The ASA's 38th National Conference on Autism Spectrum Disorders (July 11-14, 2007) of ASA

The Westin Kierland Resort & Spa, Scottsdale, AZ

For a complete author index with session numbers, please click here
Saturday, July 14, 2007: 12:30 PM-1:45 PM
Tribal A & B
#2988- Differentiating Between Sensory and Behavioral Concerns in Children with Autism Spectrum Disorders*
Students with Autism Spectrum Disorders often experience sensory processing difficulties. Professionals in the field must be able to distinguish true sensory difficulties from problem behaviors which serve non-sensory functions. Participants will be provided basic sensory system information as well as indicators of sensory dysfunction. The presentation will offer methods to analyze and subsequently treat problem behavior through addressing its true function. Various sensory and behavioral strategies or interventions are presented to address common issues for students with autism spectrum disorders.

Presenters:Sabrina Hines, M.Ed., University of Kansas, Doctoral Student - Sabrina Hines is currently a Doctoral student at the University of Kansas in Autism. In addition to formal training, Sabrina has experience as a special education teacher in the North Kansas City School District in Kansas City, Missouri. Activities included collaboration with special and general education colleagues, student instruction, instructional support, behavioral support and/or intervention, as well as Individual Education Plan case manager. 2003: Beginning Teacher Round Table Facilitator Mo-CEC Spring Conference 2003: Co-Presenter on Sensory Integration Mo-DLD/CEDS Summer Conference 2004:Co-Presenter on Sensory Integration Mo-CEC, Spring Conference 2006: Co-Presenter on Autism Spectrum Disorder Kansas City Paraprofessional Conference

Tara Mihok, M.Ed., OTR, University of Kansas, Doctoral Student - Tara Mihok is a doctoral student at the University of Kansas in the Department of Special Education. She is currently funded under a Personnel Preparation and Leadership Grant in Autism/Emotional and Behavioral Disorders. Her career experience has been in school based occupational therapy as well as work using applied behavior analysis with children with autism. 2006: Co-Presenter on Autism Spectrum Disorders Kansas City Local Administrators of Special Education Paraprofessional Conference 2006 “Individualized Education Programs for Children with Autism”; Midwest Symposium for Leadership in Behavior Disorders 2001 “Fulbright Scholarship: An Overview”; Missouri Occupational Therapy Association Student Conference

Learning Objectives:

The participants will identify the sensory processing difficulties a child with autism may experience.

The participants will distinguish between sensory and behavioral concerns.

Sensory Integration Definition

Sensory integration is defined as the normal neurological process of taking in information from one's body and environment through the senses, of organizing and unifying this information, and of using it to plan and execute adaptive responses to different challenges in order to learn and function smoothly in daily life The body is comprised of seven sensory systems: tactile (touch), proprioceptive (position), vestibular (balance), oral, visual, olfactory (smell), and auditory. The tactile, proprioceptive and viestibular sensory systems are subconscious and are the building blocks for sensory integration. The senses of hearing, vision, taste, smell and protective touch are sensory systems that respond to external stimuli from the environment. When the brain processes sensory information efficiently, the body responds appropriately and automatically. Modulation is the term used to describe the brain's regulation of its own activity, ultimately the body's activity level. As sensory information flows into the nervous system, modulation balances all information to maintain equilibrium. Throughout this process, inhibition reduces the connections between sensory intake and behavioral output. Inhibition is the neurological process that assists the brain in choosing sensations in which to attend and those to ignore. The neurological process of facilitation promotes connections between sensory intake and behavioral output. As the brain becomes accustom to familiar messages the brain disregards them because they have become ordinary, through the process of habituation. As modulation maintains a sense of balance between inhibition and facilitation the body can make smooth transitions from one state to another. Kranowitz defined a “state” as the degree of attentiveness, mood or motor response. When the brain is working efficiently messages move back and forth between touch, vision, balance, body awareness, movement and learning. As the brain's processing of sensory input and behavioral output are efficient, it is said to be effectively continuing sensory integration.

Sensory Integration and Autism Spectrum Disorders The Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition Text Revision contains the most widely used diagnostic criteria for identifying Asperger Syndrome (AS) and autism as categories of Pervasive Developmental Disorders (PDD). Within the definition of autism two characteristics are listed (a) markedly abnormal or impaired development in social interaction and communication and (b) markedly restricted repertoire of activity and interests. Asperger Syndrome differs with this definition only in that communication is not impaired. Even though sensory integration difficulties are not listed in the DSM-IV-TR as a characteristic, it has been recognized that individuals with autism and AS manifest sensory integration problems that include (a) low endurance and tone, (b) poor registration, (c) tactile challenges, (d) fine motor/perceptual problems, (e) self-regulation, and (f) oral sensory sensitivity.

Few studies have been conducted to document these difficulties. In one of the few investigations of sensory issues in autism and AS, Baranek found significant differences in sensory processing and related behaviors in children with autism and AS as compared to those who are neurotypical. Two additional studies relate evidence of sensory difficulties in children and youth with autism and AS. Dunn found through a comparison of students with autism and AS that both disorders presented similar sensory profiles Myles reported. Further supporting the existence of sensory integration difficulties, Cohn found that parents of children with sensory difficulties experienced positive social and functional effects of sensory integration therapy with a licensed occupational therapist in a clinical setting.

Sensory Integration Interventions Few studies exist documenting the effects of various sensory integration interventions. The article, Effects of Occupational Therapy with Sensory Integration Emphasis on Preschool-age Children with Autism from The American Journal of Occupational Therapy by Case-Smith and Bryan was published in 1999. Linderman, and Stewart wrote Sensory integrative-based occupational therapy and functional outcomes in young children with pervasive developmental disorders: A single subject study in The American Journal of Occupational Therapy that was also published in 1999. An article published in 2001 entitled Effects of a weighted vest on attention to task and self-stimulatory behaviors in preschoolers with pervasive developmental disorders was found in The American Journal of Occupational Therapy written by Fertel-Daly, Bedell and Hinojosa.

Case-Smith and Bryan investigated the effect of sensory integration therapy on play, non-engaged behavior (i.e. aimless, stereotypic, unfocused), and adult and peer interaction in preschoolers. In this AB design study, the researchers reported significant positive results in increasing mastery play and adult/peer interactions as well as lowered levels of non-engaged behaviors.

Linderman and Stewart conducted a single subject study (AB) to investigate the effects of sensory integrative-based occupational therapy on functional behaviors of two three-year-old children with PDD. In this study both participants displayed significant improvements in social interaction, approach to new activities, response to holding or hugging, and response to movement. Within this intervention, decreases were noted in frequency and duration of disruptive behaviors. The functional behavior of these children such as spontaneous speech, purposeful play and attention to activities and conversation increased in this study.

Another single subject design study (ABA) was conducted using the common intervention of a weighted vest to measure its effect on attention to task and self-stimulatory behaviors in preschoolers with pervasive developmental disorders. Fertel-Daly found that a weighted vest appeared to be beneficial for clinical use with children with PDD who had difficulty attending to tasks and exhibited self-stimulatory behaviors.

This presentation contributes to best practices in the area of autism spectrum disorders in the area of sensory difficulties. The above mentioned research is the basis for the remainder of the presentation which will focus on assisting participants in distinguishing sensory difficulties from non-sensory behaviors and treating accordingly. It is imperative that practitioners are aware of the foundation for sensory processing difficulties so that they may determine correctly whether the function of the behavior is actually a sensory dysfunction and subsequently that behavior can be treated correctly.

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