Adolescence Exam 1 Study Guide PDF

Test 1 Review OT 643 Adolescent Development and Stages of Adolescence Adolescent Development This period generally encompasses the ages between 13 and 19. Pre-Adolescence is between 9 and 12 (tweens) This period is characterized by: - Intense physical growth - Physiologic maturation (puberty) - Psychosocial Development Tweens Social - Peer groups predominates this age groups social interaction. Formation of best friendships - Talking and Joking are focus of interactions - Physical appearance is beginning to be important - Express themselves through their clothes ie name brand clothing - Beginning to share less and less of themselves with the adults - Video games and social media are important Social Behaviors - Cooperative - Less impulsive, able to regulate behaviors - Competitive relationships form Physical Development of Adolescents Puberty - Girls: average onset between 8-13 years - Average age for first period between 9-13 years - Boys: average onset between 11-12 years - During this time adolescent will gain 50% of their adult weight and 20% of their adult height - Bones become longer and wider - Muscles become stronger and larger - 80% of adolescences suffer from acne - Require glasses due to changes in the shape of the eyeballs - Sleep pattern changes their internal clock shifts by about two hours * Adolescents have to integrate all these physical and physiological changes in a healthy self image!! Development of Body Image Health Behaviors and Concerns Early Adolescence (11-13 years old) - Focused on self - Self evaluate their attractiveness - Compare themselves with peers in regards to their appearance and their body shape and size - Interested in their sexual development and that of their peers - Anxious about their sexual development Middle Adolescence (14-17 years old) - Have finished puberty. - Beginning to accept their bodies - Interest shifts from their appearance to grooming and enhancing their attractiveness. - This is the time where eating disorders begin and body image disorders start Cognitive Development Prefrontal lobe increases development. This leads to increased ability for abstract reasoning, processing speed, and response inhibition. Piaget: Called this stage “Formal Operations” logical thinking. - Symbolic thought. - Hypothetical-deductive reasoning. - Develop a sense of time and become interested in the future - Development of Moral and Social reasoning - Better able to understand consequences of their actions - Able to incorporate values into their decision making Adolescence Fables - Indestructible- engage in risky behavior ie smoking, fast driving, unprotected sex, don’t believe in covid-19 pandemic - Unrealistic- believe “they can do anything” - Exaggerate- believe “ everyone is watching them” Psychosocial Development Self-Identity: Two elements 1- Individualistic Component: “Who am I?” - This is a person’s self concept 2- Contextual Component: “Where and how do I fit in?” - What allows person to understand their values, beliefs, interests, and social norms for the roles they are in, such as friend, employee, student, daughter/son Psychosocial Development Characteristics Early Adolescence (10 to 13 years old) –Obsessed with self –Emotionally separate from parents; less family participation. –Less affection to parents. –Challenge rules –Mood/behavior swings –Have mostly same sex friendships. Peers become paramount. –Abstract thinking –Exploration of sexual feelings –Need privacy –Cannot think beyond what they want right now. Can regulate behavior when they want –May experiment with drugs, alcohol and jeweling/vaping/or cigarettes Middle Adolescence (14 to 17 years old) –Continue to move toward psychological and social independence from parents –Challenge parents' authority and standards –More involvement in their peer group culture –Influence of peer groups is very powerful –Participate in formal and informal peer group activities: sports, clubs, gangs –Accept their body development –Sexual exploration with a partner: dating increases –Able to reflect their feelings and the feelings of others –Become more realistic about the future and the job/career they may want Increase risk taking behaviors –Increased creative and intellectual abilities –Experiment with drugs, alcohol and jeweling vaping/or cigarettes Late Adolescence (17 to 21 years old) –Sense of self becomes more stable. Able to stick to their opinions, values, and beliefs –Strengthen relationship with parents –Increase their independence in decision making –Increased interest in the future, consider current actions in relation to their future –Increased self confidence in regards to body image –Decreased peer influence and increased confidence in personal values and their sense of self –Preference for one-to-one relationships. Start to have a serious significant other –Establish worker