Roseann C. Schaaf, PhD., OTR/L, FAOTA Zoe Mailloux, OTD, OTR/L, FAOTA Jefferson School of Health Professions Department of Occupational Therapy

European Sensory Integration Congress June 12, 2014 Naantali, Finland

Occupational Therapy Using Ayres Sensory Integration for Children with Autism A Clinician’s Guide

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intervention and measure outcomes of individually-tailored occupational therapy interventions using ASI for children with autism.

• Demonstrate use of tools in the guidebook to design

clinical reasoning, assessment, and intervention using ASI

• Become familiar with a guidebook developed to direct the

(ASI) within occupational therapy for children with autism

• Understand the application of Ayres Sensory Integration

Objectives

A theory that describes how the nervous system translates sensory information into action (Ayres, 1972) and emphasizes that behavior is linked to neural processes

What is Ayres Sensory Integration® (ASI)?

Unique in its focus on understanding the underlying mechanisms that affect participation

ASI is:

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…through a systematic process of assessing, interpreting and understanding how sensory motor factors are related to level of performance

Dr. A. Jean Ayres, an occupational therapist and neuroscientist, identified the construct of sensory integration, which has been expanded primarily in the field of occupational therapy.

History

fidelity in research and clinical practice (Blanche, et al., 2011) • Replication of research findings requires a systematic guide for others to see if findings can be duplicated • Well defined treatments with guidelines for practice can facilitate optimal use and outcomes (Carroll & Nuro, 2002).

• Manualization is an important step for ensuring

Why is a guidebook needed?

intervention is to provide sufficient structure and uniformity, while preserving the flexibility and potential for individualization that typify occupational therapy practice (Blanche, et al., 2011) • Operationalizing principles of ASI, while maintaining flexibility for individual tailoring the intervention, is especially complex.

• A key challenge in the manualization of an

Challenges in Manualization

and research for use and replication

• Stage 2 –Feasibility and efficacy testing (Schaaf, et al, 2014) • Stage 3 –Translation-describes procedures for clinicians

(Parham, et al, 2007; 2011;Schaaf, Hunt, Benevides, 2012)

• Stage 1 –Description of procedures –Development of adherence measure

Three Stages to Manual Development (Carroll & Nuro, 2002)

Janice P. Burke, PhD., OTR/L, FAOTA Ellen Cohn, PhD., OTR/L, FAOTA Shelly Lane, PhD., OTR/L, FAOTA Jane Koomar, PhD., OTR/L, FAOTA Teresa May-Benson, ScD, OTR/L, FAOTA Lucy Jane Miller, PhD., OTR/L, FAOTA

Lucy Jane Miller, PhD., OTR/L, FAOTA Diane Parham, PhD., OTR/L, FAOTA Stacey Reynolds, PhD., OTR/L Sarah Schoen, PhD., OTR/L Teal Benevides, MS, OTR/L Susanne Smith Roley, MS, OTR/L, FAOTA

And the Sensory Integration Research Collaborative

Roseann C. Schaaf, PhD., OTR/L, FAOTA Erna Blanche, PhD., OTR/L, FAOTA Zoe Mailloux, MS, OTR/L, FAOTA

Intervention Manual Stage 2 - November, 2010

Chapter 6: Goal Setting………………………………………………………………………………….

Chapter 5: Assessment………………………………………………………………………………….

Chapter 4: Step-by-step procedures…………………………………………………………………. Collaborating with Families………………………………………………………………………. Assessment of adherence to ASI........................................................................................ Overview of the ASI procedures Step-by-step guide

Chapter 3: Setting the Stage for Implementation of ASI………………………………………….. Therapists Qualifications…………………………………………………………………………. Establishing a safe environment………………………………………………………………… Equipment and space…………………………………………………………………………….. Dosage……………………………………………………………………………………………..

Chapter 2: Common Patterns of Sensory Integration Problems………………………………... Problems in Sensory Perception………………………………………………………………... Pattern of Vestibular and Bilateral Integration Problems in somatosensory-based praxis……………………………………………………... Patterns of Sensory Reactivity…………………………………………………………………...

Chapter 1: Autism and Sensory Integration………………………………………………………… Sensory integration and participation for children with Autism………………………………. Ayres Sensory Integration: Theory and History………………………………………………. Core concepts of Ayres Sensory Integration…………………………………………………... Evidence for Ayres Sensory Integration………………………………………………………... Similarities and Differences with other intervention models for autism……………………... Data Driven Decision Making……………………………….…………………………………...

Revised ASI Guidebook – Stage 3

Appendices………………………………………………………………………………………………... Appendix A: Glossary……………………………………………………………………………………... Appendix B: Data Driven Decision Making…………………………………………………………….. Appendix C: Sample Case Reports…..………………………………………………………………

Reference List……………………………………………………………………………………………..

Chapter 7: Conducting the Intervention……………………………………………………………... o Introduction………………………………………………………………………………........... ... o Establishing the context………………………………………………………………………….. § Just Right Challenge…………………………………………………………………… § Therapist and Child Collaboration………………………………………….................. § Ensuring Successful Challenges……………………………………………………….. § Playful context………………………………………………………………………........ § Therapeutic Alliance…………………………………………………………….............. o Addressing the Sensory Motor Challenges…………………………………………................ § Enhancing Sensory Perception and Processing – General guidelines……............. · Enhancing tactile perception and discrimination……………………............... · Enhancing Proprioceptive Awareness………………………………................ · Enhancing vestibular processing………………………………………............. § Facilitating the sensory-motor foundations for postural, ocular, oral and/or bilateral motor control……………………………………………………………............ § Fostering praxis and organization of behavior……………………………….............. § Regulating Sensory Reactivity – General guidelines………………………............... · Regulating sensory hyper-reactivity………………………………................... o Regulating tactile hyper-reactivity……………………………................ o Regulating vestibular hyper-reactivity………………………................. o Regulating hyper-reactivity to auditory or visual sensations............... o Regulating hyper-reactivity to olfactory or gustatory sensations…….. · Regulating sensory hypo-reactivity…………………………………………...... o Improving tactile hypo-reactivity………………………………………… o Improving vestibular hypo-reactivity…………………………………….. o Improving proprioceptive hypo-reactivity……………………………..... § Table 7a: Excitatory, Calming and Organizing Qualities for each sensory system § Table 7b: Sensory Experiences to regulate sensory reactivity……………………...