Transcript Slide 1
Are clouds forming? Then it’s time to expose the silver lining! Winnie Dunn PhD OTR FAOTA Professor & Chair Dept. of OT Education University of Kansas What are the clouds made of? Changes in the way we provide service Discontent about how we label children Changes in the way we provide service Findings from studies in Autism [as reported in Baranek, 2002] • We need to design educational programs that accommodate unique sensory processing patterns • We need to make task/ environ modifications • We need to employ systematic data collection to chart progress • Traditional SI therapy is beneficial ANECTODALLY, but evidence does not substantiate effects • Functional activities in daily routines within natural contexts increases generalization Discontent about how we label children Is this disorder for real? TIME magazine, Thursday, Nov. 29, 2007 Claudia Wallis “Some kids just cant handle life’s sights, sounds and sensations, but experts are split over whether to recognize sensory processing disorder” p. 62 You and Your Quirky Kid The girl who wears her clothes inside out, the boy who loves plumbing. What parents and experts say about the children who just don't fit in. By Lorraine Ali | NEWSWEEK Sep 17, 2007 Issue “…there is something unexamined in our thinking when we elevate the need for normalcy to a state of spiritual grace, and live under a constant anxiety that we fail to measure up to its demands…” p. 50 Lorraine Ali, Newsweek September 17, 2007 Harnessing the Power of ADD “Oftentimes you find people with ADD spending years trying to develop what they’re bad at instead of what they’re good at” [Ned Hollowell] Sophia Dembling, Delta Sky, december 2007 “…When it comes to a child with a disability, [professionals & parents] can easily spend too much time on what the child cannot do, …We can be so busy dealing with what is absent that we ignore what is right before our eyes. …what we need to make visible is not darkness but light...” p.280 Exposing the silver lining! Tapping our inner capacity Changes in the way we provide service Micro level: the child, family & school FAMILY CENTERED CARE • When practices are family centered, we achieve better family and child outcomes • • • • Ackland, 1997 Joyce & Showers 1995 Law, Darrah etal, 1998 Marchant & Young 2001 NATURAL ENVIRONMENT INTERVENTIONS • Parent facilitated child learning is equally or more effective than practitioner implemented interventions • Gibbard, Coglan & MacDonald 2004 • Law, Garret & Nye, 2004 • McLean & Cripe 1997 CHILD PARTICIPATION Children’s development is enhanced when they interact and practice in settings which demand use of skills Kelllegrew, 1998; Law etal, 1998; Roper & Dunst, 2003; Dunst, 2001, 2006 Discontent about how we label children Peeking in on The macro level “If we examine ourselves and those around us—the husband who shuns picnics because he can’t stand the texture of grass… we have to admit that everyone, to some extent is odd.” p. 50 By Lorraine Ali | NEWSWEEK: You & your Quirky Kid Sep 17, 2007 Issue “…parents need to ask themselves, Is this making him unhappy or just making me unhappy? [Dr. Perri Klass].” p. 50 By Lorraine Ali | NEWSWEEK: You & your Quirky Kid Sep 17, 2007 Issue “Autism is less a disease to be hidden than a disability to be accommodated; it is less a stigma, reflecting badly on her family, than a variation of human existence.” p.33 “…Can we make the world they’re going to grow up in sufficiently kind and welcoming to them and their quirks, and can we provide them with the basic skills they need to navigate in that world?.” p. 50 By Lorraine Ali | NEWSWEEK: You & your Quirky Kid Sep 17, 2007 Issue From The LONDON Times newspaper October 20, 2007 Are you a sensory junkie or a nervous wreck? How do you respond to bright lights, soft clothes, loud music and spicy food? Juliet Rix investigates the psychology of sight, sound and smell “Isabel has taught me that the unexpected, even the beautiful, can emerge even from the undesirable, …—no, not something “normal”, but a brilliant light or an inner truth struggling to blossom.” p. 35 “…at the end of the day when I tuck her in, she’s not a case of autism…. She’s simply my daughter….” p. 35 Let’s consider an example at the MACRO level… The experience of being HUMAN … …is imbedded in Sensory Processing “…I don’t know what a pear tastes like to you.” “…sweet, juicy, Soft on your tongue, grainy--Like sugary sand that dissolves in your mouth… How’s that?…” [City of Angels, 1996] How do you react to sounds? SEEKERS… Make noises, e.g., hum, tap throughout the day BYSTANDERS… Don’t really notice sounds around them AVOIDERS… Wear ear plugs to keep sounds away SENSORS… Ask people to stop making noises How do you react to touch? SEEKERS… Touch others when talking to them BYSTANDERS… Bump into people when walking AVOIDERS… Keep their distance from others SENSORS… Flinch when touched unexpectedly How do you react to movement? SEEKERS… Choose intense sports & amusement park rides AVOIDERS… Prefer sedate activities BYSTANDERS… Don’t know how they got scrapes and bruises SENSORS… Want to be the driver on trips How do you decorate? SEEKERS… BYSTANDERS… Have busy Have crooked wall dense decorations & decorating don’t notice schemes AVOIDERS… SENSORS… Decorate as Select clean lines little as possible & uniform color palates What are your clothing