role and financial independence –Develop a value system that becomes more stable Promoting a Healthy Self Identity - Teens want to be like other teens. Teens with disabilities face a challenge to fit in and not have their disability define them. - Teens with a disability must incorporate the disability into their self concept - Role of OT: - Model use of appropriate first person language:Instead of saying “Beth with CP”, identify Beth with another positive characteristic. “Beth with Brown Curly Hair” - Avoid emotional language: Don’t say “Chris who SUFFERS from Down Syndrome. Don’t say “John who is a girl now” - Assist Adolescent to identify their genders, abilities, interests, and positive qualities that should be the primary characteristics of their self identity Marcia’s Four States of Identity 1.Identity diffusion: Seen in Early Adolescence. A poorly defined sense of self identity. I.e unable to establish any type of goals/values 2.Moratorium: Early and Middle Adolescence. Active exploration and developing a sense of identity is occurring 3.Identity foreclosure: State where it appears person has achieved self identity, but in reality they have avoided the key ingredients of self exploration and experimentation. I.e doesn’t question things and do them as expected by parents or society 4.Identity Achievement: Late Adolescence. Comes about through the resolution of self exploration and experimentation to create a coherence between a person’s self identity and their self expression and behaviors Relationships and TUOS when working with children, adolescents and families Relationships and Therapeutic Use of Self in Adolescence Be open, warm, and approachable. Listen to the adolescent, sometimes they just need someone to talk to. Be supportive in what they have to say, do not undermine. Polyvagal Theory (PVT) in Practice - Safety and Social connectedness - Parasympathetic NS - Vagal system- safe and social system - 2 branches of the vagus nerve – dorsal and ventral - Evolution- branches differentiated in response to human development 2 Branches of the Vagus Nerve - Dorsal Vagus - Connections below the diaphragm- gut, heart, lungs- basic physiologic functions - Homeostasis - Health - Protection - **Survival - Ventral Vagus - Connections above the diaphragm- head and neck - Social Engagement System – facial muscles, eye lids, ears, neck (safe and social cues) - Developed later in response to human development - Human experience - Connectedness to others - Co-regulation and Self Regulation 3 Main Components of PVT 1- Hierarchy 2- Neuroception 3- Co-regulation Neuroception - The ability to sense safety and danger - Unconscious/ conscious - Safety cues – social cues - Environmental cues safety and danger- shrill sounds, smell of smoke, seeing a violent act - Unconscious/ conscious - Stress= faulty neuroception Ventral Vagal (Safe and Social) - Happy - Content - Attuned to others - Connected to others - At ease - Playful - Self- Aware - Productive - STAR = Joi De Verve Sympathetic (Mobilized) State - On edge - Limited eye contact - Hyper-vigilant - Limited attention (auditory) - On the go - Can’t sit still - Anxiety - Stress Dorsal Vagal (Immobilized) - Shut down - Flat affect - Blank stare - Withdrawal - Decreased arousal - Under aroused - Depression Achieve a Ventral Vagal State - Safe and attuned relationships - Safe and social cues - Eye contact - Prosody of voice - Body language - Facial expression - Joyfulness Therapeutic Communication as a Means to the Therapeutic Relationship/Safe and Social Cues Listening skills - Gentle inquiry - Nonverbal responding - Summary Statements - Empathic listening Gentle Inquiry - Used to gather information in the service of richer and deeper understanding - “Would you tell me more about that?” - “Do you feel comfortable telling me more about that?” - “How did that affect you?” / “How did you react?” - “What do you think about that?” Nonverbal Responding - Face the client - Maintain adequate eye contact - Be conscious of the message conveyed in your seated posture (upright and leaning) - Facial recognition study in adolescents Summary Statements Briefly summarizing your understanding of what the client has said - Conveys your striving to understand the client’s thinking - Ensures the accuracy of your understanding - Decreases likelihood of presumptions and misunderstandings Empathetic Listening - Understanding the client’s thoughts or thinking: - Client is the expert on the meanings she attaches to her experiences **Summary statements offer best means of understanding a client’s thoughts or thinking Summary Statement Don’ts - Repeating a client’s words verbatim (parroting) - Putting words into the client’s mouth - Interpreting, analyzing, or evaluating what the client has said (“So what you are really saying is…” or “Could this mean that you really don’t want to look for a job?”) - Predicting how a thought or event must have made the client feel (when the client merely described the thought or event and did not introduce emotion in the telling) - Self-disclosing how something would have made you feel or recounting some similar event that happened to you - Reassuring, minimizing, or normalizing Application of the Concepts of IRM and Interpersonal Neurobiology TUOS 1.The relationship directly affects occupation/ outcomes 2.Neuroplasticity occurs through attention, awareness and relationships 3.