dissertation submitted to the Faculty of Health Sciences, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Science in Occupational Therapy Johannesburg, 2017 / Parents of children who have sensory modulation disorder (SMD) and who have sensory over-responsiveness (SOR) themselves may display mal-adaptive self-regulatory strategies, contributing to elevated stress levels. The purpose of the study is to determine the perceived stress levels and sensory self-regulatory strategies of mothers of children with SMD, who presented with SOR themselves. A twelve-week stress management programme using a sensory modulation-based approach was developed and implemented with a sample of five mothers with SOR. The quasi-experimental pre-test post-test design required the participants to complete the Parenting Stress Index-4 Short Form and a sensory self-regulatory questionnaire. The effectiveness of the programme was assessed by determining change in perceived stress and self-regulatory behaviours immediately after and three months following the programme. Although no statistically significant change was found, clinically relevant change with large effect sizes was evident in the scores for parental distress, difficult child, total stress, and self-regulatory behaviour after the intervention period. Further clinical change was found for parental distress, difficult child and parent child dysfunctional interaction with moderate effect sizes after the follow up period. The results of this study indicate the importance of addressing the mother’s stress levels, in addition to treating their child with SMD. / MT2017

"Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Occupational Therapy Department, College of Health Care Sciences, Nova Southeastern University." Attachment and sensory modulation are two processes that co-occur in early development and that have an impact on the future development of the child. Attachment difficulties occur when the child cannot, for whatever reason, use the primary caregiver as a secure base from which to experience the world. Sensory modulation disorder (SMD) is characterized by maladaptive responses to sensory input. Although the literature and current research in the separate areas of attachment and sensory modulation have some parallels with regard to behavioral sequelae, relation to stress, and impact on participation, the relation of the two processes has not been the focus of published research. This research examined the relation between attachment and sensory modulation in 68 children ages 3 to 6. Two assessments were administered during the course of a home visit with each participant and primary caregiver: the Attachment Q-Set (3rd edition; AQS) and the Short Sensory Profile (SSP). There were significant correlations between the AQS security criterion (AQS-S) and the SSP as well as the AQS dependency criterion (AQS-D) and the SSP providing evidence for a relation between attachment and sensory modulation. Significance was found in simple linear regression with the SSP total score and SSP section scores for tactile sensitivity and visual/auditory sensitivity predicting AQS-D scores. Multiple regression calculations were significant for AQS-S and AQS-D predicting SSP as well as SSP section scores predicting AQS-D. These findings support the view of a dynamic model of interaction between attachment and sensory modulation development as well as among the child, the caregiver, the child-caregiver dyad, and the environment.

Schizophrenia is a devastating disorder affecting millions of people in the United States. Studies leading to new understanding of and intervention for this disorder are essential, as current interventions are minimally effective. The end result is high rates of re-hospitalization, impaired occupational performance and decreased community reintegration. According to the Diagnostic and Statistical Manual of Mental Disorders, symptoms of schizophrenia are categorized as positive or negative, with both types of symptoms impacting successful occupational engagement. Based on behavioral observations occupational therapists have hypothesized that this population may also experience sensory modulation disorder (SMD). Although electrophysiological studies support the presence of SMD, studies focusing on the relationship between the observable behaviors of these two disorders are lacking. The purpose of this project is to examine the relationship between symptoms of SMD and schizophrenia. A cross-sectional design was used for this study. A convenience sample of 40 subjects was recruited from two outpatient psychiatric programs in Chicago, Illinois. Multi-site testing using the Positive and Negative Syndrome Scale (PANSS) and the Adolescent/Adult Sensory Profile (A/ASP) was used to address the following questions: 1) Is there a relationship between symptoms of schizophrenia and patterns of SMD? 2) Can positive and negative symptoms of schizophrenia reliably predict patterns of sensory modulation disorder? A Spearman correlation coefficient was used to examine the relationship between symptoms of schizophrenia and patterns of SMD, indicated a significant positive relationship between positive symptoms of schizophrenia and the low registration and sensory sensitivity quadrants of the A/ASP. Furthermore, a Mann Whitney U test uncovered significantly higher sensory sensitivity scores in African Americans compared to Caucasians. No significant relationships were found between negative symptoms and patterns of SMD. Stepwise regression found that positive symptoms predicted higher low registration scores and a combination of positive symptoms, race and gender were the best predictors of higher sensory sensitivity scores. This study did find a relationship between positive symptoms and patterns of SMD, suggesting that the relationship may actually be between psychosis and SMD and not schizophrenia. However, due to the small sample size, results should be interpreted cautiously and further studies completed.

