Modulation Flashcards
All of the following except which are examples of increased arousal? A. Breathing pattern B. Increased tone C. Decreased pupil size D. Increased heart rate E. Sweat F. Screaming (vocalize)
C. You would see increased pupil size (dilation), not decrease
(Con have increased tone in extremities, trunk, face, eyes)
What is sensory modulation?
The ability of the CNS to grade responses to sensory input in relation to the intensity, complexity, and novelty of incoming sensations as well as the context of the situation.
- Ongoing physiological changes in alertness, arousal, attention, and emotion in response to events and expectations
- These physiological changes influence observable behaviors
T/F: Ongoing physiological changes in alertness, arousal, attention, and emotion in response to events and expectations are internal in an individual and cannot be observed
False. These physiological changes influence observable behaviors
T/F: in order to modulate, one must start differentiating
False. In order to differentiate, one must begin modulating (already differentiating one thing over another)
Where does modulation occur within the brain? How about perception?
- Modulation occurs at the cortical-subcortical levels: “where am I in terms of level of arousal?”
- Perception: occurs at cortical level
T/F: With perception, we ask ourselves, “how much does this activate me?” whereas with modulation we ask, “What is this?”
False. With modulation we ask, “how much does this activate me?” whereas with perception we ask, “what is this?”
How does novelty affect hose with modulation problems?
Novelty of sensations and expectations of the situation influence modulation. People with modulation problems must know exactly what will happen before they enter a situation. If not and there are novel situations, they will have problems. e.g., they will be very activated by novel situations
T/F: If you have modulation problems, you will have problems with perception
False. Modulation problems may be accompanied by intact perception…difficult to assess.
If child’s level of alertness is high, his attention is poor, he will perform poorly e.g., discrimination will be off. BUT if bring him down to optimal arousal level, he may have no problem with perception and discrimination. So, must examine at optimal arousal.
With problems in this area, one will have a hard time differentiating between incoming signals
Sensory discrimination and perception problems
With problems in this area, one will have trouble integrating sensory data to interpret the sensory info
Sensory Discrimination and perception problems
T/F: problems with modulation will most likely affect the tactile or auditory system while problems with discrimination or perception will usually affect the prop or visual systems
False. Problems in either discrimination and perception or modulation may be expressed in one or more sensory systems: tactile, auditory, prop, visual
T/F: with modulation problems, compensatory strategies e.g., buttoning without looking, will take a great deal of effort and attention
With with discrimination and perception problems this will occur
Problems in this area will cause difficulty with regulating attention and emotion in response to sensory info
Modulation problems
Problems in this area are accompanied by under or over responding to incoming info, given the context
Modulation problems
Why is it important to assess performance when one is at optimal level of arousal?
If child’s level of alertness is high, his attention is poor, he will perform poorly e.g., discrimination will be off. BUT if bring him down to optimal arousal level, he may have no problem with perception and discrimination–problem is at a lower level. So, must examine at optimal arousal.
T/F: While perception deals with sensory input, discrimination requires in tact sensation and cognition
False. Discrimination involves integrating sensory data to interpret sensory info while perception requires cognition e.g., with pen in hand, must know that pens are long and skinny
T/F: There are many standardized assessments on modulation problems
False. There are not many.
The process by which the CNS notices sensory input
Sensory registration
T/F: Registration is discussed at the level of the receptors while detection is discussed at the level of the CNS
False. Registration is talked about at the level of the CNS while detection is talked about at level of receptors
How does the CNS play a role in registration? How about in modulation?
-Information is detected by receptors which relay it into the CNS
-CNS registers the presence of the sensory info
Then the CNS uses the sensory info in processes such as perception, modulation, praxis, and organization of behavior
T/F: sensory modulation problems is related to extreme under-responsiveness
False. Sensory registration problems is related to extreme under-responsiveness
T/F: When discussing SI problems, we talk about sensory info that is not detected by the receptors
False, we talk about info that is detected by receptors, but not registered at the level of the CNS
T/F: When discussing registration problems, a child is under/over-responsive or hypo/hypersensitive
False. In modulation, child is under/over-responsive or hypo/hypersensitive
If a child responds to input intermittently, he is considered _________
hypo/under-responsive
If a child is under/hyp-responsive, how can we increase his level of alertness?
By sensory input in the environment
T/F: If a child is underresponsive to vestibular or tactile input, his arousal levels will always be affected
False. If underresponsive to vestib input, his arousal levels will be affected. But if underresponsive to touch, his arousal levels may not be affected.