**Activity focusing must be balanced with interpersonal focusing 4.The client defines a successful relationship – perceived experiences 5.Self-awareness is the key to intentional use of self 6.It is necessary to keep head before heart – act intentionally 7.Mindful empathy is required to know one’s client Therapeutic Modes The six modes include, advocating, collaborating, empathizing, encouraging, instructing, and problem solving. Generally occupational therapists have modes that they naturally use, and each mode has its own associated style and strategies. Since clients differ in needs, occupational therapists may have to develop some underused modes of interaction. Activity focusing refers to strategies of responding to interpersonal events that emphasize “doing” issues over “feeling” or “relating” issues. Interpersonal focusing refers to strategies that emphasize feeling or relating over doing issues. Refers to strategies that emphasize feeling or relating over doing feeling) for therapeutic outcomes. Occupational therapists may benefit from learning about different modes; practicing use of a variety of modes; getting feedback from clients about the efficacy of their ability to connect and respond to children and family needs; and evaluating one’s use of modes. Advocating: involves ensuring that children and families have access to what they need, including transportation, housing, and participation in leisure, work, school, and community occupations. Collaborating: involves making decisions jointly with family, expecting families to participate in therapy (including home programs), soliciting ongoing feedback from family members, and allowing family to make decisions about the occupational therapy process. Empathizing: Occupational therapists who use the empathizing mode listen intently to clients and seek to understand the child’s and family’s experience. Encouraging: act as the client’s supporter and are positive, vocal, and demonstrative regarding the client’s successes. They present as enthusiastic and hopeful. Instructing: Occupational therapists who use the instructing mode emphasize education in therapy sessions. They tend to be directive and skilled at providing instructions. Problem Solving: Occupational therapists who use the problem-solving mode use logic and reasoning in their relationships with children and families. Explain 2 therapeutic modes and explain how they can be best utilized when working with adolescents: 1- Empathizing: This mode is appropriate for adolescents because they are living in a highly emotional state. Dan Siegal stated that this is part of the ESSENCE of adolescents (emotional spark). During this time, children will be moody, disoriented, and possibly depressed. Further the Adolescence video states that adolescent may feel as if they are the only one’s going through a particular issue, so they may feel alone. For these reasons, it is important to empathize with the adolescent and help them feel that their feelings are valid. 2- Collaborating: This mode is appropriate for adolescents because they are not starting to be able to think and plan more for themselves. The adolescence video discusses that adolescents are more likely to learn when they are actively involved in the process. For this reason, it is important to allow them to make decisions with the OT as opposed to being less involved in the process. Further, according to the adolescence videos, self-esteem increases through active participation and cooperative learning which this mode helps to facilitate. Playfulness in adolescence Playfulness Three different elements of playfulness (Bundy, 1997): - intrinsic motivation, - internal control - ability to suspend reality - each occur on a continuum Characteristics of Playful Children -Flexibility in their play and social interactions -Spontaneity -Curiosity -Creativity -Joy -In Flow Leisure - “nonobligatory activity that is intrinsically motivated and engaged in during discretionary time, that is, time not committed to obligatory occupations such as work, self-care, or sleep” - Important for development and quality of life. - Preference, desire, and motivation are critical. Facilitating Playfulness - Therapist is playful - Attitude - Body language - Speech - Model playfulness - Novelty - Imaginary play - Having fun - Shared negotiations of control