Occupational therapists theorize that behavioral responses to sensory stimuli are reflective of a child’s underlying ability to process sensory information in a manner that allows the child to engage in childhood occupations meaningfully. If a child’s ability to process sensory information is compromised, then occupational performance is compromised. Similarly if coping skills are less than adequate, successful engagement in occupations is limited. What is less clear is how sensory modulation and coping interact to influence occupational performance. This study examined the interplay between sensory modulation, coping, and occupational performance in a sample of children referred for sensory processing difficulties. Two hundred sixty children, ages 4 – 9 years of age, referred to Occupational Therapy Associates at The Koomar Center in Watertown, MA, for sensory processing concerns were examined for Sensory Modulation Disorder (SMD), coping abilities, and occupational performance. Results indicate that while sensory modulation is a strong predictor of occupational performance, it only accounts for approximately 20% of the variance in this model. As such, there are additional factors that contribute to occupational performance; these were not identified in the current study. Children with SMD appear to have mild coping deficits, and the interaction between the two, SMD and coping, remains unclear. Additional exploratory analyses revealed significant overlap between subtypes of SMD. Findings from this study laid the foundation for an emerging model reflecting the coping process of children with SMD. Testing the model in future studies will help elucidate these relationships.

Tactile and proprioceptive input provided by weighted vests is thought to decrease sensory modulation dysfunction in children with autism. This study investigated behavioural and physiological effects of weighted vests for ten children with autism, ages 3 to 10, in a classroom setting. A single-case, ABCBC design was used where A =behavioural baseline without vest or heart rate monitor; B = unweighted vest and heart rate monitor; C = vest with 5-10% body weight and heart rate monitor. Observers, blinded to treatment condition, rated targeted behaviours for each participant through video taken during structured table-top activities typical of the classroom routine. Teachers, also blinded to treatment condition, rated each childs behaviour with the Conners Global Index following each phase of the study. Educational aides, not blinded to treatment condition, provided subjective feedback about the effects of the weighted vest for each participant. Heart rate was collected when participants wore the vest. Results were mixed regarding the effects of weighted vests for children with autism. Objective data provided evidence to support the use of weighted vests to decrease off-task behaviours with some, but not all, children with autism and sensory modulation dysfunction. Weighted vests did not decrease motoric stereotyped behaviours in any participant, but did decrease verbal stereotyped behaviours in one participant. Heart rate did not decrease with the weighted vest. Subjectively, all aides reported that weighted vests were effective in improving behaviours in all participants at least some of the time. All teachers and aides reported that weighted vests were appropriate modalities to use in the classroom and wanted to continue using weighted vests following the study. Although weighted vests may be an appropriate modality to include as a component of intervention with some children with autism, results were not strong or consistent across participants. The results do not support the use of weighted vests in isolation to improve classroom function in children with autism. / Rehabilitation Science