T/F: Modulation problems are always linked to one’s level of arousal, but are not always linked to sensory processing.
True. May be other reason’s one is low-arousal e.g., if poor nights sleep, food you eat, health, environmental factors. We all have level of arousal.
What types of sensory processing affect one’s level of arousal?
- Hypersensitive to touch/auditory/visual/vestibular
- Hyposensitive to vestibular
In order to assess a child’s level of arousal who comes to see you, what do you need to do?
- What’s his current level of arousal?
2. What’s happening? Is it related to sensory processing? Related to other factors e.g., anxiety?
T/F: if a child doesn’t register, he enters fight/flight
False. If he doesn’t modulate, he enters fight/flight
Why must we be careful when giving a child a discrimination test?
A child who doesn’t discriminate may not do so because he did not register the input in the first place, not because of a discrimination problem. Registration problem, not discrimination problem.
T/F: Often times, a child that does not register and is underresponsive is lumped together with a modulation or discrimination problem
True
Arousal is:
A. The sate of responsiveness to sensory stimulation
B. The act or state of waking from or as if from sleep
C. The act of stimulating to readiness or to action
D. All of the above
E. None of the above
D. All of the above
State of vigilance of relatively permanent character
Tonic arousal
Short endurance, dependent on stimulus novelty
Phasic arousal
When you’re doing an eval on modulation/arousal, what is the first thing you want to look at?
First want to look at the level of arousal when child comes in. Then see how he responds to different sensory inputs in the environment. Does his arousal level go up if he is underresponsive?
Hebb (1949,1955) proposed the idea of ___________
Optimal level of arousal.
- Impact of sensory stimulation on reticulocortical system
- Originally focused on stimulus intensity in arousal modulation
Berlyne (1960, 1971) identified a range of qualities affecting ________.
Arousal. E.g., intensity, size, color, modality, affect, novelty, complexity, congruence, degree and timing of change from prior stimulus
Berlyne (1960, 1971) linked optimal arousal to: A. Affect B. Somatic nervous system C. Autonomic nervous system D. All of the above E. A and C
E. Affect and Autonomic nervous system
T/F: Berlyne (1960, 1971) Proposed that tonic arousal levels and phasic arousal thresholds are consistent across all children
False. Proposed individual variations in tonic arousal level and phasic arousal level thresholds. Must always bring each child to optimal level of arousal
The management of emotions and behavior in socially acceptable ways across many settings
Self-regulation
What are the Four A’s of Self-Regulation?
- Maintain optimal arousal levels
- Maintain focused attention to task
- Demonstrate appropriate affect
- Engage in purposeful action
T/F: Kids with low arousal levels often will shut down while those with high arousal levels will not respond
False. Children at high levels of arousal will often have temper tantrums and will shutdown because they are receiving too much sensory input. Those with low-arousal will not respond because they are not receiving enough.
How can we determine why a child is not at optimal level of arousal (too much/too little input)?
By knowing what happened before
What will the arousal level of a child who is underresponsive to vestib. input look like in class?
- Will be sitting and falling asleep
- OR monkeying around/moving around in order to increase level of arousal
If a child screams and has increased breathing when she is picked up or put on hammock, what does this mean?
- Her level of arousal is increasing
- Responding to vestib. more than anything else
T/F: if a child has self-regulation problems, this means he has sensory processing difficulties
False. May have self-regulation problems due to frontal lobe issues, not related to sensory processing
High level cognitive processes that facilitate new ways of behaving and optimize one’s approach to unfamiliar circumstances
Executive Functions
T/F: several research studies have been done which look at sensory modulation and executive functions; show that sensory symptoms (measured with SP) are not associated with executive functions
False. Studies have shown association between sensory symptoms and executive functions. However, many studies use sensory profile, which is a parent report. Need observation.
How is sensory modulation linked with participation?
- Person is sufficiently alert and relaxed to experience enjoyment and satisfaction in everyday activities and relationships
- Allows person to approach new situations with openness while avoiding potentially dangerous situations
- Attention is dynamically allocated to relevant stimuli, tuning out unimportant sensory cues
How can modulation affect one’s behavior?
