Tuesday, January 31, 2012

New Research on SPD (Sensory Over-Responsivity)

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Exciting New Research on Sensory Over-Responsivity!

New Research on Sensory Over-Responsivity (SOR) suggests possible prenatal risk factors, genetic heritability and supports uniqueness of Sensory Processing Disorder/SOR.
Dr. Hill Goldsmith, a member of the SPD Scientific Workgroup from the University of Wisconsin-Madison and his colleagues recently published two peer-reviewed manuscripts that evaluated the genetics of Sensory Over-Responsivity1, 2. The first study focuses on SOR at age 2 years and examines toddler temperament and prenatal risk factors. The second paper focuses on SOR at age 7 years and examines distinctiveness of SOR with other diagnoses.
In the first paper 1 1026 pairs of twins were evaluated at 2 years of age. This study did not include any individuals with autism, fragile X, cerebral palsy, spina bifida, or Down syndrome, and 94.4% of the twins in the study were reported to be white. There were 348 monozygotic (i.e., identical), 358 dizygotic (i.e., fraternal) same-sex, and 320 dizygotic opposite-sex twin pairs. Caregiver reports were used to obtain information on temperament and SOR.
This study reported that at 2 years of age:
Signs of negative temperament or distress reactions (e.g., anger, sadness, and more troublesome to sooth) and fear (e.g., fearful of objects and social situations in contrast to finding many situations pleasurable) were moderately correlated with auditory and tactile SOR symptoms.
Prenatal complications significantly predicted tactile SOR symptoms. However, birth weight, length of stay in NICU, birth complications, neonatal complications, and neonatal morbidity were not associated with either tactile or auditory SOR.
Girls with a male co-twin showed greater SOR at age 2 years than same-sex female dizygotic twins, suggesting a possible increase risk associated with in utero testosterone exposure.
Both auditory and tactile SOR domains were heritable. Each SOR domain had a similar genetic relationship with temperamental fear and negative affect.
In summary, this study suggests that the causes and risk factors for tactile versus auditory SOR are to some degree unrelated to each other. Additionally, the findings indicate that prenatal factors should be further investigated, especially in relation to tactile SOR.
The second study2 evaluated SOR in relationship to other common diagnosis in 7 year old children. The primary caregiver (mostly mother’s) of 970 children completed the Sensory Over-Responsivity Inventory3 and a diagnostic interview. Children with autism or pervasive developmental disorders were not included. The study included approximately equal numbers of female and male children and approximately equal numbers of monozygotic, same-sex dizygotic, and opposite-sex dizygotic twin pairs. The majority of the sample was Caucasian (83%), with 4% Hispanic, 4% African American, and 6% other. A limitation of this study was that a confirmatory diagnosis of SPD was not provided by clinicians or occupational therapists for those individuals who screened positive for SOR.
This study reported that at about 7 years of age:
A majority (58.2%) of individuals who screened positive for SOR did not qualify for a DISC diagnosis (Diagnostic Interview Schedule for Children; ADHD, conduct disorder, oppositional defiant disorder, agoraphopia, general anxiety, obsessive-compulsive disorder, panic disorder, separation anxiety, social phobia, specific phobia, depression, enuresis, trichtollomaniatics, selective mutism, pica).
A majority (68.3%) of individuals who screened positive for a DISC diagnosis did not screen positive for SOR.
Children who screened positive for SOR only and typical children had similar rates of physical health problems.
In summary, the results provide tentative support that SPD, and more specifically SOR occurs independently of other recognized common childhood psychiatric diagnoses. However, SOR is also a relatively frequent comorbid condition with recognized diagnoses and possibly genetic factors contribute to this comorbidity.
1.Keuler MM, Schmidt NL, Van Hulle CA, Lemery-Chalfant K, Goldsmith HH (2011). Sensory overresponsivity: prenatal risk factors and temperamental contributions. Journal of Developmental & Behavioral Pediatrics, 32(7):533-541.
2.Van Hulle CA, Schmidt NL, Goldsmith HH (2011). Is sensory over-responsivity distinguishable from childhood behavior problems? A phenotypic and genetic analysis. Journal of Child Psychology and Psychiatry, [Epub ahead of print].
3.Schoen SA, Miller LJ, Green KE (2008). Pilot study of the sensory over-responsivity scales: Assessment and inventory. American Journal of Occupational Therapy, 62:393-406.
DARCI M NIELSEN, PhD, Senior Neuroscientist, Sensory Processing Disorder Foundation
This entry was posted on Wednesday, November 16th, 2011 at 8:44 am and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

