Week 12: Using SI in Pediatric OT

Question 1

Treatment Considerations when using an SI Approach

Answer 1

• Child directed.
• Safe physical and emotional environment.
• Find the child’s inner drive.
• Provide the just right challenge.
• The child should experience success.
• Emphasize adaptive interactions or adaptive responses – child must be active, not passive.
• Therapist facilitated treatment activities may focus on input to particular sensory systems.
• Outcomes are occupation-focused.
• Use the therapeutic relationship to reframe the problem behaviors.
• Have measurable outcomes to guide intervention and discharge.

Question 2

Criteria for Recommending OT using an SI Approach

Answer 2

-Meaningful cluster of behaviors on standardized testing.
-At least 1 major occupational role is significantly disrupted.
-Concerning behaviors fall outside of the developmental norms for the chronological age of the child.
-Treatment is a child and family priority.
SPD is a reasonable and justifiable hypothesis that could explain the child’s behavior.

Question 3

How is SI/SPD first reported?

Answer 3

• At home, parents may observe difficulty with feeding, self care, friendships, interests or sleeping.
• School personnel observe poor hand skills, social skills or restricted engagement in activities.
• OT evaluation must determine if the presenting behaviors are due to SPD or something else.
• Follow the OT Process to determine the extent of any occupational performance or participation deficits.
• Develop a treatment hypothesis based in strong theory, research and rationale to explain these deficits and intervene from there.

Question 4

Interpreting Concerning Behaviors:

Answer 4

• Look for consistency in behaviors across different environments.
• Differentiate significant from non-significant behaviors to see sensory-based patterns.
• Consider all possible explanations and hypothesis.
• Standardized testing is important but it must be interpreted through the prism of an experienced clinician and a thorough parent/child interview.

Question 5

How do you know that children have SI dysfunction and not behavioral problems or something else?

Answer 5

• Can be difficult to determine; it takes many years of experience to become competent with this decision.
• Compare multiple evaluations from different professionals and gain insight from the family to inform your assessment.
• Know that children can have SI as part of another disorder or it may stand alone.

Question 6

Common Co-Morbid Conditions:

Answer 6

ADHD/ADD
ODD
PDD/Asperger’s/Autism
Abuse/Neglect/Deprivation
Anxiety or Mood Disorders
Genetic Disorders
Mental Retardation 
History of prematurity or poor early feeding or sleeping skills.

Question 7

Sensory input can be used systematically to… (Adaptive Responses)

Answer 7

…elicit an adaptive response.

Question 8

Registration of meaningful sensory input is necessary… (Adaptive Responses)

Answer 8

…before an adaptive response can be made.

Question 9

An adaptive response contributes to… (Adaptive Responses)

Answer 9

…the development of sensory integration.

Question 10

Better organization of adaptive responses… (Adaptive Responses)

Answer 10

…enhances the child’s general behavioral organization.

Question 11

More mature and complex patterns of behavior… (Adaptive Responses)

Answer 11

…involve consolidation of primitive behaviors.

Question 12

The more inner-directed a child’s activities are… (inner drive)

Answer 12

…the greater potential for the activities to improve neural organization.

Question 13

Subtypes of sensory modulation disorder

Answer 13

over responsive, under responsive, seeking/craving

Question 14

Subtypes of sensory-based motor disorder

Answer 14

dyspraxia, postural disorder

Question 15

Subtypes of sensory discrimination disorder

Answer 15

visual, auditory, tactile, taste/smell, position/movement

Question 16

Stay true to occupation-based interventions

Answer 16

• Increased adaptive responses to everyday stimulation
• Improved gross and fine motor skills
• Improved cognitive, language and academic performance
• Increased self-esteem and self-confidence
• Increased occupational engagement and social participation
• Increased participation in family routines and roles