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The importance of a comprehensive assessment

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.

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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?”

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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:

 

 

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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:

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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”.

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Research for Practice: Sensory Integration and Dyslexia.


Ayres’ published her research findings, making a case for emerging patterns of sensory integration dysfunction including;   

  • developmental dyspraxia – this pattern linking motor planning difficulties with deficits in tactile perception
  • difficulties with integration of both sides of the body; poor right-left discrimination, difficulties crossing the midline, and  reduced bilateral motor coordination – impacting on posture and postural control, thought to related difficulties processing vestibular input 
  • visual perception, form and space perception deficits impacting on visual-motor functions
  • difficulties with visual figure-ground discrimination
  • deficits in auditory and language functions.
  • tactile defensiveness and related sensory reactivity difficulties impacting negatively on attention 

A key feature of Ayres’ Sensory Integration is the adaptive response;  “an adaptive response is a purposeful, goal-directed response to a sensory experience … play consists of a series of adaptive responses that make the sensory integration happen. In turn, as sensory integration develops, better organization and more complex skills are possible” Ayres 2005.

In 2013, Viana et al reported that children with dyslexia show poor performance and variability while relating visual and somatosensory information. Children with dyslexia showed less coherent and more variable body sway;  suggesting difficulties in multisensory integration from sensory cues coming from multiple sources.

 

man in brown jacket holding a book

Studies with adults and children found that there is reduced neurophysiological adaptation in adults and children with dyslexia. In 2016, Perrachione et al published research suggesting that people with dyslexia are likely to have differences in sensory integration and processing, noting significantly reduced adaptation to speech from a consistent voice and less adaptation to the repetition of words, objects, and faces. They provide evidence to support the hypothesis that reading skills in dyslexia are related to the degree of neural adaptation.

In 2017 Wandel and Le confirmed the importance of the effective processing of multiple sensory inputs, including successful sensory integration for competent reading. 

“Successful reading involves the ability to efficiently integrate visual signals with the sounds of speech and the language system; thus, diagnosing the reading circuitry requires testing the cortical and white matter regions that carry reading information from the visual, auditory, and language systems. Reading impairment can result from problems within neural circuits that are used for multiple purposes, not uniquely reading (Rayner et al., 2012, Seidenberg, 2017). Hence, we advocate assessing the circuitry broadly, not just portions that are highly specialized for reading.”

In clinical practice, some children with sensory integration difficulties benefit more from the use of coloured overlays. Research from Kriss and Evans (2005) suggests that 

“Children with dyslexia seem to benefit more from coloured overlays than non‐dyslexic children. MIS and dyslexia are separate entities and are detected and treated in different ways. If a child has both problems then they are likely to be markedly disadvantaged and they should receive prompt treatments appropriate to the two conditions. It is recommended that education professionals as well as eye‐care professionals are alert to the symptoms of MIS and that children are screened for this condition, as well as for other visual anomalies.”

Read the full article: The relationship between dyslexia and Meares‐Irlen Syndrome

Read more here:

Dyslexia link to eye spots confusing brain say scientists.

Dyslexia and Sensory Processing, is there a link?

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Research update: Forest design for mental health promotion—Using perceived sensory dimensions to elicit restorative responses

Forest design for mental health promotion—Using perceived sensory dimensions to elicit restorative responses, research into the qualities of the natural environment which promote restoration

forest design for mental health promotion - research update

download full article – open access pdf here  

 

gray bridge and trees

 

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Christmas Themed – Calm Down Glitter Bottle Timer

Thanks so much for this beautiful, simple idea sent to us by one of our families.

Have you tried making and using a glitter-filled calm down bottle timer to help your little ones? It’s easy to put a Christmas theme into them by using festive colours and adding seasonal themed sequins or beads.

With so many versions on the internet, here is a blog post from my Crazy Blessed Life with tried and tested instructions to make your own. While Mama OT explains how the bottles can work by aiding self-regulation http://mamaot.com/sensory-calm-down-bottle/

And a Christmas themed jar from Teaching Mama

Christmas Sensory Bottle

Don’t forget there is still time for you to win a copy of Love Jean by entering our Christmas time book give away. Share your Christmas themed sensory ideas with our community… by leaving a comment on one of our Christmas themed blog posts or on our facebook page … before the 15th December 2018

love jean book

 

 

 

assorted color sequins

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‘Sensory’ in Autism isn’t just about sensitivity.

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.

http://idoinautismland.com/?p=376