and decision making Playfulness and Disability - Play and playfulness is limited in youth with disabilities - Limited early play experiences - Limited affordances in terms of play experiences - Results in hindered playfulness as adolescents - Limited leisure participation often due to access Play and the ESSENCE of an Adolescent (question in powerpoint) - How does play and playfulness relate to the Essence of adolescence and the reverse? Article: Adolescent Playfulness and Well-Being Study found that playful adolescents experienced higher levels of leisure satisfaction. Less playful adolescents seem to experience more problems with peers. Adolescent playfulness is associated with higher participation in sports teams, but not the number of hours participating. No association was observed with other extracurricular activities, or how well they do academically at school. However, playful teens like to go to school, are more likely to take school seriously, and to regard secondary education as very important. Also, they appear to find opportunities to be playful in school. In terms of health and well-being, playful adolescents experience higher affect, high levels of self-confidence, and physical health that is higher overall well-being. The analysis suggests that differences exist in the way playful adolescents experience their leisure and that they are particularly active socially, physically, and the outdoors. They generally like going to school and take school and future academic experiences seriously. Playful adolescents actually felt school offers them the opportunity to be playful. Overall, playful adolescents experience high mental and physical health. Less playful adolescents appear to experience problems with their peers and with issues related to self. Playfulness appears to function as a positive mediator rather than an antagonistic force in the experience of stress and coping. Findings from this study suggest the importance of promoting play and playfulness as an asset to positive adolescent development and well-being. The findings imply that playfulness functions as a type of dispositional resiliency during adolescence due to its stress-moderating properties particularly during leisure. Playfulness has the capacity to alleviate boredom, release tension and prevent aggression, and to promote group membership and civic engagement, which may enhance positive experiences at school, at home, or even during leisure. Quiz Question: Explain the role of play and playfulness in supporting the mental and physical health of adolescents. There is a correlation between playfulness and various aspects of mental and physical health, including leisure satisfaction, relationship to the self, and peer interactions. Adolescents who are more playful have increased physical and mental health. “Playfulness” is said to be a trait that can lead to positive coping strategies as well as reduce perceived stress of adolescents. One study used a playfulness scale specifically made for adolescents to suggest that adolescents who are identified as playful have higher rates of leisure satisfaction in regard to their social, educational, and physiological aspects. Further, playful adolescents are shown to play more on sports teams and are more likely to view school as highly important. In addition, playful adolescents also have different coping mechanisms than non playful adolescents do, and also seem to have fewer problems with their peers. Thus, playful adolescents have overall better mental and physical health. Supporting Mental Health in Adolescence School Mental Health: Movement in the US to develop and expand school mental health (SMH) program and services SMH has been motivated by several factors including the high prevalence of mental health conditions among youth, an awareness that more youths can be reached in schools and by federal initiative. The IDEA was the first federal initiative to place significant responsibility on schools to meet the mental health needs of students with emotional challenged SMH has evolved to become a framework of approaches that expand on traditional mental health services to emphasize promotion, prevention, positive youth development and schoolwide approaches ○ This framework (SMH) promotes interdisciplinary collaboration among mental health providers, related service providers, school administrators, teachers, and families. The fact that the absence of essential social emotional skills is a major barrier to learning and not necessarily a lack of sufficient cognitive skills points to the critical need for schools to be active partners in the mental health of children and youth The Goal of mental health includes effective schooling and the goal of effective schooling includes the healthy functioning of students Public Health Perspective: Emphasizes a systems wide promotion of mental health and