Using the Adolescent/Adult Sensory Profile for Intervention ...

Using the Adolescent/Adult Sensory Profile for Intervention ...

The Adolescent/Adult Sensory Profile Tana Brown PhD, OTR FAOTA University of Kansas Medical Center Occupational Therapy Education Presentation topics History of the A/ASP Overview of the sensory processing model Taking and scoring the profile

Interpreting the profile Intervention guidelines Practice designing environments to support sensory processing preferences Considerations for specific diagnostic groups General information before we get started Not a sensory integration presentation

The model applies to all people not an impairment model Will provide a framework for assessment and intervention that is applicable regardless of the population History of the A/ASP Statistical analysis of the childrens

version of the Sensory Profile Development of the model of Sensory Processing Relationship to adult issues Development of the Adult version Revisions to make applicable to adolescents Overview of Dunns

Model of Sensory Processing Theoretical framework for interpreting the measure and designing intervention Dunns Model of Sensory Processing Behavioral Response in accordance Behavioral Response

to counteract Passive Active Low Threshold Low Registration

Sensation Seeking High Threshold Sensory Sensitivity Sensation Avoiding

Sensory Sensitivity passive response to a low threshold easily respond to sensory stimuli notice things other people dont notice highly aware of their surroundings distractible Sensation Avoiding

active counteracting a low threshold intentional withdrawal or blocking of sensation use of rituals and routines overwhelmed by sensory rich environments good at creating structured and supportive environments

Low Registration Passive response with a high threshold miss available sensory input spacey, clumsy under-responsive or slow to respond can focus in distracting environments flexible, comfortable in wide range of environments

Sensation Seeking behavioral response to counteract a high threshold enjoys sensory rich environments creates sensation easily bored trouble tolerating low stimulus

environments Adolescent/Adult Sensory Profile measure of sensory processing preferences Self questionnaire 60 items 15/quadrant Taste/smell, movement, visual,

tough, auditory, activity level Ages 11 and up If/when the A/ASP is revised Change the double negative items Better distinguish sensory sensitivity and sensation avoiding by making sensitivity items focus on detection and not annoyance of sensation

Who should fill out the A/ASP? It is designed to be a self-report Informant reporting should be done cautiously and avoid interpretations based on scores Best informants would be those that have caretaking responsibilities

Fill out and score the A/ASP Classification System Based on standardization sample 193 adolescents, 496 adults, 261 older adults

Cut scores for each quadrant Classifications Much less than most people

Less than most people Similar to most people More than most people Much more than most people Uses normal distribution Support for Reliability Internal consistency for quadrants range

from .65 - .78 Each item on a subscale correlates best with its intended subscale Standard error of measurement ranges from 3.58 4.51 Validity Evidence Discriminant Validity with Adult Temperament Questionnaire (Chess & Thomas, 1998)

Sensation seeking scores negatively correlated with withdrawal and dysphoric mood subscales Sensitivity subscales positively correlated with dysphoric mood and sensory threshold subscales Sensation avoiding positively correlated with low adaptability, withdrawal and dysphoric mood Further support for validity Physiological data consistent with

four quadrants

Sensory sensitivity respond intensely and habituate slowly Sensation avoiding respond intensely but habituate quickly Low registration respond weakly and habituate quickly Sensation seeking respond weakly but habituate slowly More support for validity

Distinguished people with and without mental illness Distinguished younger and older adults Child version distinguished children with autism and ADHD Considerations Scoring different than child,

infant/toddler versions All preferences have advantages and disadvantages Consider all quadrants together

Consider meaning of low scores (particularly for seeking and avoiding behaviors) Consider patterns within sensory categories Intervention Strategies Create a supportive environment

Increase tolerance, rather than change the persons preference Increase tolerance Graded exposures Personal commitment, rewards or other external motivators

Analyzing the environment Intensity Amount Repetition Competing stimuli Predictability Familiarity Speed The Auditory Environment

