None todeclare Sensory Difficulties and FASD · • Epigenetics (affectsthe response to the abovefactors) •Brains are built from the bottom up. •Neural connections are built through

https://treetangleOT.com

Conflict of Interest

�None to declareSensory Difficulties and FASD

Where body and mind meet

Jo Pennell Consultant Occupational Therapist


Occupation• To an occupational therapist, ‘occupation’ refers to

any of the things a person needs, wants or is obliged to do to live their life.

• Occupational performance is supported by a good fit between

• Sensory Integration Theory should not be used in isolation (SINetwork; RCOT)

Person

OccupationEnvironment


What we know about brain development

• Brain development starts in utero and may be influenced by many factors such as:• Genetics, including structural abnormalities• Diet and health of the mother during pregnancy• Exposure to teratogens such as

alcohol/drugs/medication/infections• Epigenetics (affects the response to the above factors)

• Brains are built from the bottom up.

• Neural connections are built through experience

• Motor, cognitive, language, and social skill development in humans highly depends on successful interaction among the sensory systems


Sensory Processing and FASD

• Sensory issues are common in people with FASD• 54-80% of children with FASD found to have

sensory processing difficulties (Jirikowic et al;Carr et al)

• Sensory issues often underlie behavioural challenges/ dysregulation

• Understanding sensory needs and challenges can help people with FASD and carers develop strategies, modify environments, redesign activities


Sensory or behavioural (or both)?

• Difference between typical behaviour management and helping with sensory based needs has to do with filling the sensory need versus just getting rid of the behaviour

• Every behaviour has a purpose and root from something else


Is it Behaviour OR is it Sensory?Jon and Billy are playing in the sandpit

• Antecedent: Billy moves close to Jon with her toy

• Behaviour: Jon hits Billy • Consequence: Billy runs

off. • Interpretation: Jon gets

the toy Billy was playing with

• Antecedent: Billy moves close to Jon and brushes up against him

• Behaviour: Jon hits Billy • Consequence: Billy leaves

the sandpit• Interpretation: Jon found

the tactile experience painful; not attending to peripheral vision so was shocked; misjudged the force of push…….


Sensory Integration (processing)

• Sensory integration is the neurological process that organises sensation from one’s own body and from the environment and makes it possible to use the body effectively within the environment.

• The brain must select, enhance, inhibit, compare and associate the sensory information in a flexible, constantly changing pattern, in other words the brain must integrate it.” Ayres 1989


Building blocks for learningskills

©Dr L. A. Scott & L. Elliott 2017


What is Sensory Integration?

• Examples: In order to reading a book– We screen out noises going on around us – We don’t notice the feel of our clothing– We automatically adjust posture and muscle

tone to maintain sitting balance– We are able to scan the page by moving our

eyes without our head

We received messages from all of our senses and respond to this information in a way that allows us to do the things we want or need to.


What are the senses?

The obvious 5• Sight• Hearing• Vision• Smell• Touch

And the hidden 3• Proprioception• Vestibular• Interoception


Recognising sensory dysfunction• Sensory differences are what make us unique• They are only an issue if they get in the way of the things

we want or need to do.• Sometimes a simple task becomes super difficult because

we are not able to accommodate for our unique needs for example I like to move around when I talk, staying still makes it a little harder for me to stay focused so I am usually able to make moving around part of my teaching style. If I really needed to move around to concentrate and I was in an environment that couldn’t accommodate that need (some schools) I wouldn’t be able to perform to my optimum level



Sensory Dysregulation and FASD

• Sensory dysregulation interferes with ability to access and apply strengths on demand

• FASD = neurologically dysregulated in more than one area of brain function

• Therefore dependent upon the external environment to provide regulation, especially under stress

• “External Brain” needed all times and in all settings to ensure safety and success

• Dysregulation means that behaviour is more reactive than intentional


Sensory Dysregulation and Adaptive Behaviours

• Studies show correlation between sensoryprocessing behaviours, sensory-motorperformance and adaptive behaviours for childrenwith an FASD diagnosis.

• Significantly more problems with sensory modulation, poorer sensory motor and more soft neurologicalsigns.

• Pattern of over-responsivity to tactile, auditory and visual stimuli, as well as patterns of under-responsivity, seeking behaviours and poor auditory filtering.

• (Jirikowic et al., 2008)


We constantly self-regulate and reflect preferences


Self-regulation is developed

Carer’s regulationDysregulation

Co-regulationSelf-regulation


DysregulatedBrain

• Perceives all sensory stimuli as arriving with variable intensities

• No filters to selectively attend to some stimuli and ignore others

• Results in a very confusing world to try to interpret• So requires movement to think, and why can be so emotionally

volatile.• Can’t organize all incoming information• Can’t organize information once its in• Can’t organize information for output• Leads to significant Frustration


But basically it feels like this….

Check out the awesome Kelly at https://eatingoffplastic.wordpress.com


Be a sensory detective• review and reflect on possible triggers for a child’s

behaviour.

• Take note of sitting posture; how child uses their vision;how do they respond to background noises and toverbal instructions.

• Movement- do they fidget, slouch in their seat, move stiffly, tend to use only one hand during fine motor tasks (i.e. forget about their helper hand).


Be a sensory detective• Does child respond more quickly/accurately

when moving around the room or whenfidgeting?

• Does child report hearing background noises or report smells from background (e.g. clock ticking)?

• Does child touch you or desk or carpet and when does so can participate (i.e.: calmer)?

• Does child give crushing hugs, throw self on floor a few times before returning to testing?

• Does child verbally respond with innate rhythm?


