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INTELLECTUAL DISABILITIES DEVELOPMENTAL DISABILITIES FACT suspected case

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INTELLECTUAL DISABILITIES DEVELOPMENTAL DISABILITIES FACT  suspected case Powered By Docstoc
					                                  OUTREACH SERVICES OF INDIANA

  INTELLECTUAL DISABILITIES / DEVELOPMENTAL DISABILITIES FACT SHEET
CATEGORY: HEALTH AND SAFETY
TOPIC: RECOGNIZING SENSORY PROCESSING DISORDERS

Introduction: This information is being provided by Outreach Services of Indiana to assist persons with
intellectual/developmental disabilities to lead safe, healthy and happy lives. It is general information and will not
necessarily be pertinent to each person’s individual circumstances based on other contributing factors.
Fact Sheets can be found at www.iidc.indiana.edu/training

Objectives: Individuals will learn the definition of Sensory Processing and the symptoms of disorders of sensory
processing. Also addressed will be the method to obtain a sensory processing evaluation. A general overview of
treatment and other strategies.

Definitions: A sensory processing disorder is when an individual’s brain does not process the incoming
information from the senses (vision, hearing, taste, smell, touch or movement) normally in order to produce an
“adaptive response”.


Facts:
Sensory processing is present in all individuals throughout their lifetime. A newborn must learn how to use the
incoming sensory information to act on their environment. In infancy often a parent must help a child to learn to
calm themselves (self regulation). As the child progresses they learn to calm themselves as well as to use the
incoming sensory information to explore and learn about their own bodies and the world around them. This
process is called sensory integration or sensory processing. How an individual processes information varies from
person to person based on their experience, and preference. Although our brain receives a great deal of
information from our senses, we are aware of only about 5% of the incoming information at one time. A person
with normal sensory processing is able to attend to the important information in order to respond to environmental
demands. Everyone will experience problems with integrating incoming information at times due to lack of
sleep, over stimulation, stress, illness or other factors. In most cases a person with normal sensory processing will
modify their behavior or the environment to allow them to function in that situation. There are several theorists
who classify Sensory Processing Disorders. As a result terminology used to describe each disorder may vary.
This was selected as it was based on individual with developmental disabilities. The research included within this
presentation is based on the work of Judith Reisman and Bonnie Hanschu., and more recent work by Bonnie
Hanschu related to the “READY APPROACH”. Hanschu identifies 4 types of Sensory Processing Disorders
which are as follows: TYPES/SYMPTOMS: 1) DEFENSIVENESS is difficulty tolerating certain types of
sensation (i.e. Touch, taste, sound, movement or visual input); 2) MODULATION is difficulty recognizing or
focusing on the important information in order to interact with others or the environment (i.e. Poor attention span,
fixation, trouble transitions from activity to activity or difficulty coping with even minor changes in routine); 3)
Under REGISTRATION is a lack of body awareness, a result of limited development of the body map within the
brain. 4) Poor INTEGRATION is difficulty moving the body in order to complete tasks in a functional or
coordinated manner when compared to other’s at their cognitive level (trouble with coordinating movement for
gross motor tasks such as catching a ball or maintain balance; or for fine motor tasks such as writing or cutting).
Hanschu arranged these disorders in order of priority for treatment. In general persons who have impaired
Sensory processing disorders can range from mild where the individual is able to function with the
implementation of strategies or environmental modifications to severe where it affects all areas of their life, and
severely impairs their quality of life.