Difficulties with modulation affect alertness, attention, and emotion, and consequently can interfere with the ability to organize behavior in the most effective or appropriate manner
Offers metaphors that help us to visualize how brain activity affects behavior–and thus help us to plan and direct intervention
Neurophysiological theory
T/F: It is likely that sensory modulation occurs at multiple levels of the brain function
True. It is likely that sensory modulation involves complex interplays among threshold levels, orienting responses, habituation, sensitization, affective responses, memory of past experiences, and expectations and perception of present situation
T/F: Behavioral level is what we observe, but sensory modulation is ocurring at cellular and neural levels
True
Level at which temporal summation, habituation, and sensitization alter neuronal excitability by changing the state of the nueron so it is more likely, or less likely, to spread messages to other neurons
Cellular level
Level at which there is rhythmic interaction of reticular, autonomic, limbic, and cortical systems
Neural Systems level
Level relating to person’s ability to regulate arousal and emotion; may reflect underlying neural regulation or dysregulation (e.g., irritability in response to sensations interferes with behavioral organization)
Behavioral level. What we observe
Regulation of neural activity at the cellular or synaptic level, leading to enhanced or dampened responses to input
Neural modulation
Reduction or cessation of a behavioral response during repeated exposure to the eliciting stimulus
habituation (get used to stimuli)
Enhancement of an elicited behavior after a strong or noxious stimulus; with repeated stimulation the enhanced response becomes even stronger
Sensitization (gets heightened)
- In a neuron, this is the point at which the neuron begins to fire, i.e., initiates an action potential as a result of the cumulative effect of stimulation from synapses with other neurons
- At a behavioral level, the lower amount of stimulation required to required to evoke a particular responses (e.g., the lowest degree of stimulus intensity that can be detected)
Threshold
-At a behavioral level, the lowest amount of stimulation required to required to evoke a particular responses (e.g., the lowest degree of stimulus intensity that can be detected)
Threshold
With repeated stimulation of a neuron, each stimulus event depolarizes the neuron (i.e., brings the neuron closer to threshold) until it eventually reaches the threshold for an action potential
Temporal summation
Behavioral response in which a person or animal turns toward a stimulus and momentarily stops previous activity, enabling attention and decision-making
Orienting response
Child received eight sensory input of the same kind in a row followed by a rest period (Eight auditory; rest period; eight tactile ; rest; eight visual; rest…)
Sensory challenge protocl
T/F: If a child is provided with repeated stimuli in a short time, sensitization should occur
False. Sensitization is a problem e.g., tactile defensiveness. Habituation should be ocurring (we all habituate)
T/F: A child with an active SNS and less active PNS in response to repeatedly stimuli in a short time period is more sensitive
True
Why do we not discuss underresponsiveness to tactile input with modulation?
Underresponsiveness to touch may not affect the level of arousal. Overresponsiveness definitely will–tactile defnesiveness
T/F: Sensory symptoms (measured with SP) in pre-term preschoolers are usually not associated with executive functions measures
False. Sensory symptoms (measured with SP) in pre-term preschoolers are associated with executive function
T/F: Difficulties with modulation and behavior only affect those with sensory processing difficulties
False. All of us experience these problems at time, particularly when fatigued, stressed, or sick . However, some seem to have difficulties with modulation much more often, and to a greater extent, than is typical
T/F: Links between neural activity and behavior are very complex and have not been fully mapped out by research
True
T/F: Sensory modulation involves regulatory processes at multiple levels of the brain
True. Regulatory processes occur at the cellular and neural levels. Behavioral level is what we observe.
Networks throughout the nervous system that accelerate or slow down or stop the spread of sensory messages
Synaptic networks
Part of brain that activates the entire brain for wakefulness, orientation, and attention
Reticular formation (of brainstem)
System that involves both sympathetic and parasympathetic aspects
Autonomic Nervous System
System with physiological reactions associated with orienting, stress, fear, and anger
Sympathetic nervous system (part of autonomic nervous system)
System with physiological reactions associated with restoration, relaxation, digestion; may regulate sympathetic nervous system
Parasympathetic nervous system (part of autonomic nervous system)
The synaptic networks are a brain structure important for what process?
The synaptic networks are neural structures involved in modulation. They accelerate or slow down or stop the spread of sensory messages throughout the nervous system
The reticular formation is a neural structure involved in what process?
The reticular formation of the brainstem is involved in modulation. It activates the entire brain for wakefulness, orientation, and attention
The autonomic nervous system is a neural structure involved in what process?
The autonomic nervous system is involved in modulation. Includes both the sympathetic (physiological rxns associated with stress, fear, anger) and parasympathetic (physiological reactions associated with restoration, relaxation, digestion; may regulate sympathetic nervous system)
The limbic system is a neural structure involved in what process?
