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Occupational Therapist Tips: Treating Adolescents and Adults With SPD

A Review of Literature

Jamie Schreckler, MA, OTR
Occupational Therapist, STAR Center

is an active partner and enthusiastic sponsor of the Sensory Processing Disorder Foundation, the leader in Sensory Processing Disorder research, education and advocacy. It is the premier clinic for research-based treatment of Sensory Processing Disorder (SPD) and other sensory challenges in children, adolescents, and adults. Our comprehensive occupational therapy assessments and multidisciplinary evaluations lay a cornerstone for the innovative and effective .

The STAR treatment model is based on the fundamental principle of relationship.

Without a foundation of trust, support and collaboration, progress toward functional change simply is not possible. As occupational therapists, we know the importance of relationship regardless of the age of the client. Additionally, understanding the interrelations between the sensory and emotional components of behavior is essential to effective treatment. However, for many OTs, dealing with the multiple layers of emotions of adolescents or adults may be harder.

A recent influx of adolescent and adult referrals to the STAR Center over the last few months has engaged our team in examining how the STAR model can effectively be applied or adapted to meet the needs of these age groups. Sensory Processing Disorder often persists into adolescence or can go undiagnosed until adulthood. The functional manifestations of the disorder are compounded by the increasingly complex social and emotional challenges of high school, college and the workforce. However, many pediatric clinics do not know how to deal with this population. This review draws from the work of Teresa May-Benson, ScD, OTR and Moya Kinnealey, PhD, OTR within the context of the STAR treatment model. Two articles (plus personal communication) were used in preparing this summary: an article by Mary Ellen Johnson and Rebecca Irving entitled Implications of Sensory Defensiveness in a College Population from the AOTA Sensory Integration Special Interest Quarterly in June of 2008 and an article by Teresa May-Benson from the June 2009 issue of OT Practice entitled Occupational Therapy for Adults with Sensory Processing Disorder.

Current research indicates that adults with Sensory Over-Responsivity present with a variety of emotional difficulties (Pfeiffer, et. al. 2011). Although more research is needed, preliminary evidence suggests that intervention needs to focus on facilitating relationships, improving adaptive skills and developing successful coping strategies.

Intervention may employ a direct service model or consultation.

Consider the following important elements:

  • Sensory integration issues can impact function and mental health in adults
  • OT assessment for adults looks different than for children:
    • Evaluation begins with a comprehensive interview
    • Developmental history and sensory questionnaire standardized tools can be used in a non-standardized way to obtain essential information, e.g. using portions of the SIPT even if client is not within age range
  • Direct Service should include:
    • Clinic activities
      • Clients should be seen intensively, multiple times per week, for several weeks
      • Activities based on the principles of Ayres Sensory Integration
      • Goals should be client centered
      • Select activities that motivate the client but are targeted to their sensory challenges
      • Incorporate natural contexts, e.g. meet at the gym, the mall, at a restaurant
      • Provide education focused on reframing the problem and physiology
      • Use a combination of approaches including: Integrated Listening Systems, Interactive Metronome, the Kawar protocol, Wii, Kinect, etc.
    • Home programs for developing coping strategies and new functional patterns
      • Daily Sensory Activities- using sensory tools for optimizing arousal
      • Remedial Activities- designed with guidance from OT with the purpose of changing underlying nervous system function
  • The Consultative Model focuses on empowering individuals in daily life. Therapeutic activities can be conceptualized as altering the individual's sensory emotional state. Include any or all of the following:
    • Counseling to develop adaptive coping mechanisms
    • Prescription of daily sensory activities to address arousal modulation and problems in sensory responsivity
    • Lifestyle redesign, e.g. doing exercise at different times of the day
    • Environmental adaptation, e.g. reducing clutter in the house
    • Development of social support

What if the adolescent or young adult is not ready or willing to participate in treatment?

We have encountered teens or young adults, who are "forced" to go to therapy by their parents. They are suspicious and unmotivated often because they think their parent is "trying to change them" or because they fear something is "wrong with their brain." Behaviorally they appear oppositional and angry, when in fact they are really just afraid.

Recognizing the complexity of these cases is essential prior to initiating your assessment. While it may take longer to collect the necessary background information and to derive a sensory clinical impression of the individual, the initial goal must be to empower the fearful adolescent or adult to want to adapt his/ her sensory lifestyle.

In summary

Adults and adolescents are a growing population of individuals with SPD seeking intervention. Clinics must be prepared for facing this challenge and adapt existing intervention models to meet the needs of these individuals. Both direct service and consultative models can be effective. Complex emotional issues may compound the sensory symptoms and mask an underlying willingness to engage and change. Occupational therapists are the experts on addressing individual needs and on recognizing the primary role of relationship in our interventions.

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