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

2. 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

3. 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

4. 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

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

6. 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

7. 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

8. 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

9. 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.

10. 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

11. 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

12. 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

13. 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

14. Fill out and score the A/ASP

15. 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

16. Uses normal distribution

17. Support for Reliability
Internal consistency for quadrants range from
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

18. 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

19. 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

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

21. 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

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

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

24. Analyzing the environment
Intensity
Amount
Repetition
Competing stimuli
Predictability
Familiarity
Speed

25. 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

26. 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})

27. 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

28. 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

29. 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

30. 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

31. Let’s analyze an environment

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

34. 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

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

36. 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

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

38. 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

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

40. 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

41. Other strategies……

42. 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

43. 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

44. 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

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

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

47. Design an environment for each quadrant around a specific occupation

48. Findings related to specific populations

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

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

51. Older adults Low scores on sensation seeking
High scores on low registration with cumulatively higher scores as age from 60 –

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

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

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