Intensity soft/loud Amount intermittent, constant Repetition rhythmic Competing stimuli background noise, multiple conversations Predictability - startle Familiarity accents or garbled speech Speed rate of speech

The Visual Environment Intensity brightness, colors Amount number of objects to process Repetition clean lines, patterns Competing stimuli - clutter Predictability organized, movement Familiarity visual input is recognizable, known vs. unknown setting Speed how much time to process information

(static environment versus moving {driving}) The Tactile Environment Intensity light versus deep pressure, degree

of irritability Amount body surface Repetition constant or intermittent Competing stimuli consider ambient environment temperature, wind, fans Predictability handshake versus being touched from behind Familiarity recognize what you are touching (stepping on something unfamiliar)

Speed fast/slow The Gustatory Environment Intensity spices, temperature Amount how much is taste a part of the

experience Repetition different tastes or lots of the same Competing stimuli eat everything separately, mix foods together Predictability taste surprises (e.g. plantains not bananas) Familiarity eaten before Speed how quickly you eat and therefore taste

The Olfactory Environment Intensity strength of the smell Amount e.g. bath stores, restaurants Repetition less relevant Competing stimuli unpleasant smells can be especially distracting Predictability can detect when and where Familiarity can detect what

Speed tends to be more constant, smells generally do not come and go quickly The Vestibular/Proprioceptive Environment Intensity large, pounding movements Amount activity level Repetition rhythmic, cadenced Competing stimuli mostly when not executing

movements on own, - car, rides, elevator Predictability can anticipate movement and body in space Familiarity established motor patterns Speed slow versus quick movements Lets analyze an environment Low Registration

Intensity Amount Consistency Competing ( intensity of salient stimuli) Predictability Familiarity Speed Other Low Registration Considerations

There could be safety issues related to not noticing Will probably have a high level of tolerance for different types of environments so capitalize on flexibility Cues are an essential strategy because it increases accessibility of salient/important information

Sensation Seeking Intensity Amount Consistency Competing Predictability Familiarity Speed Other sensation seeking

considerations Incorporate additional sensations into daily routines What may be distracting for others, may help increase arousal/promote attention for sensation seekers Sensory Sensitivity Intensity

Amount Consistency Competing Predictability Familiarity Speed Other sensory sensitivity considerations How capable is person of assimilating

multiple stimuli (may be sensitive but able to handle/process information effectively) Otherwise remove distractors and create organizational systems Sensation Avoiding Intensity Amount

Consistency Competing Predictability Familiarity Speed Other sensation avoiding considerations Be sure to distinguish low registration

and avoiding because approaches are often contradictory When possible give the individual control over the environment when introducing sensory input Other strategies Distress tolerance Idea comes from dialectical behavior

therapy There are times when will have to tolerate an uncomfortable situation Develop coping mechanisms for managing those times Information is part of the intervention Awareness of personal preferences

increases self-awareness and is reassuring Provide information to relevant others spouses, employers, parents, teachers, so that they can understand Incorporate breaks Avoider may need to leave the party and

retreat to the kitchen Seeker may need to leave a long lecture and go outside for a run Meet needs internally/selfsoothing Self talk Meditation Chew gum Rock

Use others as intervention To help focus attention To provide feedback about behavior To reassure To distract Design an environment for each quadrant around a specific occupation

Findings related to specific populations Individuals with schizophrenia Low scores on sensation seeking High scores on sensation avoiding and low registration People with bipolar disorder

Average scores on low registration High scores on sensation avoiding and low scores on sensation seeking Older adults Low scores on sensation seeking High scores on low registration with cumulatively higher scores as age from

60 70 - 80 Autism/Asperger More likely to exhibit behaviors in Sensation seeking, low registration and sensory sensitivity Especially sensitive to auditory and oral

motor input Attention Deficit Hyperactivity Disorder Differences across all quadrants may be more reflective of a modulation problem

Adults with brain injury High scores on sensory sensitivity Low scores on sensation avoiding

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