Exam 3: SPD and ADHD

neurophysiologic condition where sensory input from the body or the environment is poorly detected, modulated, on interpreted resulting in atypical responses to sensory messages that manifest as problems with motor coordination, organization or attention, behavioral, or emotional responses

sensory processing disorder

SPD includes difficulties in ____________

habituation and adaptation to sensations resulting in poorly organized behaviors i.e.

-motor coordination

-attention and organization

-emotional and behavioral reponses

Sensory dysfunction

-difficulties with detection, modulation, integration, interpretation, and organization of the sensory information we receive from out environment

What causes SPD?

environment (sensory depravation, lack or decreased opportunities for sensory stimulation)

pre/post natal stressors

low birth weight

prematurity

maternal illness

NO SPECIFIC IDENTIFIED CAUSE!!

How many senses do we have?

8

visual

auditory

olfactory

gustatory

proprioceptive

vestibular

tactile

interoception

What disorders fall under sensory processing disorder?

sensory modulation disorder (SMD)

sensory discrimination disorder (SDD)

sensory based motor disorder (SBMD)

Sensory Modulation Disorder (SMD)

occurs when there is difficulty with regulating and organizing external or internal sensory stimuli which results in a maladaptive emotional or motor response

subtypes

-sensory overresponsivity (SOR)

-sensory underresponsivity (SUR)

-sensory seeking/craving (SC)

sensory overresponsivity (SOR)

-characterized by responses to stimuli that are more intense or have a longer duration than typically expected and may occur in one or multiple sensory modalities/systems

-behaviors observed are often viewed as intentional bc responses are context-dependent

-ppl often demonstrate inflexibility and hyper-vigilance and tend to be difficult to console when in "OR" mode

seen in ADHD, autism, fragile X, mood disorders

part of Sensory Modulation Disorder (SMD)

The fire alarm goes off in the middle of the class sending Henry into a state of panic and distress. After the fire alarm turns off Henry is still screaming and crying. His teacher cannot seem to console him. What subtype of sensory modulation disorder is Henry exhibiting?

sensory overresponsivity (SOR)

Alex's mother finds it difficult to dress him in the mornings since he frequently tears off his clothes. She is perplexed as to why Alex has such a strong aversion to clothing, as evidenced by his tears at the thought of wearing his school t-shirt. These signs are evident of what sensory modulation disorder (SMD) subtype?

sensory overresponsivity (SOR)

sensory underresponsivity (SUR)

-experience challenges in the feed-forward mechanism of the CNS, lacking a central predicative set of actions in given situations

-child often seen as having "lazy tendencies"

-lack of ability to detect incoming sensory information

-less interest in active exploration of the environment

-hypo-aroused manner; lack of natural, exploratory sensory behavior

-inefficient tactile and proprioceptive sensory response

-difficulty with sustained task performance due to the lack of consistent interactions with sensory input

part of Sensory Modulation Disorder (SMD)

At recess, Kelly often sits by herself and doesn't explore the playground like her peers do. She prefers to sit on the extremely hot concrete as it does not phase her. She drags her feet on the ground and often bumps into walls or her peers in the hallway but remains unphased. When she interacts with toys, she becomes bored very quickly. What subtype of sensory modulation disorder is Kelly exhibiting?

sensory underresponsivity (SUR)

sensory craving (SC)

-children seek sensory input through erratic, disorganized behaviors

-behavior seems to be impulsive, unsafe, boundary-free

-child is labeled "fearless"

-engages in constant spinning, jumping, and running into objects with a "crashing and bashing" approach

-crave rotation, vertical, or angular stimulation that comes from jumping, climbing, swinging, twirling (at playground)

-aggressive social interaction and intrusion of other's play space

-often like to engage in extreme sports and thrills

part of Sensory Modulation Disorder (SMD)

At the park, Ava loves to constantly spin herself around on the merry-go-round and enjoys climbing objects that are not meant to be climbed. When playing with others she is aggressive and often invades the personal space. If it were up to her, she would jump off from the top of the castle at the park. What subtype of sensory modulation disorder is Ava exhibiting?

sensory craving (SC)

Sensory discrimination disorder (SDD)

difficulty discriminating the following sensations:

-visual

-auditory

-olfactory (smell)

-gustatory (taste)

-proprioceptive (body in space)

-vestibular (head in space)

-tactile

-interoception

When working on a puzzle with her friends, Bethany can't seem to figure out which piece matches with which, repeatedly trying to connect pieces that do not fit together. She also had difficulty with writing her name, often reversing the letters. These symptoms are most indicative of what sensory processing disorder?

Sensory discrimination disorder (SDD)

Sensory-Based Motor Disorder (SBMD)

postural disorders and dyspraxia

Postural disorder

-difficulty stabilizing the body during movement or at rest

-abnormal muscle tone, poor control of movement or force, instability, poor balance, poor equilibrium & righting reactions, poor weight shifts

part of Sensory-Based Motor Disorder (SBMD)

Emma typically maintains a slumped position while attempting to complete her handwritten homework. She tries to maintain an upright posture but quickly falls right back into a slumped position. Emma's signs are characteristic of what disorder?

postural disorder

-Sensory-Based Motor Disorder (SBMD)

Consider Lilly, a young girl with a postural disorder, which of the following symptoms is most indicative of her condition?