Sensory Impairment versus Sensory Processing Disorder.
Individual who have vision and hearing loss, cerebral palsy, spinal cord injuries are not considered sensory
processing disorders, but they often have symptoms which are similar due to impaired or lack of sensation.
If a Sensory Processing Disorder is suspected?
As health care professionals, there are specific steps you can take to assist in determining if an individual should
be referred. Nurses, Physicians and Behavioral Clinicians can assist by ruling out disorders which may have
similar symptoms as sensory processing disorders. A functional behavioral analysis and behavior plan, if
appropriate are important components to have been completed prior to a referral for a Sensory Processing
Evaluation. Speech and Language Pathologists can provide valuable insight through their clinical observations
or assessment to identify symptoms of sensory processing disorders. They are also valuable in implementing
strategies such as visual supports and augmented communication to allow the individual to express information
regarding their sensory needs. Case Managers and Direct Care Staff can assist by implementing behavior or
speech treatment plans consistently. They may also be asked to collect frequency data or complete a check list of
observed symptoms when impaired sensory processing is suspected. The Case Manager and Physician would
be involved in obtaining a referral to an occupational therapist to complete a sensory processing evaluation. It is
recommended that the occupational therapist have advanced training in sensory processing disorders, as well and
experience in treating individual within the individuals’ same age range.

What should the evaluation include?
Informal or standardized testing; interview of the individual as well as parents or caregivers; and observation of
the individual’s response to a different types of sensory input (if possible observation in their natural setting);
Make sure you get a copy of the report and ask the therapist questions if you don’t understand its results or
recommendations. Ask the therapist if there are things you can do to modify the individual’s environment to
improve function and comfort within the home and other settings.

What kinds of services are available?
Depending on the severity, services may be provided through 1) consultation to assist in implementing strategies
or a sensory diet or 2) direct treatment in therapy. It may be helpful to observe therapy so that activities may be
continued within the home or other natural settings. It is always helpful to have follow up for consultation
services to ensure the strategies or sensory diet is having the desired effect/results.
* A “sensory diet” are prescribed activities at specific times of the day to meet the individuals’ sensory needs. A
sensory diet should be individualized and therefore should not be used with other individuals.
Modifying the environment is a useful strategy to help individuals with sensory processing disorders. Examples
include things such as providing extra time for a person to transition from one activity to another, assisting the
individual in building routine and structure with a daily schedule, and reducing clutter. If a person is identified as
being defensive, reducing exposure to the offensive sensation is also a helpful strategy.

What types of activities may be included in treatment?
Sensory integrative therapy uses many types of equipment to provide sensory input. Swings, ball pits, mini
trampoline, vibrators, therapy balls are commonly used. Activities that include pushing, pulling, lifting and
carrying provide “heavy work”. If the individual is defensive specific treatment involving therapy brushes and
joint compression may be incorporated in treatment and taught to care providers to use at home. The “just right”
challenge is important in order to produce an adaptive response. These are important components to sensory
integration therapy, although individuals with intellectual/ developmental disabilities may not be able to self
direct or actively participate which are other components to traditional sensory integration treatment.

What is the goal or desired outcome of treatment? The overall goal is to improve the individuals’ ability to
function within their environment, but is specific to the individual. These might include decreased anxiety or
fear, increased independence in self care, improved communication, improved coordination, or greater flexibility
and ability to adapt to change.


