We will be hosting a Q & A session tonight. Come and join us to hear about Sensooli and Chewigem products. We will be joined tonight on the call by Jenny McLaughlan and Loz Young, who will be telling us more about Chewigem and their new initiative Sensooli . They are keen to hear therapist feedback about their products and how this relates to our practice;including what we might like to know more about. For more information please see https://chewigem.com/and their new spacehttps://sensooli.com/.
Please post any questions before the session to the ASI in Practice Telegram Group or email through to firstname.lastname@example.org.
This is an open evening session, so please also do bring any others questions or chat about anything related to ASI.
PANDAS and PANS Sensory Integration and Processing Difficulties
Sensory Systems: Vestibular processing deficits, often low PRN Poor postural control especially antigravity extension Can slouch, slump – extension against gravity is tricky and tiring Likes to move and not stop/fidgeting Can have low levels of alertness when not moving Scared of the dark without visual input to support spatial understanding Altered spatial awareness Poor grading of force May appear ‘low toned’ – but normal Beighton Scale Poor self-awareness – spatial; position in space and body awareness ARFID and picky eating | often poor tactile registration and poor modulation Super sensitive to some tastes Altered temperature perception Delayed cues re ill, nauseous, hungry, full or needing toilet Hyper-responsivity to some textures and light touch eg certain fabrics/textures May dislike light touch; skin, hair, tooth and nail care can be tricky Dislike being touched or held when not on own terms Slow or under-responsivity to pain, Hyper-responsivity in far senses; smell, vision and hearing
The dyspraxic patterns seen can include; Often bumping into things and people Difficulty playing with manipulating tools and toys Difficulty learning new/novel movement/motor skills Fine motor co-ordination difficulties e.g., handwriting, bilateral co-ordination, poor tool use Speech praxis difficulties include stutter, slurred words, poor pronunciation and timing Ideation, planning and execution can all be affected.
Emotion Regulation Rage Anger Irritability Poor frustration tolerance Difficulties with co and self-regulation Poor self-awareness – emotional lability is common Tearful one moment, raging the next 0-100 in 3 seconds
Executive Function Poor processing speed Multi-tasking is hard Poor timing and sequencing Poor concentration and focus Slow to perform tasks ? observed difficulties with language processing ? observed difficulties with more complex and abstract problem solving that is age-appropriate
Fatigues easily and needs lots of reset time May go ‘off legs’ Looks like have regressed
May need much parental encouragement and support Lose resilience to trying new things Low self-esteem
Older children Self-loathing and disgust at self Extreme fear and losing control of agency over the world Awareness of personality change and burden on parents and siblings
Thank you to the families who gave consent and our secret blogger OT for this contribution.
“A little while ago, two mums approached me and both asked about assessments for their children. Both were young adults, academically highly able and struggling with their self-organisation and motor skills.
Both young people consented to an assessment and completed, through self-report, the Adult/ Adolescent Sensory History (AASH) questionnaire. They were also assessed with the Sensory Integration and Praxis Test (SIPT). The SIPT is a standardised assessment with normative data for ages 4 through 8 years, 11 months. On this particular assessment tool, sensory integration and processing skills scores plateau at around this age, though the test is still informative for people beyond this age, who should have achieved.
The young lady assessed has a diagnosis of social anxiety and has low confidence, while the young man is quite a confident character. She has a history of bumps, trips and spills, and will tell anecdotes of these with great humour; while he prefers to focus on what he does well in conversation.
I love the AASH, the reports it gives highlight each sensory system, differentiate between discrimination and modulation difficulties and addresses motor planning, sequencing and social/ emotional aspects of sensory integration and processing needs.
It uses clear, non-patronising language and activities appropriate to adults and adolescents. It shows up really clearly a person’s (or their caregiver’s as necessary) perception of their sensory integration and processing needs and how these affect their day to day life. In this instance, the young lady highlighted many sensory processing needs.
The young man reported almost no difficulties, his only score in the primary sensory systems section was mild proprioceptive difficulties. When questioned as to the accuracy of his answers, he tended to reply “well, nobody likes that, do they?”
Having scored the AASH checklists, I completed a SIPT with each person. The SIPT is a battery of 17 tests which assess a person’s sensory integration and processing including perceptual-motor skills through tasks with standardised administration and normative data against which to compare an individuals test results. Guess which person showed more significant difficulties in the direct assessment?
On the SIPT assessment scores between -1 and +1 standard deviation are considered typical, above +1 are strengths and scores below -1 are of clinical significance and require support and will benefit from direct intervention.
The exception to this being Post Rotatory Nystagmus in which a low (below -1) or high score (above +1) indicates significant difficulty inhibiting response to vestibular information and often relates to a low Standing and Walking Balance score.
Here are the young lady’s SIPT results:
Definite movement, balance and body awareness difficulties but also some areas of significant strength, particularly around her visual skills and imitation, which she uses to compensate for her body awareness difficulties.
Here’s the young man’s chart:
Strong visual skills, compensating for significant challenges in the other areas.
This experience taught me so much. From the AASH scores, I was expecting the young lady to have much more problems in the SIPT than the young man, their conversation about their lifestyles confirmed this expectation. Still, then the assessment showed so clearly how much of that was related to confidence.
An evaluation based solely on checklists is not enough. It tells you what a person perceives to be their difficulties, guides the direction of evaluation and adds experiential evidence to the overall assessment.
A good questionnaire is evidence-based and norm-referenced, but it always needs to be triangulated with direct observation and where possible structured and standardised assessment. These tools can tell you so much about the respondent’s confidence and resilience and what they find easy or difficult in day to day life. But I have learned it is a mistake to rely upon one alone when assessing somebody’s sensory integration and processing skills and needs”.
ASI WISE was recently invited to deliver a presentation about Autism and sensory issues to a UK National Autistic Society meeting. Our presentations to the audience addressed the science and evidence behind autism and explored a families experience of sensory integration therapy.
Since the presentation we have had interesting conversations with some parents who attended. A common theme has been parents discovering that motor and praxis difficulties are part of sensory integration theory and therapy, and that ‘sensory’ in autism isn’t just about sensitivity.
Here is a great blog by an adult with autism who describes those sensory integration difficulties from visual scanning to actually doing.