Modulation. The limbic system Includes both the amygdala (interprets situation and initiates fear, anger, aggression, or escape behaviors; activates sympathetic nervous system) and the hippocampus (interprets situation by comparing incoming info to past experiences,; excites or inhibits amygdala)
Neural structure important for modulation that interprets situation and initiates fear, anger, aggression, or escape behaviors; activates sympathetic nervous system
Amygdala (part of limbic system)
The limbic system, important for modulation, is made up of what two structures?
- Amygdala: interprets situation and initiates fear, anger, aggression, or escape behaviors; activates sympathetic nervous system
- Hippocampus: interprets situation by comparing incoming info to past experiences; excites or inhibits the amygdala
T/F: The amygdala excites or inhibits the hippocampus and the hippocampus activates the sympathetic nervous system
False. The Amygdala activates the sympathetic nervous system (initiates fear, anger, aggression, or escape behaviors) and the hippocampus excites or inhibits the amygdala
The amygdala and the hippocampus are part of what system?
The limbic system
T/F: The cerebral cortex is involved in registration
False. The cerebral cortex is involved in modulation
Part of brain important for modulation that perceives and interprets body position and its relationship to environmental space and objects
Parietal lobe (part of cerebral cortex)
Part of brain important for modulation that perceives and interprets sounds, including speech and language
Temporal lobe (part of cerebral cortex)
Part of brain important for modulation that perceives and interprets visual info
Occipital lobe (part of cerebral cortex)
Part of brain important for modulation that uses info from all cortical areas to plan behavior
Frontal lobe (part of cerebral cortex)
Part of brain important for modulation that regulates limbic system in order to accomplish goals
Frontal lobe (part of cerebral cortex)
Part of brain important for modulation that uses language and mental imagery to manage behavior
Frontal lobe (part of cerebral cortex)
With modulation, which three conditions are mainly discussed?
Gravitational insecurity, aversion to movement, and tactile defensiveness
The cerebral cortex, limbic system, synaptic networks, reticular formation, and autonomic nervous system are all important for what?
The cerebral cortex, limbic system, synaptic networks, reticular formation, and autonomic nervous system are all important for modulation
Who introduced the concept of tactile defensiveness?
Ayres (1964)
A concept introduced by Ayres defined as: negative emotional response to tactile stimuli that most people experience without being bothered
Tactile defensiveness
Theory behind tactile defensiveness
Imbalance in the dual tactile system:
- Protopathic (protective touch) via anterolateral/spinothalamic system dominates over discriminative touch via DCML
- Dominance of anterolateral system results in weak neural and behavioral inhibition of noxious tactile qualities
Introduced the concept of sensory registration related to autism (1979, 1980)
Ayres!
T/F: Ayres conceptualized sensory registration problems as the same type of disorder as defensiveness
NOPE. She conceptualized sensory registration problems as a different type of disorder than defensiveness
Problem that exists when a child does not notice that a stimulus is present
Sensory registration problem
Ayres proposed that dysregulation among among which structure/s leads to impaired registration of environmentally relevant cues?
Ayres proposed that dysregulation among limbic structures e.g., amygdala, hippocampus leads to impaired registration of environmentally relevant cues
Kickerbocker (1980) suggested that sensory responsiveness problems reflect an imbalance of ________ vs. ________ throughout the nervous system, affecting multiple sensory systems.
Knickerbocker (1980) suggested that sensory responsiveness problems reflect an imbalance of inhibition vs. excitation throughout the nervous system, affecting multiple sensory systems
One end of Kickerbocker’s suggested continuum, in which under-inhibition causes over-responsivity, resulting in disorganized, hyperactive behavior
Sensory defensiveness
One end of knickerbocker’s suggested continuum in which over-inhibition causes under-responsivity, resulting in disorganized behavior that is immature for age
Sensory dormancy
What does Knickerbocker’s suggested continuum model of sensory modulation problem look like?
Continuum with sensory defensiveness (over-responsive) on one end and sensory dormancy (under-responsiveness) on the other end
Knickerbocker introduced the term ________ to refer to under-responsiveness and ________ to over-responsiveness across multiple sensory systems
Knickerbocker introduced the term sensory dormancy to refer to under-responsiveness and sensory defensiveness to over-responsiveness across multiple sensory systems
Royeen & Lane (1991) coined the term “sensory modulation disorder” which was later used by Miller (1998). This term was used primarily in reference to ______
Sensory Modulation Disorder was used primarily in reference to defensiveness as a discrete disorder
Which of the following is not synonymous with the other terms?
