The Adolescent/Adult Sensory Profile Tana Brown PhD, OTR FAOTA University of Kansas Medical Center Occupational Therapy Education

Presentation topics History of the A/ASP Overview of the sensory processing model Taking and scoring the profile Interpreting the profile Intervention guidelines Practice designing environments to support sensory processing preferences Considerations for specific diagnostic groups

General information before we get started Not a “sensory integration” presentation The model applies to all people – not an impairment model Will provide a framework for assessment and intervention that is applicable regardless of the population

History of the A/ASP Statistical analysis of the children’s version of the Sensory Profile Development of the model of Sensory Processing Relationship to adult issues Development of the Adult version Revisions to make applicable to adolescents

Overview of Dunn’s Model of Sensory Processing Theoretical framework for interpreting the measure and designing intervention

Dunn’s Model of Sensory Processing Behavioral Response Behavioral Response in accordance to counteract Passive Active Low Low Registration Sensation Seeking Threshold High Sensory Sensitivity Sensation Avoiding

Sensory Sensitivity passive response to a low threshold easily respond to sensory stimuli notice things other people don’t notice highly aware of their surroundings distractible Trouble screening out sensation, sensations may seem more intense, Frank at café – if someone toughes him jumps out of his skin – wants to socialize but finds it very overwhelming – will often leave the room, pace with fingers in his ears – Tana I’m not anxious, I’’m just hallucinating f I was to do this all over again, or if I revise the form - IWould like to emphasize the increased awareness/sensitivity and downplay the discomfort – as a way to better distinguish from sensation avoiding – because have become aware that there are many people who are able to take in the sensation/information and not be overwhelmed by it – Stat teacher who noticed everything that went on in the room – often commented on it but didn’t interfere with his lecture or would even incorporate it into what he was doing – Mostof the items on the sensitivity scale reflect discomfor – I’m uncomfortable wearing certain fabrics But still is a distinction from avoiding b/c you may be bothered but not do anything about it – true wit many of the populations we deal with – don’t create strategies to manage the discomfort

Sensation Avoiding active counteracting a low threshold intentional withdrawal or blocking of sensation use of rituals and routines overwhelmed by sensory rich environments good at creating structured and supportive environments This is an active quadrant – so person does things to structure their environment, activity to reduce senstion Close the blinds Sitting at the end of an aisle in the movie theatre Friend who shared with me that when he goes to a party he often unscrews light bulbs in lamps b/c the room feels too bright Recent experience of not having any time alone – in hotel with Lauren and friend, at someone’s house week before

Low Registration Passive response with a high threshold miss available sensory input spacey, clumsy under-responsive or slow to respond can focus in distracting environments flexible, comfortable in wide range of environments Tell the joke and three minutes later, OHHHHHHH I’ve always known daughter was low registration – eating hamburger with Winnie and juice dripping down her arm- So knew driving was going to be a challenge – friend I remember she had trouble riding a bicycle Consumer who had trouble noticing when setting table, (would put a completely empty salt shaker on the table) My dissertation advisor said, these are the people I feel sorry for. But really these are the people I’m envious of – b/c tend to be easy going, don’t have a lot of environmental requirements – happy regardless of where you decide to go to lunch, take a vacation etc.

Sensation Seeking behavioral response to counteract a high threshold enjoys sensory rich environments creates sensation easily bored trouble tolerating low stimulus environments When look at scoring, this is where most people predominate, the healthy, productive response is to seek out information about our environment However, people can still be at the extreme end of the continuum and can be dysfunctional in certain environments or if always seeking Different than risk taking – zuckerman has a sensation seeking scale which includes things like parachuting, bungee jumping, drug use On sensory profile includes things like smell fresh flowers, wear bright colors, like to be in crowds Friend that needs intense, joint pounding exercise (runs, swims) to feel calm enough and focused to do cognitive work – very fidgety

Adolescent/Adult Sensory Profile measure of sensory processing preferences Self questionnaire 60 items – 15/quadrant Taste/smell, movement, visual, tough, auditory, activity level Ages 11 and up

If/when the A/ASP is revised… Change the double negative items Better distinguish sensory sensitivity and sensation avoiding by making sensitivity items focus on detection and not annoyance of sensation

Who should fill out the A/ASP? It is designed to be a self-report Informant reporting should be done cautiously and avoid interpretations based on scores Best informants would be those that have caretaking responsibilities

Fill out and score the A/ASP

Classification System Based on standardization sample 193 adolescents, 496 adults, 261 older adults Cut scores for each quadrant Classifications Much less than most people Less than most people Similar to most people More than most people Much more than most people

Uses normal distribution

Support for Reliability Internal consistency for quadrants range from .65 - .78 Each item on a subscale correlates best with its intended subscale Standard error of measurement ranges from 3.58 – 4.51 Items correlated best with other items in their quadrant Physiological data – skin conductance while listening to tones Sensory sensitivity – responded more intensely and did not habituate Avoiding – responded intensely but habituate quickly Low registration – low responsivity and habituates Sensation seeking – low responsivity but many trials to habituation

Validity Evidence Discriminant Validity with Adult Temperament Questionnaire (Chess & Thomas, 1998) Sensation seeking scores negatively correlated with withdrawal and dysphoric mood subscales Sensitivity subscales positively correlated with dysphoric mood and sensory threshold subscales Sensation avoiding positively correlated with low adaptability, withdrawal and dysphoric mood

Further support for validity Physiological data consistent with four quadrants Sensory sensitivity respond intensely and habituate slowly Sensation avoiding respond intensely but habituate quickly Low registration respond weakly and habituate quickly Sensation seeking respond weakly but habituate slowly