Friday, January 27, 2012

January App of the month

Dexteria- Fine Motor Skill Development
This month I reviewed an app that has been talked about for months in the therapy community, but only recently did I add it to my library. Dexteria has received numerous accolades, most recently being awarded the Editors Choice in Children's Technology Review for Excellence in Design!

Age Range:  Dexteria is suitable for children and adults of all ages.

In a Nutshell: Dexteria is basically a portable OT session, and a good one at that!!!  It presents users with a series of exercises focused on fine motor coordination and handwriting skills.  Users are able to create an individual profile, which allows parents and or therapists to follow multiple clients progress.  Upon signing on, users choose from three types of activities titled "tap it" "pinch it" and "write it".
Tap it-  Focus on finger isolation, precision and dexterity. Tap it goes through a series of 10 progressively difficult levels.
Pinch it- Cute, little, green crabs grace the screen when using pinch it.  Users are required to "pinch" each crab to make it disappear (pincer grasp, thumb & pointer finger isolation/coordination) As users progress through the levels they will be given more and more crabs, and eventually the cute little suckers begin moving about the screen, requiring the user to motor plan on a higher level. In my experience, this is the most motivating part of the app for clients!!!
Write it- As a handwriting "specialist" (if you will) I am not overly impressed with many of the pre-writing, handwriting apps that I have encountered.  Most allow children to get away with starting letters in the wrong place, and do not enforce proper formation or control.  Dexteria, however, does require precision and encourages proper formation.  Users are required to use their finger to connect dots within a given form.  Each letter presents the child with the proper "start point" and actually holds the user responsible for touching each individual dot which encourages attention and precision leading to good handwriting habits.

Praise: I could go on and on with praise for Dexteria!!!
1. At only $4.99 it is an affordable app that could benefit countless users. It's free!!!
2. Excellent home programing opportunity!!! Dexterity has a built in Activity Log which allows clients to complete activities from the comfort of their own home, and send a report of progress to a therapist on a regular basis.  This is a fantastic way of allowing the therapist to track progress without having to transport the iPad or iPhone to and from each session!!!!
3. Usable on iPad, iPhone and iPod Touch.
4. Comes in various languages including English, Spanish, Chinese and French

Needs Improvement: Dexteria lacks the bells and whistles that many other "therapeutic apps" offer.  As clients progress through levels, there is a very basic bell that chimes and a screen prompt to move on to the next level appears in the upper corner, however there is no praise for success or improvement.  I find that younger clients and those that really respond to verbal and visual praise, tend to tire of this app. rather quickly. I recommend parents or therapists sit close by, when children use dexteria so praise for success can be offered!!!

Survey Says: Two thumbs up!


Check out a video blog of Dexteria:  http://vimeo.com/22428863

An amazing story I would like to share with you

This is an amazing story that was recently shared with me, get your tissues ready!!! A true depiction of just how amazing and brilliant each and every child is, especially when given the gift of communication.

http://www.youtube.com/watch?v=vNZVV4Ciccg&feature=email

Tuesday, January 24, 2012

SNOW SNOW SNOW

Winter in New England can be full of excitement for people that enjoy skiing, snow shoeing or just simply watching the enchantment that accompanies each falling snow flake, however for others it is a time of hesitation, hibernation and pure hatred...

I have yet to find a child that doesn't jump for joy over a coating of white in the front yard.  For kids a substantial snow fall means a new sled, finding the biggest hill in town, hot cocoa and best of all, a good chance that they will not have to open a textbook the next day!!