A. Over/Under-reactivity
B. Hyper-/Hypo-responsiveness or responsivity
C. Hyper-/Hypo-sensitivity
D. All are synonymous with each other
D. All are used synonymously.
-Note: in neuroscience, “sensitivty” refers to the receptor threshold for detecting presence of a stimulus, not regulation of arousal and emotion in response to stimuli
Person responds unusually strongly and adversely to sensory stimuli, compared to most people
Over-responsiveness. Also called overreactivity, hyper-responsivity, defensiveness
Person does not respond to sensory input to the extent that most people would
Under-responsiveness. Also called under-reactivity, hypo-responsivity
T/F: Poor registration is liked to over-responsiveness
False. Poor registration is linked to under-responsiveness
T/F: It is very common in clinical problems for the same child to demonstrate over-responsiveness at some times, and under-responsiveness or lack of registration at other times
True
If you see a child who is demonstrating over-responsiveness at some times and underresponsiveness or lack of registration at others and the problems are ocurring in the same system, what do you need to find out?
Need to find out if it is the environment that is affecting responsiveness
Modulation problems are heterogeneous. What does this mean?
Different underlying neural events are probably responsible for varying patterns of behavior that are associated with poor modulation
Dunn (1997) developed a quadrant model of sensory processing differences related to temperament. What did she say we need to look at for modulation problems?
Said we need to look at the threshold (neurobiological level) and the behavioral response to the input. If low threshold, everything comes in. If high threshold, input doesn’t get in.
Miller et al. (1998-2010) suggested that sensory modulation disorders is a differential diagnosis within a broader class of sensory processing disorders. What did he/she classy as the three sensory processing disorders?
- Sensory modulation disorder
- Sensory Discrimination Disorder
- Sensory-Based Motor Disorder (we see this as discrimination problem)
T/F: Estimates of prevalence of sensory modulation difficulties in general population vary significantly, based on sample characteristics and research methods in study
True. Most studies go over 10% prevalence
Why is it important to consider alternative explanations for the reported or observed behaviors related to sensory modulation and registration problems?
Need to consider alternative explanations e.g., if task is too difficult, arousal problem beyond sensory processing. If it is one’s arousal beyond sensory processing problem, you’re response to input will also be off. Did sensory affect arousal or did level of arousal affect sensory?
When sensory input has excessive impact given the context of the situation; person responds unusually strongly and adversely to sensory stimuli, compared to most peers
Over-responsiveness (also called sensory defensiveness)
Which of the following is not a feature of over-responsiveness?
A. Heightened sympathetic nervous system activation (fight/flight reaction)
B. Negative emotional tone, often manifested as irritability, anger, fear, anxiety
C. Aversive responses often lesson with repeated exposure to stimuli e.g., distractibility, escape behavior, or lashing out
D. May experience elevated pain intensity and duration related to sensory stimuli
E. Parasympathetic nervous system may be under-responsive
C. Aversive responses often BUILD with repeated exposure to stimuli e.g., distractibility, escape behavior, or lashing out
-May have behavior/attention problems e.g., ADHD over to touch, under to vestib
T/F: Under-responsiveness is associated with attention and behavior problems
False. Over-responsiveness is associated with attention and behavior problems
T/F: Over-responsiveness may lead to withdrawal, anxiety, overtly defensive or aggressive behavior, or difficulty coping
True
How may sensory problems related to over-responsiveness be masked?
Chronic defensiveness leads to coping strategies such as avoidant and controlling behaviors that become engrained with age, and can mask the sensory difference
Over-responsiveness is limited to one sensory system (tactile, auditory, vestib, olfactory, visual, or prop)
False. Over-responsiveness is limited to one sensory system (tactile, auditory, vestib, olfactory, visual, or prop) or may be a combination of over-responsiveness in two or more systems
Why don’t we talk about over-responsiveness to prop?
B/c it is so rare–only 1/1000 children
Which of the following is NOT true regarding tactile defensiveness:
A. Aversive responses to tactile stimuli with light pressure
B. Aversive response to light touch stimuli that is moving
C. Aversive response to unexpected touch sensations
D. Avoids objects, materials, foods that have certain textures or consistencies
E. May often seek out light touch pressure experiences
F. Major impact on self-care e.g., eating, dressing, grooming
G. Major impact on play and social participation
H. Associated with poor tactile perception, poor fine motor skills, and eating disorders
E. With tactile defensiveness, may often seek out deep touch pressure experiences
Hypersensitive to sounds that don’t bother others
Auditory defensiveness
How may a child who is auditory defensive react to sounds?
- Distress to noisy environments
- Distress or distraction when encountering certain types of sounds e.g., shrill sounds, alarms, machines or appliances
- May cover ears if sound is painful, or flee from source
T/F: A child who is auditory defensive may have difficulties participating in group or community activities.