More support for validity Distinguished people with and without mental illness Distinguished younger and older adults Child version distinguished children with autism and ADHD

Considerations Scoring different than child, infant/toddler versions All preferences have advantages and disadvantages Consider all quadrants together Consider meaning of low scores (particularly for seeking and avoiding behaviors) Consider patterns within sensory categories Scoring is the opposite – high score means you have a lot of it – are sensitive are a seeker Look at patterns – e.g. person with head injury that was high on sensitivy and low on avoidng, or people with schizophrenia – high on both low registration and avoiding, so not only do they miss information but put self in situation to limit exposure so have few opportunities to learn Think about what it means to not be a seeker – not necessarily an avoider but you just don’t put any effort into seeking May not have a high.low score on a quadrant but may find some extremes within – manual has pattern grids so can look within auditory processing for example and find the person is an avoider but in movement they are a seeker

Intervention Strategies Create a supportive environment Increase tolerance, rather than change the person’s preference

Increase tolerance Graded exposures Personal commitment, rewards or other external motivators

Analyzing the environment Intensity Amount Repetition Competing stimuli Predictability Familiarity Speed

The Auditory Environment Intensity – soft/loud Amount – intermittent, constant Repetition – rhythmic Competing stimuli – background noise, multiple conversations Predictability - startle Familiarity – accents or garbled speech Speed – rate of speech

The Visual Environment Intensity – brightness, colors Amount – number of objects to process Repetition – clean lines, patterns Competing stimuli - clutter Predictability – organized, movement Familiarity – visual input is recognizable, known vs. unknown setting Speed – how much time to process information (static environment versus moving {driving})

The Tactile Environment Intensity – light versus deep pressure, degree of irritability Amount – body surface Repetition – constant or intermittent Competing stimuli – consider ambient environment – temperature, wind, fans Predictability – handshake versus being touched from behind Familiarity – recognize what you are touching (stepping on something unfamiliar) Speed – fast/slow

The Gustatory Environment Intensity – spices, temperature Amount – how much is taste a part of the experience Repetition – different tastes or lots of the same Competing stimuli – eat everything separately, mix foods together Predictability – taste surprises (e.g. plantains not bananas) Familiarity – eaten before Speed – how quickly you eat and therefore taste

The Olfactory Environment Intensity – strength of the smell Amount – e.g. bath stores, restaurants Repetition – less relevant Competing stimuli – unpleasant smells can be especially distracting Predictability – can detect when and where Familiarity – can detect what Speed – tends to be more constant, smells generally do not come and go quickly

The Vestibular/Proprioceptive Environment Intensity – large, pounding movements Amount – activity level Repetition – rhythmic, cadenced Competing stimuli – mostly when not executing movements on own, - car, rides, elevator Predictability – can anticipate movement and body in space Familiarity – established motor patterns Speed – slow versus quick movements

Let’s analyze an environment

Low Registration ↑ Intensity ↑ Amount ≈ Consistency ≈ Competing (↑ intensity of salient stimuli) ↓ Predictability ↓ Familiarity ↓ Speed

Other Low Registration Considerations There could be safety issues related to not noticing Will probably have a high level of tolerance for different types of environments so capitalize on flexibility Cues are an essential strategy because it increases accessibility of salient/important information

Sensation Seeking ↑ ↑ Intensity ↑ Amount ↓ ↓ Consistency ↑ Competing ↓ Predictability ↓ ↓ Familiarity ↑ Speed

Other sensation seeking considerations Incorporate additional sensations into daily routines What may be distracting for others, may help increase arousal/promote attention for sensation seekers

Sensory Sensitivity ↓ Intensity ↓ Amount ↑ Consistency ↓ ↓ Competing ↑ Predictability ↑ Familiarity ↓ Speed

Other sensory sensitivity considerations How capable is person of assimilating multiple stimuli (may be sensitive but able to handle/process information effectively) Otherwise remove distractors and create organizational systems

Sensation Avoiding ↓ ↓ Intensity ↓ Amount ↑ Consistency ↓ ↓ Competing ↑ Predictability ↑ Familiarity ↓ Speed

Other sensation avoiding considerations Be sure to distinguish low registration and avoiding because approaches are often contradictory When possible give the individual control over the environment when introducing sensory input

Other strategies……

Distress tolerance Idea comes from dialectical behavior therapy There are times when will have to tolerate an uncomfortable situation Develop coping mechanisms for managing those times

Information is part of the intervention Awareness of personal preferences increases self-awareness and is reassuring Provide information to relevant others – spouses, employers, parents, teachers, so that they can understand

Incorporate breaks Avoider may need to leave the party and retreat to the kitchen Seeker may need to leave a long lecture and go outside for a run

Meet needs internally/self-soothing Self talk Meditation Chew gum Rock

Use others as intervention To help focus attention To provide feedback about behavior To reassure To distract

Design an environment for each quadrant around a specific occupation

Findings related to specific populations

Individuals with schizophrenia Low scores on sensation seeking High scores on sensation avoiding and low registration

People with bipolar disorder Average scores on low registration High scores on sensation avoiding and low scores on sensation seeking

Older adults Low scores on sensation seeking High scores on low registration with cumulatively higher scores as age from 60 – 70 - 80

Autism/Asperger More likely to exhibit behaviors in Sensation seeking, low registration and sensory sensitivity Especially sensitive to auditory and oral motor input

Attention Deficit Hyperactivity Disorder Differences across all quadrants – may be more reflective of a modulation problem

Adults with brain injury High scores on sensory sensitivity Low scores on sensation avoiding