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Sensory Modulation Disorder (SMD) reduces a child’s ability to respond to sensory stimuli in the environment in a manner that corresponds to the nature or intensity of the stimulus; this disorder therefore significantly can impact participation in developmentally appropriate play and functional activities. More studies are needed to enhance research in the field of SMD and aid the general community in understanding the disorder and its causes. The purpose of this study was to characterize the prevalence of SMD among Puerto Rican preschoolers and examine the relationship between specific risk factors (socioeconomic status, pre-natal alcohol exposure, low birth weight, preterm delivery, and lead exposure) and SMD in this population. The sample consisted of 141 caregivers of preschool children; 78 were from Head Start programs and 63 were from private preschools. The Short Sensory Profile was used to determine the presence of SMD. A Demographic and Risk Factors Data Sheet was used to obtain information about the risk factors, except for lead exposure, which was measured using results of blood lead levels tests available in the records of Head Start preschoolers. Prevalence of SMD among the total sample, calculated through descriptive statistics, was 19.9%, which is higher than previously reported estimates of studies with children on the US mainland. According to an Analysis of Variance test, no differences were found in the prevalence of SMD based on parents’ education and/or household income. Diverse multivariate analyses, including structural equation modeling, were used to determine the relevance of risk factors used to explain variance in SMD scores. Due to limitations of the data collected, it was not possible to provide a definite conclusion about the most relevant risk factors identified in this study. In general, when compared to the other risk factors included, findings point to household income and low birth weight as relevant variables to explain scores on the SSP for the total sample. For the Head Start sample, lead exposure and low birth weight, followed by household income, achieved the better relative relevance to explain scores in the SSP (when compared to the other risk factors considered). However, due to the low effect sizes and low percentage of shared variance found among the variables, findings from this study do not support strong associations between risk factors and SMD as suggested in previous literature. More research is required to further understand SMD and the complex interaction among potential risk factors that might be associated with its prevalence.

Abstract EFFECTIVENESS OF SENSORY INTEGRATION AND BEHAVIORAL INTERVENTIONS ON NONENGAGEMENT IN PRESCHOOL AGED CHILDREN By Tiffany Ann Kuyper, OTR/L A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Occupational Therapy at Virginia Commonwealth University Virginia Commonwealth University, 2012 Director: Marie Anzalone ScD, OTR, FAOTA This single subject pilot study explored a combination of sensory-based interventions and behavioral interventions in a preschool aged child identified with Sensory Over-Responsivity (SOR). Children often display nonengagement associated with escaping and avoiding tactile and/or vestibular information because they perceive sensory input as negative or aversive. The subject was a 3-year old child who engaged in alternating treatments over the course of six weeks of occupational therapy. The first condition was a sensory-based intervention (SB), a widely used intervention approach for sensory over-responsivity. The alternating condition was a sensory-based intervention combined with behavioral interventions (SBB). The behavioral intervention used tangible reinforcement as the primary technique to facilitate engagement in sensory intensive play that was part of the sensory-based interventions. It was hypothesized that nonengagement behaviors would decrease during the SBB condition and play engagement behaviors would increase during the SBB condition. It was also hypothesized that the subject would demonstrate an improvement in perceived performance and satisfaction of daily living activities. The outcomes of this study included frequencies of nonengagement, play engagement and the family’s perceived performance and satisfaction of a child’s performance of occupations. The frequency of nonengagement behaviors was assessed when the subject was presented with sensory intensive play that was part of sensory-based interventions in each condition. The frequencies of nonengagement and play engagement were coded over each session to determine if there was any change between and within conditions. Also, performance and satisfaction with occupations were compared from the initial evaluation and the last intervention session. Results of this study revealed that the subject’s nonengagement behaviors actually increased throughout the interventions. This finding did not support the first hypothesis that nonengagement behaviors would decrease in the condition using a combination of sensory-based interventions and behavioral interventions. It was also found that the subject’s number of play engagement behaviors decreased within both conditions. This finding did not support the second hypothesis that play engagement behaviors would improve as result of participating in a combination of sensory-based interventions and behavioral interventions over time. However, the qualitative improvements as identified by the subject’s mother when using the Canadian Occupational Performance Measure (COPM; Law, Baptiste, McColl, Polatajko, & Pollock, 2005) improved significantly across both interventions in the home and community settings. As a result of participation in this study, the subject made improvements with regard to all occupational performance areas as initially collaborated upon in the initial evaluation.

