Objectives. Session 304: At an Impasse? Reduce the Likelihood of Escalating Behaviors Using A Sensory Framework Robyn Otty, OTD, OTR/L, MEd, BCPR

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1 To comply with professional boards/associations standards: I declare that I (or my family) do not have a financial relationship in any amount, occurring in the last 12 months with a commercial interest whose products or services are discussed in my presentation. Additionally, all planners involved do not have any financial relationship. Requirements for successful completion are attendance for the full session along with a completed session evaluation. Vyne Education and all current accreditation statuses does not imply endorsement of any commercial products displayed in conjunction with this activity. Session 304: At an Impasse? Reduce the Likelihood of Escalating Behaviors Using A Sensory Framework Robyn Otty, OTD, OTR/L, MEd, BCPR Leading the Way in Continuing Education and Professional Development. Objectives Identify neurological sources to sensory and behavior challenges. Create opportunities to influence challenging behaviors through a pro-active sensory approach. Evaluate different areas of practice to incorporate experiences to reduce likelihood of patient escalation and other challenging behaviors. 1

2 What do you see? Behavior Challenges Observed in YOUR Setting Before During After Patterns to Behavioral Changes Sensory Challenges & Connection to Behavior Behaviors: Influence on the Therapeutic Process (Kirby, Boyd, Williams, Faldowski, & Baranek, 2017) Hyperresponsive behaviors Avoidant behaviors Sensory seeking and repetitive/stereotypic behaviors Hyporesponsive behaviors 2

3 Behaviors: Influence on the Therapeutic Process (Chapparo and Lane, 2012) Inattention / distractible Unable to listen Fidgety / Difficulty sitting Excessive talking Talking before acting Impulsivity Neurological Connection: Inhibition Neurons [Inhibitory Neurons] Reduce the stimulus by 20% (Lane, 1991, p. 42) Neurological Connection: Sensory Homunculus 3

4 Somatosensory Connection from the Source Tactile System Light touch: Alerting Deep touch: Calming Vestibular Connection from the Source Strong & Long Lasting Gravitation Insecurity Marked with excessive fear during movement through space (and pull of gravity) OVER-RESPONSIVE to vestibular input (Parham & Mailloux, 2015) Ways to Assess 4

5 Assessment Strategies Parent Report Observational Standardized Assessment Canadian Occupational Performance Measure (OT) Developmental Coordination Disorder Attention Hyperactivity Disorder Autism Spectrum Disorder Gold-standard client centered, standardized assessment measure - semi-structured interview 1) Determine problem Rate importance (10-point rating scale) 2) Five problems are identified by client Score performance and satisfaction (10- point rating scale) 3) Intervention 4) Client reassessment Score performance and satisfaction Sensory Modulation Evaluation of Sensory Processing Touch Inventory for Elementary School-Aged Children Sensory Integration Practice Test Sensory Profile 5

6 Sensory Profile Autism Spectrum Disorder Attention Deficit Hyperactivity Disorder Sensory Processing Disorder Versions: Infant/Toddler (Birth-36 mos); Child (3-14 years) Short Sensory Profile Version School Companion (3-11:11 years) Adolescent/Adult Sensory Profile (11+ years) * Established validity and reliability Sensory Processing Assessment Tools Support the identification and treatment of children with sensory processing difficulties (home and/or school). Age 5-12; PRESCHOOL Version Age 2-4 Home & School Version Categories: Social participation, vision, hearing, touch, taste and smell, body awareness, balance and motion, planning and ideas. * Established reliability and validity (Kuhaneck, Henry, & Glennon, 2007) Goal Attainment Scale (GAS) Meaningful goals are set Each are then weighted by the client/parent Provides partial accomplishment of given goals. 6

7 Data-Driven Decision Making (DDDM) Structure to guide OT practitioners to link patient priorities to underlying factors that prevent occupational performance. Identify family goals Based on child s strengths and participation challenges Parents ID 5 specific goals OT facilitated goals related to child s and family s everyday life Hypothesis Generated by OT Sensory integrative factors influencing performance (Schaaf, et al., 2015) Data-Driven Decision Making Step-By-Step 1) Identify Participation Challenges and Goals 2) Describe Current Level 3) Identify Factors Affecting Participation 4) Conduct Assessment 5) Identify Strengths and Barriers 6) Generate Hypothesis 7) Design Intervention 8) Identify Outcomes 9) Conduct Intervention 10) Collect, Display, and Analyze Data 11) Monitor Progress (Schaaf, 2015,p.2) Intervention Approaches 7

8 Cognitive Approach Active mental processes: memory and attention Self-Control Strategy- General Encourage Self-Talk (verbalization) strategy Encourage changing the environment to reduce urge (or source of potential reduced self-control) Encourage self-distraction (i.e.: fiddling, alternative activity) (Manfra, Davis, Ducenne, & Winsler, 2014) Cognitive Example Cognitive Orientation to daily Occupational Performance (CO-OP) Based on learning & cognitive-behavioral theory Learning in context Client-centered (Polatajko & Mandich, 2004) Encourages active problem solving and self-examination of strategy use 8

