Here is another study reminding us about the sensori-motor differences typically co-occurring in Autism.
Sensory registration and discrimination are necessary for praxis. Information from the vestibular system, tactile and proprioceptive systems are especially important, and work together with information from the visual and auditory systems to help us know what we are doing in any given moment. Then when we get new information (when something happens in our own body or from the world around us) this “happening” can triggers our sensory system into action “Right body, brain just registered things have changed – time to do something different”. And then our brain uses this new information, alongside what we already know from past to learning, to create and choose from a list of next possible actions, choose the one that is likely to result in best possible outcome. Then our brains help us and plan the sequence and orders the what we will do and the how. As we carry out and action our plan, the brain via the senses monitors the what and how do we adapt and alter our actions in the here and now, hopefully ensuring a successful outcome.
Difficulties registering and perceiving sensory input can interfere with and discombobulate that process as any step or stage, resulting in sensory motor challenges that can disrupt process that should ensure successful outcomes in a person’s participation in everyday life.
Assessment of sensory differences for clients with Autism should extend beyond Sensory Profiles, reactivity and modulation. Comprehensive testing with tools like the SIPT and EASI will help ensure comprehensive testing to identify strengths and difficulties to inform person specific intervention planning.
When supporting other therapists to interpret their clinical data, I find a common theme tricky patterns emerging while trying to make sense of assessment data. It is always helpful to remember to explore and reference the latest supporting evidence.
Dr Susanne Smith Roley reminded our Module 6 delegates of this just last night. She emphasised the importance of staying up to date and using evidence from the last 5 or so years to support our clinical reasoning, as the evidence base about ASI is rapidly expanding, mainly within our domain of practice, occupational therapy. There is also a raft of evidence in related fields like ENT, neurology, mental health, trauma and other related areas. We need to search widely. This reminder from Susanne was the perfect timing for a conversation this morning and my reflections on that conversation this morning.
In summary; we should all remember to link our clinical findings with the latest research and evidence. This means we should link our evidence searches to the clinical patterns we suspect may be emerging from our assessment data.
If it doesn’t make sense – keep looking and exploring. Go back and ask more questions. Clinical reasoning is about data from a range of sources pointing to and in sync with performance and participation challenges.
Data from standardised testing, questionnaires, narrative and interview and clinical observations provides a holistic and individualised view of your client’s strengths and challenges. Exploration and understanding of their interests will allow you to capitalise on what will motivate them in therapy; supporting engagement and creating the right conditions of neural plasticity needed for therapeutic change.
Emerging evidence suggests that children with attention deficit and hyperactivity disorder (ADHD) present more difficulties in standing and walking balance than typically developing children.
Anecdotally many Occupational Therapists who use Ayres’ Sensory Integration to inform assessment and practice report the close links between ADHD and sensory integration challenges. This article by expert Sensory Integration researchers Shelley Lane and Stacey Reynolds offers research evidence and neuroscience in strong support of the links between differences in processing and integrating sensory input for those who meet criteria for a diagnosis of ADHD.
Abstract “Years of research have added to our understanding of Attention Deficit Hyperactivity Disorder (ADHD). None-the-less there is still much that is poorly understood. There is a need for, and ongoing interest in, developing a deeper understanding of this disorder to optimally identify risk and better inform treatment. Here, we present a compilation of findings examining ADHD both behaviorally and using neurophysiologic markers. Drawing on early work of McIntosh and co-investigators, we examined response to sensory challenge in children with ADHD, measuring HPA activity and electrodermal response (EDR) secondary to sensory stressors. In addition, we have examined the relationship between these physiologic measures, and reports of behavioral sensory over-responsivity and anxiety. Findings suggest that sensory responsivity differentiates among children with ADHD and warrants consideration. We link these findings with research conducted both prior to and after our own work and emphasize that there a growing knowledge supporting a relationship between ADHD and sensory over-responsivity, but more research is needed. Given the call from the National Institute of Health to move toward a more dimensional diagnostic process for mental health concerns, and away from the more routine categorical diagnostic process, we suggest sensory over-responsivity as a dimension in the diagnostic process for children with ADHD”.
Dr Susanne Smith Roley shared the draft of this with us when she teaching CLASI CASI M6 with ASI WISE in June. Lovely to see it in press and able to be shared! Thank you to all the authors! Just what’s needed to support practice.
Many Occupational Therapists using a sensory integration approach in their clinical practice have worked productively and mindfully with children, adults and older adults with trauma. Our unique education and training facilitates our practice in a range of settings- schools, mental health settings and hospitals, where as a profession we are tasked to address barriers to participation in everyday life.
Occupational Therapists are uniquely placed to be able to offer not only cognitive behavioural and occupation based activities.
Neuroscience now provides us with the evidence to support our practice of Ayres’ Sensory Integration with our clients with trauma – confirming our understanding about how trauma impacts early and ongoing sensory and motor development, underlying physiology and levels of arousal and attention.
Now and into the future, we will need to further consider the evidence for how inter-generational trauma manifests in underlying neurobiological processes that underpin function – the sensory, motor and cognitive building blocks of participation in everyday life.