Objective. The purpose of the study was to determine if there were significant relationships between dysfunction in sensory modulation, affective disorders, and adaptive behaviors in children and adolescents between the ages of 6 and 17. There were four main hypotheses: (a) there will be a positive relationship between sensory defensiveness and anxiety, (b) there will be a positive relationship between sensory hyposensitivity and depression, (c) there will be a negative relationship between the levels of anxiety and depression and overall adaptive behaviors, and (d) there will be a negative relationship between levels of hyper and hyposensitivity and overall adaptive behavioral functioning. Method. Parents of 46 children and adolescents between the ages of 6 and 17 diagnosed with Asperger Syndrome based on the DSM-IV-TM criteria completed the (a) Sensory Profile for children ages 6 to 10 or the Adolescent/Adult Sensory Profile for adolescents ages 11 to 17; (b) the Adaptive Behavior Assessment System: Parent Version; (c) Revised Children's Manifest Anxiety Scale Adapted Parent's Version; and (d) the Children's Depression Inventory Adapted Parent's Version. Descriptive statistics and the Pearson product-moment coefficient of correlation calculations were used for data analysis. Results. There were statistically significant positive correlations between anxiety and sensory defensiveness (r = .270, p = .035) in the total group and depression and sensory hyposensitivity in only the older group (r = .461, p =.024). There was an inverse significant relationship between depression and the total adaptive behaviors score (r = −.256, p = .043) and specific inverse relationships with the adaptive behaviors of functional academics, leisure and social skills. The relationship between anxiety and adaptive behaviors was not significant (r = −.121, p = .212) although there was a significant inverse relationship between sensory defensiveness and adaptive behaviors (r = −.254, p = .044). The relationship between hyposensitivity and adaptive behaviors approached significance (r = −.214, p = .077). Conclusion. The data supports relationships between anxiety and sensory defensiveness in all age ranges and the relationship between depression and hyposensitivity in older children. A temporal relationship between anxiety and depression may explain the developmental nature of the results. Depression and sensory defensiveness demonstrated significant inverse relationships with overall adaptive behavior functioning. Occupational therapy evaluations and interventions need to address these relationships when treating children with Asperger Syndrome.

In pediatric pelvic health, sensory processing is not often considered as a significant factor. The current gold standard for addressing bowel and bladder dysfunction is urotherapy and medication. Urotherapy encompasses education regarding the anatomy and function, behavior modifications including fluid intake, removing or managing bowel and bladder irritants, diet changes, timed or scheduled voids, toilet postures and avoidance of holding maneuvers, manual therapy, and biofeedback. These forms of treatment have shown a roughly 50% success rate six months to several years after treatment is concluded (Pijpers et al., 2010 and Noordhoff et al., 2018). While the previously mentioned treatment methods are often necessary and appropriate, they fail to consider the central role that sensory processing, sensory integration, and emotional regulation play in basic biological functions and homeostasis. This doctoral project involved the creation and piloting of the Sensory Modulation – Bowel and Bladder Questionnaire (SM-BBQ) questionnaire to help diagnose children who have bowel or bladder dysfunction due to sensory under-responsivity. Results demonstrated a strong positive correlation between children who leaked both urine and stool and demonstrated hypo-responsiveness on the Sensory Processing Measure -2 (SPM-2) and their SM-BBQ scores. Significant findings were also noted between the SPM-2 scale scores and scores on both the SM-BBQ. In contemplating how these findings fit with Ayres Sensory Integration theory, perception and threshold may be more relevant than responsivity, as most participants were noted to be hypo- and hyper- responsive to input. A larger scale follow-up study will need to be conducted to ensure that the SM-BBQ is a reliable and valid measure for identifying children with toileting dysfunction related to sensory perception and helping those families to find appropriate services. / 2025-05-08T00:00:00Z