9 CO-OP Application of CO-OP: GOAL: Identify occupation (meaningful activity) Perform the activity- Determine if the child has a general idea how to complete the activity PLAN: Develop strategy DO: Trial the PLAN CHECK: Confer with child for performance satisfaction If performance is not successful, repeat PLAN and DO until CHECK is achieved Research to Support CO-OP Promote self-regulatory and metacognitive skill for motor skill acquisition with children with DCD Results: Improved task performance link with self-regulatory performance (Sangster Jokic, Polatajko, & Whitebread, 2013) Promoting Strategy Use 9

10 CO-OP Practice Activity Goal Plan Do Check Sensory Approach Systematic to provide the CNS the information it needs to modulate and accommodate Guiding Principles to Sensory Input Inhibitory (Calming) Linear movement Containment/reduced sensory input Deep pressure (proprioceptive) input Oral input (sucking/blowing/prolonged chewing) Excitatory (Alerting) Rapid vertical movement Light pressure Intense vestibular input- Rotary Intense oral input (spicy, cold/hot, sour, crunchy) Vibration 10

11 Suggested Guidelines Encourage active exploration by the child Linear vestibular input Promote a safe environment for active exploration Provide opportunities for exploration & habituation Revisiting YOUR Environment Modify & Utilize Objects/Opportunities to encourage calm & predictability Behavior Approach Relationship of the stimulus, consequence, and response. 11

12 Mindfulness & Sustained Attention N= year olds Program: Mindfulness exercises: Breath counting and breathing exercises Discussion: worries, avoid reacting badly to situations Results: Significant teacher-rated ADHD symptoms & Improved focus (Thomas & Atkinson, 2016) Picture Schedule Creating Structure Creative Commons regionivcat.wikispaces.com Picture Schedule Creating Structure 12

13 Questions Robyn Otty Linked In: Linkedin.com/in/robynotty Chappar, C. & Lane, S.J. (2012). Learning disabilities and intellectual disabilities: Why is this so hard for me? In S.J. Lane & A. C. Bundy (Eds.), Kids can be kids: A childhood occupations approach (pp ). Philadelphia, PA: F.A.Davis Company. Howe, F.E. & Stagg, S.D. (2016). How sensory experiences affect adolescents with an autistic spectrum condition within the classroom. Journal of Autism Developmental Disorders, 46, doi: /s Kirby, A.V., Boyd, B.A., Williams, K.L., Faldowski, R.A., & Baranek, G.T. (2017). Sensory and repetitive behaviors among children with autism spectrum disorder at home. Autism, 21(2), doi: / Lane, S.J. (1991). Structure and function of the sensory systems. In A.C. Bundy, S.J. Lane, & E.A. Murray (Eds.), Sensory integration: Theory and practice (2 nd ed.), (pp ). Philadelphia, PA: F.A. Davis. Manfra, L., Davis, K.D., Ducenne, L., & Winsler, A. (2014). Preschoolers motor and verbal self-control strategies during a resistance-to-temptation task. The Journal of Genetic Psychology, 175(4), doi: / Parham, L.D. & Mailloux, Z. (2015). Sensory integration. In. J.Case-Smith and J. Clifford O Brien s (Eds.) Occupational Therapy for Children (7 th ed, ). St. Louis, MO: Elsevier. Polatajko, H. & Mandich, A. (2004). Cognitive orientation to daily occupational performance. Ottawa, Ontario: CAOT Publications. Reynolds, S., Glennon, T.J., Ausderau, K., Bendixen, R.M., Miller Kuhaneck, H., Pfeiffer, B., Bodison, S.C. (2017). Using a multifaceted approach to working with children who have differences in sensory processing and integration. American Journal of Occupational Therapy, 71(2), Sangster Jokic, C., Polatajko, H., & Whitebread, D. (2013). Self-regulation as a mediator in motor learning: The effect of the cognitive orientation to occupational performance approach on children with DCD. Adapted Physical Activity Quarterly, 30(2), Schaaf, R.C., Cohn, E.S. Burke, J., Dumont, R., Miller, A., & Mailloux, Z. (2015). Linking sensory factors to participation: Establishing intervention goals with parents for children with autism spectrum disorder. American Journal of Occupational Therapy, 69(5),

14 Thomas, G., & Atkinson, C. (2016). Measuring the effectiveness of a mindfulness-based intervention for children s attention functioning. Educational & Child Psychology, 33(1), Wiglesworth, S. & Farnworth, L. (2016). An exploration of the use of a sensory room in a forensic mental health setting: Staff and patient perspectives. Occupational Therapy International, 23(3), doi: /oti.1428 Willems, A., Embregts, P., Hendriks, L., & Bosman, A. (2016). Towards a framework in interaction training for staff working with clients with intellectual disabilities and challenging behavior. Journal of Intellectual Disability Research, 60(2), Doi: /jir