A. Effortlessly maintaining balance and stability during physical activities.

B. Demonstrating precise and controlled movements without any difficulty.

C. Struggling with maintaining an upright posture while sitting or standing.

D. Excelling in activities that require rapid shifts in body weight and position.

C. Struggling with maintaining an upright posture while sitting or standing.

Dyspraxia

-difficulty with motor planning

-fine motor incoordination

-the inability to plan unfamiliar or novel tasks, resulting in clumsy, awkward, maladaptive responses

-when attempting a task that is not not part of the persons repertoire of skills, the person will demonstrate awkwardness in the use of hands and body to perform the task

Which of the following is a common symptom of dyspraxia in children?

a) Difficulty with reading and writing

b) Heightened sense of touch

c) Exceptional hand-eye coordination

d) Enhanced fine motor skills

a) Difficulty with reading and writing

You're a primary school teacher and notice one of your students struggling with tasks that involve fine motor skills, such as holding a pencil or tying shoelaces. They also seem to have difficulty following instructions that involve sequential steps, like putting together a puzzle or completing a craft activity. These signs are most indicative of _______.

dyspraxia

A young boy named Liam has been diagnosed with dyspraxia. Which of the following scenarios is most likely to be observed in Liam due to his condition?

A. Easily mastering complex motor tasks on the first attempt

B. Demonstrating exceptional coordination and balance skills

C. Struggling to perform activities that require precise motor control, such as tying shoelaces or using utensils

D. Excelling in sports that demand quick reflexes and agility

C. Struggling to perform activities that require precise motor control, such as tying shoelaces or using utensils

How does SPD impact occupational performance?

ADLs (self-care)

-bathing, showering, dressing, eating, hygiene and grooming

-food selectivity, sensitivity to different textures, motor planning during these tasks, sequencing

IADLs

-motion sickness in car/transit

-overwhelmed by environment (school, work)

Play

-some kids aggressive, some don't interact, some don't know how

Social participation

-difficulty maintaining "acceptable" social behaviors

SPD is frequently recognized in children who are diagnosed with ________

ASD

ADHD

learning disabilities

intellectual disabilities

fragile x syndrome

How is SPD clinically diagnosed?

behavior measures

questionnaires

-sensory profile (adolescents and adults)

-sensory profile measure

-EASI (evaluation Ayres Sensory Integration)

How does OT play a role in SPD interventions?

-creating individualized tx plans to address sensory needs

-SI 'preparatory tasks' followed by occupation-based interventions

-adapting the environment to (based on sensory needs i.e. SC, SOR, SUR)

-compensatory strategies (headphones, fidget chairs)

-positive behavior support (reward positive behaviors)

-family/caregiver education

-advocacy

ADHD

a psychological disorder marked by the appearance by age 7 of one or more of three key symptoms: extreme inattention, hyperactivity, and impulsivity

What are the three subtypes of ADHD?

ADHD combined (most common)

ADHD predominantly inattentive (ADD)

ADHD predominantly hyperactive-impulsive

ADHD other specified or unspecified

Sarah often fails to give close attention to details in schoolwork, does not appear to listen to the teacher when directly spoken to, has difficulty following instructions, and is often sidetracked by unimportant stimuli. She is disorganized and has difficulty managing sequential tasks. These symptoms are characteristic of what type of ADHD?

ADD predominantly inattentive

Cole fidgets with his hands, taps his feet, squirms in his chair and often gets up and out of his seat when he is expected to remain seated. He likes to talk a lot and often blurts out the answer to the question before the teacher has finished speaking. He often skips the lines during recess. These symptoms are characteristic of what type of ADHD?

ADHD predominantly hyperactive-impulsive

What causes ADHD?

largely unknown BUT genetics play a significant role

-genetic factors

-environmental factors

-nutrition

-brain injuries

-social environment

What are some co-occurring conditions associated with ADHD?

motor

sensory

learning

mental health disorders

-mood, anxiety, disruptive behaviors

Is ADHD only a pediatric disorder?

NO

it is a lifelong disorder

T or F: 30-50% of individuals diagnosed with ADHD receive special education.

true

T or F: Findings shows that adults diagnosed with ADHD have higher college attendance with lower dropout rates and higher GPAs.

FALSE

lower college attendance

higher drop out rates

lower GPA

T or F: In adults, ADHD symptoms present as risk taking behaviors, poor driving skills, and increased problems in the workplace.

true

Diagnosis of ADHD includes symptoms ________

prior to age 12 and continues into adulthood

Children are referred to ______ for diagnosis of ADHD

pediatric neurologist

clinical psychologist

developmental pediatrician

childhood psychiatrist

How is ADHD diagnosed?

observations and behavior reports

medical history and genetic testing

ruling out other conditions (hearing, IQ, sensory integration deficits, etc.)

ADHD is clinically managed through an individualized multimodal approach including ______

parent/caregiver education

patient education (adults)

behavior interventions: ABA, CBT

mindfulness

coaching

community resources

school-based interventions (accommodations, special ed, IEPs, 504 plans)

pharmacological (ritalin, adderall, vyvanse)

What is the role of OT with ADHD?

teach compensatory strategies

-problem-solving

-organizational skills

-adapting environment

emotional regulation

education (IEPs, accommodations)

health management (Rx management)

advocacy

ADHD impacts all occupations with a high emphasis on what three occupations?

education

work

rest and sleep

Impact of ADHD on occupational performance

ADLs (self-care often neglected, not completed, disorganized)

IADLs (inability to carry out chores, tasks, manage finances; driving)

social participation and play (turn-taking, follow instructions, overstimulated, irritable)

leisure

education/work

rest and sleep (Rx disrupts sleep)