True. May not like to be in large groups b/c noise
High anxiety and fear related to moving head and/or body through space, especially vertical space
Gravitational Insecurity. Using elevators or climbing up a ladder is very distressing. Movement of the head backward through space is usually avoided e.g., tilting head backward to have hair washed
How does gravitational insecurity have a major impact on play?
- Child avoids and has extremely limited participation in gross motor play, eventually limiting social play
- Will try to avoid heights
- Move very slowly
How will gravitational insecurity create serious limitations in community mobility ?
- Fear of escalators, elevators, stairs, getting in and out of car, public transportation
- Participation in community outings with family members can be very limited
Why are praxis and motor skill development often areas of concern with gravitational insecurity?
May be impacted in long run b/c doesn’t move much due to fear of moving through space
Easily nauseated by angular movement through space (turning head or changing direction of head movement, orbiting, rotating, strong car- or sea-sickness)
Intolerance to movement
T/F: Intolerance to movement is a sensory integration problem treated similarly to Gravitational insecurity
False. Not treated as a sensory integration problem; refer for medical eval and tx
-Don’t treat much unless related to other disorder or is very extreme
Disturbed by visual stimuli when body is moving through space
Visual over-responsiveness
Visual over-responsiveness may be related to what type of processing problems?
My be related to vestibular processing problems (disturbed by visual stimuli when body is moving through space )
Visual over-responsiveness has been studied thoroughly and systematically
False. Has not been studied systematically
Why may a person with visual over-responsiveness be distracted or disturbed by stimulating visual environments or by high visual contrasts in the environment?
-May involve difficulty filtering irrelevant visual info (inadequate inhibition of neural messages affecting vision)
Why may a person with visual over-responsiveness by overly sensitive to bright light?
May involve inadequate adaptation of retinal receptors or inadequate inhibition by other neurons involved in processing vision
With a child who is over-responsive, what do you need to consider?
-Identify specifically which sensory systems are involved (could be one or two or more sensory systems; could be across all)
-Rule out general arousal regulation problem
(with tactile defensiveness, have high arousal in response to tactile stimuli; high activity level doesn’t always indicate high arousal level; some children with ADHD have high activity level but low physiological arousal)
-Consider possibility of anxiety disorder-refer for eval if appropriate
-In some cases, child may have periods of “shut down”-overwhelmed and no longer registers input, perhaps self-protective mechanism
T/F: Children with tactile defensiveness have low arousal in response to tactile stimuli
False. Children with tactile defensiveness have high arousal (SNS activation) in response to tactile stimuli
T/F: High activity level indicates high arousal level
False. High activity level does not always indicate high arousal level
T/F: Some children with ADHD have high activity level but low physiological arousal
True.
Why should we not see many kids who are shutting down in practice?
Means you overwhelmed them–not at just right challenge
Which of the following is not a calming sensory experience for an individual who is over-responsive A. Deep, steady touch pressure B. Heavy work or weight-bearing activities providing prop resistance C. Slow rocking D. Sucking and chewing E. Sitting on a ball F. Dim lights G. Soothing sounds
E. Sitting on a ball
When should you use modulating sensory experiences with a child?
Before the child is highly overstimulated to help attain and maintain an optimal state. Want him to have optimal level of arousal while he’s with you
T/F: It is important when giving sensory stimuli to a child that you have active control over the stimuli
False. Should allow child to have some degree of active control over challenging sensory stimuli. Adjust specific sensory stimuli to individual preferences and responses
T/F: Sensory strategies should only be used with general arousal problems
False. Can still use strategies to bring to optimal level of arousal
When evaluating a child who is under-responsive what should you consider?
- Identify which sensory systems are involved: one/two/across all sensory systems
- Consider which type of stimulated is involved, within an identified sensory system
- Rule out generally low arousal or general arousal regulation problem
- Consider presence of perceptual difficulties or cognitive delay
Why may you see high activity level with some children with under-responsiveness?
High activity level may be seen in some children with underresponsiveness plus low arousal level . Important to rule out low arousal or general arousal reg. problem with under-responsiveness
When considering a child who many be under-responsive, what may be some reasons he doesn’t explore stimuli
- May not explore stimuli due to discrimination or perceptual difficulties in particular sensory system
- May not explore stimuli due to general cognitive delay
When considering a child who may be under-responsive, what do you need to rule out regarding arousal?
Need to rule out generally low arousal or general arousal regulation problem
(High activity level may be seen in some children with under-responsiveness plus low arousal)
When selecting strategies to use for under-responsiveness, strategies should be based off findings from what?