prevention for mental illness. ○ Multi Tiered framework of services supports a change in thinking to a whole population strengths based approach ○ It calls for a paradigm shift to better prepare all school personnel (teachers, administrators, psychologists, social workers and related service providers) to proactively address the mental health needs of all students. Similar to response to intervention and positive behavioral intervention and supports (PBIS) addressing the mental health needs of students can be envisioned within a three tiered framework Mental health promotion: emphasize teaching competencies associated with mental health such as social and emotional skills and coping strategies. Mental health promotion efforts include creating supportive school, home, and community environments as well as reducing stigma and discrimination and educating children on how to develop and maintain positive mental health Mental health prevention: focus on reducing the incidence and seriousness of problem behaviors and mental health disorders. Intervention strategies for mental health promotion prevention and intervention Intervention strategies are integrated in the classroom schedule, school routines and curriculum Tier 1: universal- whole school services Geared toward the entire student body, including the majority of students who do not demonstrate mental health or behavioral challenges. Universal services reflect a dual commitment to promotion and prevention Individual or small group interventions embed strategies and activities into existing individual or group interventions that specifically promote positive mental health Whole classroom or school interventions embed whole classroom or school services that focus in creative social, emotional and physical environments and activities that are enjoyable for all students ○ Informally observe ○ Promote mental health literacy: mental health education initiative- embed information and activities focusing on mental health literacy into everyday OT practice and conversations ○ Clearly articulate the scope of OT- social participation, social emotional function and mental health ○ Collaborate with teachers, administrators, and other school personnel ○ Evaluate lunch and recess ○ Provide in service education Tier 2: targeted prevention services for at risk students Prevention of mental illness and promote of competencies to offset early symptoms (relaxation and coping strategies) – more direct role in evaluation and intervention Services geared toward students who are at risk of mental health or behavior problems such as students with disabilities, students living in poverty or who have a genetic predisposition to mental illness Deep breathing yoga, coping strategies, enjoyable occupations Look for changes in ○ Affect or mood ○ Thinking ○ ADL’s ○ Social and leisure participation Use purposeful activities, social skills – parent education for kids in detention ○ Learn more about the early signs of common mental illnesses ○ Use both informal and formal evaluation strategies ○ Evaluate social participation ○ Provide EI services me ○ Consult with teacher ○ Provide parent education Tier three: individualized interventions When targeted interventions do not meet the needs of students individualized intensive interventions are provided for students with identified mental, emotional, or behavioral disorders that with identified mental, emotional or behavioral disorders limit their participation in needed and desired areas of occupation performance throughout the school day 90-95% of children with ASD have a comorbid psychiatric disorder Accommodations under 504 for gen ed students Systems of care approach and partner with others ○ Evaluate school function ○ Promote development of individual interests ○ Assisting the functional behavior assessment ○ Collaborate with the other SMH providers ○ Provide tuos ○ Collaborate with teachers ○ Analyze the students unique sensory need Quiz Question: Explain the biological and environmental factors specific to adolescence that impact emotional regulation/dysregulation During adolescence, the prefrontal cortex is still developing which results in less connectivity between the amygdala and the prefrontal cortex. Since this connection is still developing its strength, this limits the space that adolescents have between their thoughts and emotions, which impacts the ability to identify and manage feelings and responses to situations. In addition, their executive skills which include aspects of self regulation such as self control, are still in the process of developing and can contribute to dysregulation. An adolescent requires a positive adult to teach emotional regulation skills such as tolerating distress, labeling uncomfortable situations, and identifying emotions; without this guidance it is likely that the adolescent will not be able to cope