choices? SEEKERS… BYSTANDERS… Want layers, Are casual, & textures & lots sometimes of accessories mismatched AVOIDERS… Have a few pieces used over & over SENSORS… Use only specific brands and fabrics; sparse accessories How do you prefer to dine? SEEKERS… Prefer busy & entertainment venues BYSTANDERS… Do best with buffet style or multi course AVOIDERS… Prefer to eat at home, use carry out or delivery SENSORS… Prefer off peak hours, low lighting, favorite venues How do you organize you workspace? SEEKERS… BYSTANDERS… Have many Have casual projects spaces that may available at one appear time disorganized AVOIDERS… SENSORS… Close doors, Clear surfaces find isolated each day; have places, may precise telecommute organization How do you vacation? SEEKERS… BYSTANDERS… Create a busy, Have no schedule vigorous & change plans schedule easily AVOIDERS… SENSORS… Repeat the Create a precise same trip, select timeline of solitary venues activities & don’t deviate easily Example of sensory processing Wears layers Home décor is pattern & accessories Casual and eclectic Amt of trait Seeker Bystander Sensor Avoider What and where to eat doesn’t Matter too much Tidies up workspace at end of day SEEKERS always want more [high thresholds + They create excitement & change all around them active self regulation] AVOIDERS want more of the same thing and nothing more They create routines to keep life peaceful & manageable [low thresholds + active self regulation] SENSORS keep track of everything They notice what is going on & have precise ideas about how to handle situations [low thresholds + passive self regulation] BYSTANDERS don’t know what they are missing They are easy going and can focus even in busy places [high thresholds + Passive self regulation] What sensory pattern does this person have for dressing? What sensory pattern does this person have for dressing? Same as others less than others -- more than others - + ++ = This is the range of typical performance 2% 14% 34% 34% 14% 2% Sensory Profile measures are based on the Bell Curve whole So, at the macro level, intervention takes the form of A change in the context So more people can function successfully ISBN # 978 1 84310 871 9 Jessica Kingsley Publications www.jkp.org October 2007 Our sensory profile:Who we really are How we react to smells and sounds all but defines us By Heidi Dawley Oct 29, 2007 LONDON Making sense Of your senses By Claudia Wallis Are you a sensory junkie or a nervous wreck? Juliet Rix investigates the psychology of sight, sound and smell ISBN # 978 1 84310 871 9 Jessica Kingsley Publications www.jkp.org October 2007 Eating and Dining Let’s practice….. Low Registration Sensation Seeking What is the optimal dining experience?? Sensory Sensitivity Sensation Avoiding The location for eating and dining BYSTANDER Places that provide interest and changes throughout the meal SEEKER Loud, active, busy places during peak hours SENSOR Favorite places and menus during off-peak hours AVOIDER Eat at home with a predictable menu The foods we eat REGISTRATION Contrasting flavors, textures, colors; in many serving dishes SEEKING Ethnic foods with Varied/ unusual spices SENSITIVITY Familiar menu items always selected AVOIDING Have a routine menu LIVING SPACES Features of the living spaces LOW REGISTRATION SENSORY SEEKING Unusual floor plans Open living spaces with changes in flooring room to room SENSORY SENSITIVITY Floor plans with functions grouped together SENSORY AVOIDING Self contained spaces in floor plan Decorating your home REGISTRATION SEEKING Eclectic style with Bright, contrasting color unusual arrangements schemes Uneven placement of windows, doorways SENSITIVITY Homogeneous color palate Favorite piece of art on wall AVOIDING Sparse with separate areas for being alone e.g., how life is SENSATIONAL for… AN AVOIDER A BYSTANDER A SEEKER A SENSOR So, how can we use these ideas in everyday life? The older girl needs a lot of sensory input… So what about getting dressed? This baby cannot stay alert to eat… So how could we change the sensory environment to help Eating? This man needs a quiet place… …so what do we offer him for when his grandchildren are coming over? “…Isabel hated things that vibrated. She didn’t like pressure on her fingertips so much that she refused to even try to learn to button…or tie… or hold a pen...” p.277-278 “…Isabel at first refused …; eventually she stuck with it [cello playing]. The sound and touch sensitivities didn’t go away, but they lost their grip on her...” p.277-278 “…in order to help people with autism, we don’t always need to …pretend that they are not different…. Rather, we need to provide roles in our communities for people with autism, some of which they may in fact, be able to perform better than anyone else...” p.291 The essence of INTERVENTION Intervention must not be solely focused on fixing children’s behaviors. Sometimes we need to create a context that is more supportive, a strategy which acknowledges that the challenges children face do not reside within them, but rather in the space between the children and their contexts… The essence of INTERVENTION This is how we reduce judgment, create resilience & increase acceptance, so that differences are just a DIFFERENCE, not a source of disorder, but rather what makes a person interesting, quirky, funny… HUMAN. So, we return home. The clouds open And reveal New possibilities