Strategies should be based off of assessment findings.
For what kind of problem what you introduce light moving tactile sensations or irregular or intense vestibular sensations
With low arousal, use excitatory sensory input to increase arousal and attention e.g., light moving tactile sensations, irregular or intense vestib. sensations
What kind of activities should you provide someone who is under-responsive?
Use activities that involve a lot of prop input via traction, weight bearing, and resistance. Provide ample opportunity to experience strong input under safe and socially acceptable conditions
T/F: With underresponsiveness, may need to focus on tactile defensiveness, body awareness, or praxis
True. Select strategies that address the underlying reasons for under-responsiveness, based on assessment findings
The following are all examples of what type of behavior:
- Often stomps when walking
- Pushes against or pulls objects and people
- Likes to crash, jump, bump
- May also seek deep touch pressure
Proprioceptive seeking
The following are examples of what type of behavior:
- Child craves movement through space
- Likes to spin self, run, swing, jump
- Loves amusement park rides with intense input
Vestibular seeking
The following are examples of what type of behavior:
-Child is very touchy–frequently touches/handles objects and surfaces
Tactile seeking
easier to see than prop or vestib
If a child is a jumper, he is seeking….
If a child is a jumper, he is seeking vestib. or prop
T/F: If a child is a jumper and a climber, he is seeking vestib
False. He is seeking prop
If a child is always jumping and running or twirling, he is seeking what?
Seeking vestib input
When looking at whether child is seeking vestib or prop, what do you need to make sure to do?
Always need to look at more than one behavior to see if seeking vestib or prop
If a child has tactile defensiveness, why may he seek sensory input?
If tactile defensive, my seek intense prop or deep touch pressure input to inhibit tactile sensations
If a child has generally low arousal level, why may use intense sensory input?
False. If a child has generally low arousal level, he may use intense sensory input to increase arousal and attention
What are some reasons a child may seek sensory input?
- Child has generally low arousal and uses intense sensory input to increase arousal and attention
- Child often doesn’t register body sensations and seeks strong input to feel body sensations
- Child registers stimuli but is under-responsive, so intense input in the affected sensory systems is sought to increase arousal or attention
- Child has poor proprioception, tactile perception, or vestibular discrimination and needs more intense or more frequent input to perceive body position or movement more accurately
- A child has tactile defensiveness and uses intense prop or deep touch pressure input to inhibit tactile sensations
Why may a child who doesn’t register body sensations seek input?
A child who doesn’t register body sensations may seek strong input to feel body sensations
Why may a child who registers stimuli but is under-responsive seek sensory input?
A child who registers stimuli but is under-responsive may seek intense sensory input in the affected sensory systems to increase arousal or attention
Why may a child with poor prop, tactile perception, or vestibular discrimination seek sensory input?
A child with poor prop, tactile perception, or vestibular discrimination may need more intense or more frequent input to perceive body position or movement more accurately
What is a stereotyped behavior?
When repeated often, behaviors that originally had sensory functions may become entrenched habits or stereotyped behaviors; they may or may not still be functioning to compensate for sensory or arousal difficulties
-If behavior doesn’t decrease when provide behavior he is seeking, not sensory related
How may praxis lead one to have a stereotyped behavior?
- If ideation is poor, child may repeat the same actions repetitively due to lack of ability to conceptualize a new activity
- If motor planning is poor, child may repeat the same action patterns repeatedly due to limited ability to plan and perform a new sequence of actions
Why may a child chew with her front teeth only and keep food at the front of her mouth?
She may be overresponsive to touch
Why may a child not have fluid movements when brushing her teeth?
May be underresponsive to prop
Why may a child not apply pressure when brushing her touch?
Decreased prop or increase to touch
Sensory Modulation problems are especially common among children with what dx?
ASD, ADHD, Fragile X syndrome, Anxiety disorders (ADD, ASD, OCD)
T/F: DSM V definiation of ASD includes sensory issues under the rubric of “restricted, repetitive patterns of behavior, interests, or activities”
True.
“Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights of movement)
What sensory modulation problems are common in ASD?
Auditory and tactile modulation problems are common in those with ASD
T/F: With ASD, over-responsiveness often alternates with under-responsiveness or registration problems
True
What types of sensory modulation problems are common with ADHD?
Poor tactile discrimination and tactile defensiveness, high sympathetic activation
Miller found that in what disorder is sympathetic activation in one sensory system associated with sympathetic activation in other sensory systems?
Fragile X syndrome.
