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

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.

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.

"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.

The aim of this study was to investigate a sensory intervention of moderate pressure touch on children with sensory modulation disorder on the outcomes of sleep behaviors and social participation. 50 children, aged 6-11 years, with both sensory modulation disorder and sleep difficulties were randomly divided into an experimental group and a control group. The experimental group participants received three weeks of nightly massage by their parents. The parents filled out questionnaires reporting on sleep behaviors, sensory modulation, and social participation, as well as recording a sleep log, and determining goal attainment scaling goals. The questionnaires used were the Short Sensory Profile, the Child Sleep Habits Questionnaire, the Child Behavior Checklist (CBCL), and the Sensory Processing Measure social sub-section. Significant improvement was found between the total and sub-group scores of sleep and social participation measures. While obstructive sleep disorders remained unchanged, behavioral sleep difficulties of sleep onset, sleep anxiety, parasomnias, sleep duration, and daytime sleepiness, as well as the total sleep scores ( F(1,48)=24.71, p