A snow storm also brings along significant sensory experiences!!!  The list below is just a short compilation of activities to try with your sensational kids!

  • Make snow angels, roll snow balls, build a snowman or an igloo for great heavy work and motor planning.
  • Have a snow ball fight!!! Great for visual motor skills and motor planning.
  • Go sledding or snow tubing for fantastic fun with huge amounts of vestibular input and movement.  Don't forget to let the kiddos pull their own sled back up the hill for heavy work and proprioceptive input.
  •  Let the kids assist with shoveling the walkway for great heavy work that will be claiming and organizing and not to mention exhausting!!!
  • Bring some snow inside!  Fill large containers of snow and toy cars or trucks to create a fun sensory bucket that is sure to last for hours, or as long as it takes the snow to melt! 
  • Take a stroll! Walking in snow is difficult which provides some very fun muscle work and is also a great opportunity to work on balance and coordination!
  • Hide objects in a large pile of snow and encourage the little ones to dig in and find them!  This works on visual discrimination and provides some fun and encouraging tactile input!
These are just a few suggestions but there are endless activities that can provide fun sensory experiences for the whole family.  Just be sure to follow up with a large mug of hot chocolate!!! EXTRA MARSHMALLOWS!!! 

Saturday, January 21, 2012

Today in the New York Times... Changes on the horizon have me feeling very ambivalent!?

New Definition of Autism Will Exclude Many, Study Suggests

Todd Heisler/The New York Times
Mary Meyer, right, of Ramsey, N.J., said that a diagnosis of Asperger syndrome was crucial for her daughter, Susan, 37.
Proposed changes in the definition of autism would sharply reduce the skyrocketing rate at which the disorder is diagnosed and might make it harder for many people who would no longer meet the criteria to get health, educational and social services, a new analysis suggests.