How is the sympathetic response different in those with Fragile X syndrome?
- Sympathetic activation in one sensory system is associated with sympathetic activation in other sensory systems
- Sympathetic response is stronger, lasts longer
- Findings suggest role of sympathetic nervous system in sensory over-responsiveness of these children
High rates of coexisting sensory over-responsiveness and anxiety disorders are documented for children with what disorders?
- ADD
- ASD
- OCD
Why may (ADD, ASD, or OCD) cooccur with sensory over-responsiveness and anxiety disorders?
- Anxiety may cause sensory over-resonsiveness
- Sensory over-resonsiveness causes anxiety
- Some other factor causes both anxiety and sensory over-responsiveness (e.g., abnormal amygdala activity)
Genetics play a role in which types of modulation problems?
Genetics influence tactile and auditory defensiveness, with tactile more heritable then auditory
What should we also keep in mind when thinking about how genetic factors influence the development of difficult behaviors?
The environment often responds in ways that affect the child’s experiences
-e.g., child has severe tactile defensiveness –> parent removes noxious stimuli from the environment
=Child has gravitational insecurity –> parent avoids movement experiences that may upset child
The following are all examples of how ______ can have an affect on sensory modulation difficulties
- Prenatal alcohol or illicit drug exposure
- Prenatal stress
- Postnatal lead exposure and other environmental toxins
- Poverty
Environmental influences on sensory modulation difficulties
T/F: Difficulties registering or modulation sensory info affect only children who have medical or developmental conditions
False. Also affect children with no other identified condition
T/F: Registration and modulation difficulties interact with perception functions, but not praxis
False. Registration and modulation difficulties interact with other sensory integrative functions such as perception and praxis
This system may have a major impact on emotion, behavior, and sometimes learning
Sensory modulation and registration
Take home message from the study by little
All subtypes may reflect variability in children
Marsha enjoys jumping on a trampoline and bouncing on a ball. She avoids going on swings. She is seeking input into…
Otoliths
Tactile defensiveness is most seen in conjunction with what?
Attention problems
Schoen, Miller, and Sullivan evaluated the new Sensory Processing Scale (SPS) to see its effectiveness for future use , in particular for sensory modulation dysfunction. What did they find?
Found that the SPS assessment appears to be a reliable and valid measure of sensory modulation. The scale has the potential to aid in differential diagnosis of sensory modulation issues
T/F: Little, Dean, Tomchek and Dunn used profile analysis to determine the number of sensory subtypes in a sample of 1132 children with typical developed and developmental conditions. They found that subtypes reflected only those with developmental conditions
False. They found that sensory subtypes included both children with typical development and those with developmental conditions. Elevated scores on sensory processing patterns are not unique to ASD, but are reflections of children’s abilities to respond to environmental demands.
Mailoux et al. (2011) examined patterns of SI dysfunction in 273 children who received OT evals in two private practice settings. What did they find regarding Ayres Sensory Integration (ASI) Frame of Reference?
Test results on the SIPT, portions of the Sensory Processing Measure, and parent report found patterns similar to Ayres early studies. found that ASI is one of the most developed and sistinctive FOM in OT
Mailoux et al. (2011) examined patterns of SI dysfunction in 273 children who received OT evals in two private practice settings. He found that Ayres SI is important for OTs because…
OTs with specialized knowledge of ASI have a unique understanding of the ways in which functions such as vest. processing, tactile perception, and praxis contribute to daily life participation and success. Understanding diff. patterns of SI dysfunction allow OTs to be better equipped to design, implement, and study intervention programs to alleviate challenges and support occupational performance.
Mailloux et al (2014) explored the use of PRN test for children younger than current norms (4.0-8.11 years) as a tool for early signs of vestibular-based sensory dysfunction. What did they find?
A. The PRN test cannot be validly adapted with children under 4 y.o.
B. The PRN test can be validly adapted with children under 4 y.o.
C. The PRN test can be validly adapted with children under y.o. old with a great amount of modifications
B.
- The PRN test can be validly adapted with an adult holding the child for testing young children and older children who can’t maintain required testing position independently
- PRN can be appropriately used with children younger than 4 as part of other developmental sensory integration evals
T/F: Mailloux et al (2014) explored the use of PRN test for children younger than current norms (4.0-8.11) as a tool for early signs of vestib-based sensory dysfunction. They found that the PRN test can be appropriately used with children older than the norms (4.0-8.11) as part of other developmental SI evals
False. They found that the PRN test can be appropriately used with children younger than the norms (4.0-8.11) as part of other developmental SI evals