Learning Assessment (Questions that can be used to verify a person’s competency in the material contained
in this Fact Sheet):
    1. Sensory Processing occurs in all people throughout their lifetime? T or F
2. Identify the statement that is FALSE when referring to normal sensory processing.
    A. People with normal sensory processing can have periods of time when they feel overwhelmed by
       incoming sensory information.
    B. It results in a “maladaptive response”.
    C. It is normal for infants to have difficulty with self regulation.
    D. Illness, lack of sleep, stress, or alcohol may impair a person’s sensory processing.
3. Examples of activities that may be used in therapy include all but one of the following:
    A. Swinging, bouncing on a mini trampoline, crawling through a ball pit
    B. “Heavy work” pushing, lifting, or carrying objects
    C. Brushing with a sensory brush and joint compressions
    D. Activities that are too challenging for the individual to complete successfully
4. Which is NOT a symptom of a Sensory Processing Disorder?
    A. Blindness
    B. Becomes upset with even minor changes in routine.
    C. Withdraws when touched or approached by others
    D. Fixates on one activity or difficulty shifting focus.
5. If you suspect a person has a Sensory Processing Disorder you should?
    A. Make a list of the symptoms you observe.
    B. Suggest a referral to an occupational therapist for a Sensory Processing Evaluation.
    C. Explore methods to modify the environment or your interactions with them to help them cope.
    D. All of the above.
    E. None of the above.
6. What types of services may be provided by an occupational therapist for an individual who has a Sensory
Processing Disorder?
    A. Consultation regarding sensory strategies or environmental modifications.
    B. Cognitive training to help them improve their ability to retain information.
    C. Sensory integration therapy and development of a sensory diet.
    D. A and B
    E. A and C
8. Providing a structured daily routine, reducing clutter, and reducing offending sensations are examples of
strategies to modify the environment for someone who has a sensory processing disorder. T or F
7. It is important to seek evaluation for an individual you suspect has a Sensory Processing Disorder if :
    A. The individual’s functional abilities are far below what would be expected for their cognitive level.
    B. They have a poor quality of life due to restricted ability to interact with others or tolerate their
         environment.
    C. If they are unable to participate in activities due to severe movement limitations as a result of Cerebral
         Palsy.
    D. A and B
    E. None of the above
9. Activities suggested within a sensory diet for one individual would be helpful if used with another person
with a Sensory Processing Disorder? T or F
10. If a person has difficulty accepting touch or hand over hand assistance when performing self care
activities, this may be a symptom of:
   A. Poor Modulation
   B. Poor Integration
   C. Tactile Defensiveness
   D. Under Registration
11. Nurses, physicians, and/or behavior clinicians should assist in ruling out other medical or psychiatric
conditions prior to referring an individual for a sensory processing evaluation. T or F
References:
1. Hanschu, B. (2003). Evaluation and Treatment of Sensory Processing Disorders:
        from the perspective of The Ready Approach., Madison, Wisconsin.
2. Reisman, J. E. & Hanschu, B. (1992). Sensory Integration Inventory-Revised: For Individuals with
       Developmental Disabilities. Hugo, Minnesota, PDP Press.
3. Fisher, A.G., Murray, E.A., Bundy, A.C. (1991). Sensory Integration: Theory and Practice. Philadelphia: F.A.
         Davis Company.
4. Hanschu, B. (2003) Autism & Attention Deficit Disorder/Hyperactivity: a Sensory Perspective
         Fort Lauderdale Florida.
5. Ayres, A.J. (1979). Sensory Integration and the Child. Los Angles: Western Psychological Service. How
       sensorimotor integration affects behavior and learning.
www.brainconnection.com
www.kidfoundation.org/spdchecklist/
www.sensory-procesing-disorders.com/
www.sensory-processing-disorder.com/sensory-processing-disorders.html
Http://classes.kumc.edu/sah/resources/sensory-processing/learning- opportunities/concepts/sp_concept_main.htm
http://www.sinetwork.org/aboutspd/defining.html
http://www.spdbayarea.org/SPD_what_is_sensory_processing_disorder.htm

Additional Related Resources:
Miller, L. & Lane, S. (2000). Toward a Consensus in terminology in sensory integration theory and practice: part
   1: taxonomy of neurophysiological processes. Sensory Integration Special Interest Section Quarterly (23:2),
   American Occupational Therapy Association, Rockville Maryland.
Ross, M, & Bachner, S. (Eds). (1998). Adults with Developmental Disabilities: Current Approaches in
    Occupational Therapy. Rockville, MD. American Occupational Therapy Association
www.sensory-processing-disorder.com/sensory-processing-disorder-checklist.html
www.kidfoundation.org/spdchecklist/
www.icdl.com
www.sensorysmarts.com/diet.html
www.sensorysmarts.com/diet.html#Sample
 http://www.southpawenterprises.com
 www.sensorycomfort.com
www.abilitation.com
http://www.flaghouse.com


For Questions, Comments, or Suggestions, please contact Outreach Services at: Cynthia.Speer@fssa.in.gov
Author: Connie Ortman, OTR
Date of Initial Sheet: 9-30-07
Date Fact Sheet Distributed via BDDS Announcement:

Review/Update Dates:
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Description: INTELLECTUAL DISABILITIES DEVELOPMENTAL DISABILITIES FACT suspected case