges. Children with ASCs have received a wealth of attention in the literature with regard to these sensory challenges, whereas, in contrast, trauma affected children have received very little direct attention at all. It is the aim of this paper to focus on the environmental aspects of sensory processing in trauma affected children, specifically in relation to the physical environment of children’s residential homes.

from the Scottish Journal of Residential Child Care 2016 – Vol.15, No.1 Scottish Journal of Residential Child Care ISSN 1478 – 1840 6

Read the full article free here.

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The Teenage Brain – Can neuroscience help us unravel the perplexing mystery of those often erratic and unpredictable years?

The teenage brain and the behaviours it can drive in young people can be perplexing and often scary to the parents standing by, watching and supporting. Knowing” what is sensory and what is “just teenage brain” can be tricky to parents of young people with neurological diversity.

Neuroscience is helping us understand why teens can suddenly engage in extreme, rollercoastering unpredictable behaviours that challenge those caring for them.

Here is a lovely youtube explaining some of the neuroscience behind these often turbulent and troubled years.

Tomorrow at 6pm we will be exploring The Teenage Brain and Cannabis

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Research Update: Mobile brain scanners

Is there a place for these in Ayres’ Sensory Integration research studies in the future? Watching the little girl in my last post play outdoors I was thinking it would be great if she could be wearing one of the new mobile brain scanners just reported on yesterday.

It would be fantastic if we could actually see what is going on inside her brain as she jumps and leaps, and then has an adaptive response, as it happens. Will it be possible to capture those magic therapy moments in a discreet person friendly way?

I am imagining we will be able to do this kind of study quite soon, though the look and construction of the scanner will clearly need to be less scary and more robust. They will  need to change somewhat before we can use them safely in ASI studies; I can’t see these somewhat scary face mask type helmets being jumping, swinging, rolling, crawling and crashing safe. However, exciting times I’m sure, for the ASI practitioners and researchers who can get involved in this kind of development and study!

Read more about the wearable brain scanner here.


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Research Update: What is Ayres’ Sensory Integration Therapy(ASI) and what is not? Do not believe everything you read – ASI shows promise as an intervention for those with Autism.

It is so disappointing to once again read research about Ayres’ Sensory Integration purporting to examine ASI versus other therapies, reporting ASI does not have an effect. This is especially important when there is an evidence for ABA, the behavioural intervention in these studies possibly resulting in trauma.

2011 – Comparison of Behavioral Intervention and Sensory-Integration Therapy in the Treatment of Challenging Behavior

2017 – Comparison of behavioral intervention and sensory integration therapy on challenging behavior of children with autism

2018 – Evidence of increased PTSD symptoms in autistics exposed to applied behavior analysis

There is a growing evidence base, not just for the existence of sensory integration difficulties and sensory processing difference across the lifespan and across a range of different clinical presentations, but also for the therapy as developed by Jean A Ayres.

Research by Smith Roley el al 2015, Lloyd, MacDonald and Lord 2013 and Flanagan et al 2012 supports earlier evidence by others including Adamson, O’Hare and Graham 2006, and Siaperas et al 2011 that Sensory Integration difficulties are common in Autism.

Intervention studies that provide evidence sensory integration may be effective include Pfeiffer et al 2011 and most recently a systematic review by Schaaf et al 2018 also examines growing evidence in support of ASI.

“evidence is strong that ASI intervention demonstrates positive outcomes for improving individually generated goals of functioning and participation as measured by Goal Attainment Scaling for children with autism. Moderate evidence supported improvements in impairment-level outcomes of improvement in autistic behaviors and skills-based outcomes of reduction in caregiver assistance with self-care activities”  Schaaf et al 2018

Recently there has been a spate of research comparing ASI to other behavioural approaches. Sadly, what is described as ASI is most definitely not. Spinning someone 10 times one way and then the next, with a few pushups thrown in, is not Ayres’ Sensory Integration!

If you read or report studies that say that ASI doesn’t work compared to other therapies for Autism, please do so very very carefully. Those of us properly trained in ASI, to postgraduate level, as per the International Council for Education in Ayres Sensory (ICEASI) guidelines read the descriptions of what is delivered, we do not recognise it as being ASI therapy. This therapy was carefully researched and developed by Jean Ayres, and overtime has been researched and further developed including the development of the ASI FIdelity Tool (Parham et al 2011).

A parent who works in advertising and marketing pointed out to me that if what is written in these studies was on a website advertising these behavioural services instead of ASI, their description of ASI and their claims may be grounds for an argument for false advertising!

Ayres’ Sensory Integration is a very specific therapy, carried out in a very specialist way, but very experienced clinicians who plan and deliver intervention only after person-specific assessment. The individualised intervention is determined and driven by the clinical data that is collected and analysed as part of the assessment, and ongoing observations and reflection are essential to the intervention.

Ayres’ Sensory Integration is about specific, personalised and targeted assessment and therapy; it includes the setting of goals and the measurement of outcomes. The therapist needs to have specialist, typically postgraduate, education in Ayres’ Sensory Integration, in line with internationally agreed standards as agreed by ICEASI.


Watch more about what Ayres’ Sensory Integration is here.

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When trauma occurs, the brain changes

Bessel A. van der Kolk M.D. is a clinical researcher who integrates developmental, neurobiological, psychodynamic and interpersonal aspects of the impact of trauma and it’s treatment. Learn a bit more from him about how perceptual changes happen because of trauma, and how this impacts on engaging with ordinary situations, focus as well as attention. Hear how this can impact on someone’s sense of self.