Environmental Strategies• Focus on various modes of the “big three”

regulators- Proprioceptive; Vestibular; Deep pressure

• Visual simplification -Display only necessary or a few decorations, Avoid clutter, covered storage areas

• Zones in the home or school- Movement zone/ Quiet zone

• Structure and routine – visual schedule, transition warnings, timers


Sensory diet strategies

• Guidelines for daily sensory intake; what is needed to attain and maintain self-regulation

• Individualized: activities, timing, frequency, intensity

• Responsive: responds to how the child looks in the moment / on the day

• Proactive: more effective when performed before troubles, less effective when performed during troubles

• Integrated into daily activities, and also as stand-alone activity times


Sensory Diet

• Sensory diet strategies are bottom-up– They use the body to help impact the brain and

behavior– They are only ½ of a plan to improve self-

regulation• Need to be supported by top-down strategies– Teach thinking about self-regulation and behavior– How Does Your Engine Run / Alert Program– Zones of Regulation


Summary• Clear evidence that sensory issues are prevalent

in people with FASD

• Sensory needs are unique to each person and situation

• Needs and solutions may change over time

• VARIABILITY

• Sensory and sleep are foundations of a regulatedbrain


References• Ayres, A.J. (1979). Sensory Integration and the Child. Los Angeles, CA:Western

Psychological Services.

• Carr, J., Agnihotri, S., Keightley, M. (2010). Sensory processing and adaptive behaviour deficits of children across the fetal alcohol spectrum disorder continuum. Alcoholism Clinical and Experimantal Research, 34(6), 1022-32.

• DeGangi, G. (2000). Pediatric Disorders of Regulation in Affect and Behaviour: A Therapist’s Guide to Assessment and Treatment (pp. 335-365). San Diego, CA: Academic Press.

• Ecker, C., & Parham, L.D. (2010). The Sensory Processing Measure-Preschool home form.• USA: Western Psychological Services.

• Franklin, L., Deitz, J., Jirikowic, T., Astley, S. (2008). Children with fetal alcohol spectrum disorders: problem behaviors and sensory processing. American Journal of Occupational Therapy, 62, 265-273.

• Jirikowic, T., Olson, H., Kartin, D. (2008). Sensory processing, school performance, and adaptive behavior of young school-age children with fetal alcohol spectrum disorders. Physical & Occupational Therapy in Pediatrics,28(2), 117-136.


ReferencesKathleen Deirdre Hansen & Tracy Jirikowic (2013) A Comparison of the Sensory Profile and Sensory Processing Measure Home Form for Children with Fetal Alcohol Spectrum Disorders, Physical & Occupational Therapy In Pediatrics, 33:4, 440-452, DOI: 10.3109/01942638.2013.791914

Tracy Jirikowic, Heather Carmichael Olson & Deborah Kartin (2008) Sensory Processing, School Performance, and Adaptive Behavior of Young School-Age Children with Fetal Alcohol Spectrum Disorders, Physical & Occupational Therapy In Pediatrics, 28:2, 117-136, DOI: 10.1080/01942630802031800

Abele-Webster, L. A., MagillEvans, J. E., & Pei, J. R. (2012). Sensory processing and ADHD in children with fetal alcohol spectrum disorder. Canadian Journal of Occupational Therapy, 79, 60-63. doi: 10.2182/cjot.2012.79.1.8

Carr, J. L., Agnihotri, S. & Keightley, M. (2010). Sensory Processing and Adaptive Behavior Deficits of Children Across the Fetal Alcohol Spectrum Disorder Continuum. Alcoholism: Clinical and Experimental Research, 34(6), 1022-1032 DOI: 10.1111/j.1530-0277.2010.01177.x

Franklin, L., Deitz, J., Jirikowic, T., & Astley, S. (2008). Children with fetal alcohol spectrum disorders: Problem behaviors and sensory processing. American Journal of Occupational Therapy, 62, 265–273


References

©Dr L. A. Scott & L. Elliott 2017

• Miller Kuhanek, H., Henry, D.A., Glennon, T.J. (2010). The Sensory Processing Measure school form. USA: Western Psychological Services

• Owen, J.P., Marco, E.J., Desai, S., Fourie, E., Harris, J., Hill, S.S., Arnett, A.B., Mukherjee, P., (2013). Abnormal white matter microstructure in children with sensory processing disorders.Neuroimage: Clinical 2, 844-853.

• Scott, L., Elliot, L. (2017) Including Sensory Dysregulation in Every Diagnosis of FASD. 7th International Conference on FASD

• Szklut, S.E. (2010, December). Using clinical reasoning to evaluate sensory processing dysfunction. Sensory Integration Special Interest Section Quarterly, 33(4), 1-4

• Zieff, C.D., Schwartz-Bloom, R.D., Williams, M. (2016). Understanding FASD: A comprehensive guide for pre-k to 8 educators. Retrieved Jan 5, 2017, from https://sites.duke.edu.

• Levitt, P., Brain Development (Online training) http://www.developingchild.harvard.edu

https://sites.duke.edu/

http://www.developingchild.harvard.edu/


Web links

• Stop wiggling OR pay attention https://youtu.be/-8jCHqA2joY

• Zoe Mailloux is a leading expert on sensory integration. Her website has some great resources http://www.zoemailloux.com/sensory-integration-resources.html

• Importance of sensory integration https://pathways.org/watch/

https://youtu.be/-8jCHqA2joY

http://www.zoemailloux.com/sensory-integration-resources.html

https://pathways.org/watch/

Documents

None todeclare Sensory Difficulties and FASD · • Epigenetics (affectsthe response to the abovefactors) •Brains are built from the bottom up. •Neural connections are built through