The “just right challenge: for this plucky young lady. She clearly likes the sensory input these activities are providing to her body and brain. These are exactly the outdoor sensory system challenging opportunities afforded by climbing trees and jumping streams that Jean Ayres’ wanted to recreate in her therapy spaces. For those of us lucky enough to live in rural areas and near great parks and other outdoor spaces, do we think about these natural spaces and resources enough.
I will be sharing this with every family I work with for Easter half term when it is a great time to start to once again out and about, now the snow has gone.
The SIPT (Ayres 1989) is one test battery used to assess for sensory integration difficulties. It is a collection of 17 tests that are designed to test various aspects of sensory perception, discrimination, reactivity and contribution to our praxis and ability to participate in everyday life.
It can, with mindful clinical reasoning, be used to assess people from 4 years, right across the lifespan – children, teenagers, adults and even older adults.
The 17 tests include tests that can identify patterns of sensory integration difficulties often associated with autism, ADHD, dyspraxia (sometimes considered a subtype of Developmental Co-ordination Disorder – DCD) and more generalised sensory integration/sensory processing difficulties (sometimes called sensory processing disorder or SPD). This set of tests can identify if difficulties in participating in everyday life are a result of problems registering, processing, integrating or reacting/responding to sensory information from the proprioception, touch, balance and visual systems.
The test was originally designed for use with children between the ages of 4 years through 8 years 11 months, but is increasingly used for older young people and adults, to indicate where sensory processing difficulties may have impacted on development and ability to participate in daily life.
The SIPT is intended to be primarily a tool to diagnose sensory integration dysfunction including praxis difficulties.
It should be only be used by those with post-graduate (or specific under-graduate) education in sensory integration. Assessment should gather and collect information in different ways and sensory integration assessment typically includes the use of a combination of assessments tools including parent/carer or self report tools like the Sensory Processing Measure (SPM)or Adolescent/Adult Sensory History (AASH) alongside interview, other testing and clinical observations to develop appropriate goals, plan outcomes measure and develop and carry out treatment plans.
The SIPT does not require the person to make verbal responses to the test items. It does require a person is able to focus and attend and be able to follow demonstration and verbal instructions. It may not be appropriate for use with all children with sensory integration and processing dysfunction.
The SIPT is increasingly being considered as a suitable assessment for use with adolescents and adults who are able to participate in more formal assessments techniques.
The plateauing of results above 8 years 11 months in the standardisation sample indicates developmental maturity of sensory integration.
Therefore deviations from the 8 years 11 months score in adolescents and adults may, as in the standardisation population, indicates specific organic problems processing sensory information, associated with learning disabilities, emotional disorders, and minimal brain dysfunction.
Statement compiled by Kathryn Smith, OT, 2011, following personal communication with Susanne Smith-Roley and Zoe Mailloux, SIPT Instructors, WPS.
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.
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