with their emotions which causes a higher risk for emotional dysregulation (Brown, Stoffel, & Munoz, 2019). Another environmental factor that can influence emotional regulations involves the peer group that the adolescent attends to and whether they are feeling accepted or rejected; being involved with peer group allows the adolescent to develop social interaction skills, and a lack of involvement can contribute to decreased emotional regulation skills (Brown, Stoffel, & Munoz, 2019). Quiz Question: Describe the difference between mental health promotion and prevention and the role of positive mental health in these Mental health promotion focuses on healthy and positive emotional and social experiences, and skills, as well as cognitive coping strategies to support positive mental health. Positive mental health is a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with people, and ability to adapt to change and cope with life circumstances (Brown, Stoffel & Munoz, 2019). Prevention, on the other hand, reduces problem behaviors and mental health disorders by decreasing risk factors and increasing protective factors. Assessment process in adolescence Quiz question: How might the approach to evaluation differ in early childhood and adolescence? According to the adolescence video series, adolescents are now able to think more abstractly and are able to reflect on their own performance and thoughts, which will allow them to become more directly involved in the evaluation process. This can lead to the use of self-report assessments and interviews with adolescents instead of more observation based assessment tools and parent interviews. Further, while the approach to assessment in childhood is more bottom-up, the approach to evaluation of an adolescent may be more top-down due to the important in social participation in a variety of occupations that are meaningful to adolescents including health management, education, social participation, ADLs, IADLs, work, and leisure. Assessments used in Adolescence (from lab and readings) Test of Visual Perceptual Skills 4 (TVPS4) Population: 5-21 Purpose: Assesses visual-perceptual abilities without requiring a motor response Type: Multiple choice format of black and white images (Image booklet is similar to the MVPT-4 used to assess Rachel & Toby in Fieldwork) DTVP-A Full Name: Development Test of Visual Perception Population: 4-12 years old Purpose: assessing visual perceptual skills in adolescents and adults. identifies visual-perceptual deficits in children and yields scores for both visual perception (no motor response) and visual-motor integration ability Type: standardized scale *Comes with a picture book with shapes. Copy shapes, visual-motor search & speed. Transition Planning Inventory Population: high school students.14-22 years Purpose: identifies transition strengths and needs for high school students preparing to move into a variety of post school settings Type: self-administration Rating form BRIEF 2 (5-18 years)/ BRIEF A (18-90) Population: 5-18yo. (11-18 for self-report form); 18-90 BRIEF-A. Individuals with potential exec function challenges such as ADHD/ASD Purpose: To rate executive function capabilities using a rating scale. There is a parent, teacher, and self report form. They rate the executive functions and then add them up to a final score to show areas of deficits Self-Monitor, Shift, Emotional Control, Task Completion, Working Memory, & Plan/Organize (in self-report form) Type: Enhanced rating scale Circle N = never, S = sometimes, or O = often AASP Population: Adolescent-older adult. Individuals with sensory processing concerns- ADD/ADHD, autism, TBI, SPD, and more. Purpose: To determine the sensory preferences of the client- you will end up with their preferences in each sense, as well as an understanding of their neurological threshold and behavioral response to that. Type: Questionnaire likert scale from 1-5 - 1: almost never, 5: almost always Questions based on 4 quadrants ○ Low registration, sensation seeking, sensory sensitivity, sensation avoiding. Comprehensive Assessment of Interoception Population: Children, adolescents, adults, anyone who can comprehend what is being asked of them and feel their own body (wouldn't be appropriate for quadriplegics probably). Purpose: To get a sense of the client’s awareness of their own body, and begin the process of identifying body cues, connecting it to an emotion, and acting (self regulating). Three subtests: interoceptive awareness interview, Assessment of self regulation, Caregiver questionnaire for interoceptive awareness Type: semi-structured interview Vineland II Population: birth though 90 Purpose: Adaptive Behavior assessment of an individual’s daily functioning Type: Survey and interview forms Interview form ○ 4 = almost always, 0 = never ○ Domains: communication, daily living