Readers’ Questions: Redefining Autism

James C. McPartland, an assistant professor in the Child Study Center at Yale University, is answering your questions about this possible new definition of autism.
Multimedia
The definition is now being reassessed by an expert panel appointed by theAmerican Psychiatric Association, which is completing work on the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, the first major revision in 17 years. The D.S.M., as the manual is known, is the standard reference for mental disorders, driving research, treatment and insurance decisions. Most experts expect that the new manual will narrow the criteria for autism; the question is how sharply.
The results of the new analysis are preliminary, but they offer the most drastic estimate of how tightening the criteria for autism could affect the rate of diagnosis. For years, many experts have privately contended that the vagueness of the current criteria for autism and related disorders like Asperger syndrome was contributing to the increase in the rate of diagnoses — which has ballooned to one child in 100, according to some estimates.
The psychiatrists’ association is wrestling with one of the most agonizing questions in mental health — where to draw the line between unusual and abnormal — and its decisions are sure to be wrenching for some families. At a time when school budgets for special education are stretched, the new diagnosis could herald more pitched battles. Tens of thousands of people receive state-backed services to help offset the disorders’ disabling effects, which include sometimes severe learning and social problems, and the diagnosis is in many ways central to their lives. Close networks of parents have bonded over common experiences with children; and the children, too, may grow to find a sense of their own identity in their struggle with the disorder.
The proposed changes would probably exclude people with a diagnosis who were higher functioning. “I’m very concerned about the change in diagnosis, because I wonder if my daughter would even qualify,” said Mary Meyer of Ramsey, N.J. A diagnosis of Asperger syndrome was crucial to helping her daughter, who is 37, gain access to services that have helped tremendously. “She’s on disability, which is partly based on the Asperger’s; and I’m hoping to get her into supportive housing, which also depends on her diagnosis.”
The new analysis, presented Thursday at a meeting of the Icelandic Medical Association, opens a debate about just how many people the proposed diagnosis would affect.
The changes would narrow the diagnosis so much that it could effectively end the autism surge, said Dr. Fred R. Volkmar, director of the Child Study Center at the Yale School of Medicine and an author of the new analysis of the proposal. “We would nip it in the bud.”
Experts working for the Psychiatric Association on the manual’s new definition — a group from which Dr. Volkmar resigned early on — strongly disagree about the proposed changes’ impact. “I don’t know how they’re getting those numbers,” Catherine Lord, a member of the task force working on the diagnosis, said about Dr. Volkmar’s report.
Previous projections have concluded that far fewer people would be excluded under the change, said Dr. Lord, director of the Institute for Brain Development, a joint project of NewYork-Presbyterian Hospital, Weill Medical College of Cornell University, Columbia University Medical Center and the New York Center for Autism.
Disagreement about the effect of the new definition will almost certainly increase scrutiny of the finer points of the psychiatric association’s changes to the manual. The revisions are about 90 percent complete and will be final by December, according to Dr. David J. Kupfer, a professor of psychiatry at the University of Pittsburgh and chairman of the task force making the revisions.
At least a million children and adults have a diagnosis of autism or a related disorder, like Asperger syndrome or “pervasive developmental disorder, not otherwise specified,” also known as P.D.D.-N.O.S. People with Asperger’s or P.D.D.-N.O.S. endure some of the same social struggles as those with autism but do not meet the definition for the full-blown version. The proposed change would consolidate all three diagnoses under one category, autism spectrum disorder, eliminating Asperger syndrome and P.D.D.-N.O.S. from the manual. Under the current criteria, a person can qualify for the diagnosis by exhibiting 6 or more of 12 behaviors; under the proposed definition, the person would have to exhibit 3 deficits in social interaction and communication and at least 2 repetitive behaviors, a much narrower menu.
Dr. Kupfer said the changes were an attempt to clarify these variations and put them under one name. Some advocates have been concerned about the proposed changes.
“Our fear is that we are going to take a big step backward,” said Lori Shery, president of the Asperger Syndrome Education Network. “If clinicians say, ‘These kids don’t fit the criteria for an autism spectrum diagnosis,’ they are not going to get the supports and services they need, and they’re going to experience failure.”
Mark Roithmayr, president of the advocacy organization Autism Speaks, said that the proposed diagnosis should bring needed clarity but that the effect it would have on services was not yet clear. “We need to carefully monitor the impact of these diagnostic changes on access to services and ensure that no one is being denied the services they need,” Mr. Roithmayr said by e-mail. “Some treatments and services are driven solely by a person’s diagnosis, while other services may depend on other criteria such as age, I.Q. level or medical history.”
In the new analysis, Dr. Volkmar, along with Brian Reichow and James McPartland, both at Yale, used data from a large 1993 study that served as the basis for the current criteria. They focused on 372 children and adults who were among the highest functioning and found that overall, only 45 percent of them would qualify for the proposed autism spectrum diagnosis now under review.
The focus on a high-functioning group may have slightly exaggerated that percentage, the authors acknowledge. The likelihood of being left out under the new definition depended on the original diagnosis: about a quarter of those identified with classic autism in 1993 would not be so identified under the proposed criteria; about three-quarters of those with Asperger syndrome would not qualify; and 85 percent of those with P.D.D.-N.O.S. would not.
Dr. Volkmar presented the preliminary findings on Thursday. The researchers will publish a broader analysis, based on a larger and more representative sample of 1,000 cases, later this year. Dr. Volkmar said that although the proposed diagnosis would be for disorders on a spectrum and implies a broader net, it focuses tightly on “classically autistic” children on the more severe end of the scale. “The major impact here is on the more cognitively able,” he said.
Dr. Lord said that the study numbers are probably exaggerated because the research team relied on old data, collected by doctors who were not aware of what kinds of behaviors the proposed definition requires. “It’s not that the behaviors didn’t exist, but that they weren’t even asking about them — they wouldn’t show up at all in the data,” Dr. Lord said.
Dr. Volkmar acknowledged as much but said that problems transferring the data could not account for the large differences in rates.
Amy Harmon contributed reporting.