skills, socialization, motor skills, maladaptive behavior. Executive Skills Questionnaire Population: Adolescents and adults Purpose: Understand the self-reported executive skill capabilities of the client such as their perception of their impulsivity or memory Type: Self report rating scale 1: Strongly disagree, 7: Strongly agree ACOPE Population: Adolescent Coping orientation to problem areas Purpose: Record the behaviors that adolescents use for the purpose of coping Type: questionnaire Likert scale from 1-5 - 1: never, 5: most of the time Coping Inventory Type of Assessment? Self report, scale 1-5, 45 questions. “A 45-item inventory assessing the person's ability to cope with stress and difficulties. Low scores indicate poor coping skills, high scores indicate good coping skills. The test yields seven subscores:” Group/Population/Condition Useful? Adult mental health Possible Setting: Contains some jargon so it should be interpreted with a therapist even though it can be self scored Quality of Life Inventory Population: Ages 17+ Purpose: assess overall level of happiness; questions focus on importance of 16 areas of life and satisfaction of those 16 areas of life Type: Rating form - likert scale Health, self-esteem, goals & values, money, work, play, learning, creativity, helping, love, friends, children, relatives, home, neighborhood, community) Rate how important each part of your life to your happiness on a scale of 0 (not important) to 3 (extremely important) Rate how satisfied you are with them on a scale of -3 (very dissatisfied) to +3 (very satisfied) Ex: how important are relatives to your happiness? How satisfied are you with your relationships with your relatives? CAPE/PAC: childrens assessment of participation and engagement/ Preferences for activities of children Full Name: Children's assessment of participation and enjoyment & Preferences for activities of children Population: Children- does not look like an adolescent assessment, ages 6-21. Not appropriate for those who cognitively cannot sort activities. Physical modifications can be made for those disabilities. Purpose: Document a child’s participation in their daily activities outside of the ones they have to do for school- and to assess their preferences for those activities. Can assess participation diversity, intensity, and enjoyment. Type: Physically sorting cards. OSA Population: All Purpose: Designed to capture clients perceptions of their own occupational competence and of the occupations they consider important Type: self rating form 4 options: I have a lot of problems doing this-I do this extremely well; this is not so important to me-this is most important to me Ex: bathing, dressing, driving COSA Population: Adolescents specifically 8-13 Purpose: client centered assessment tool and an outcome measure designed to capture youths perceptions regarding their sense of occupational competence and the importance of everyday activities. Using the instrument in therapy provides a young client with an opportunity to identify and address their participation in important and meaningful occupations. Type: Self rating: (2 types: Checklist form version & card sort version) 4 options: I have a lot of problems doing this-I do this extremely well; this is not so important to me-this is most important to me Ex: get enough sleep, get around from one place to another ACIS Assessment of Communication and Interaction Skills Purpose: ACIS was designed to gather data on the communication and interaction skills of people engaged in tasks or activities in group settings. Identifying competencies and deficiencies in this area can help in planning clinical intervention. Population: Adults. (Originally developed for people with psychiatric illness, and tested by 52 occupational therapists who completed 244 assessments on 117 clients with psychosocial disabilities version 4.0 can assess communication and interaction consequences of any illness or disability) Setting or Position: Group settings, including open unstructured, parallel, or cooperative groups and natural or simulated situations Type: Social interaction skills assessment; structured observation rating scale Description: ACIS is based on the assumption that communication and interaction during activity have 2 important outcomes: (1) goal accomplishment and (2) social impact (effect on others). The instrument measures 3 domains of communication and interac- tion skill—(1) Physicality, (2) Information Exchange, and (3) Relations—using 20 verbs that describe per- formance. Four social situations are recommended for observation: unstructured situation, parallel group, cooperative group, and dyadic situation (as agreed by client and therapist). Skills related to each domain are rated on a 4-point scale as competent (4), questionable (3), ineffective (2), or deficient (1) manual provides detailed descriptions for rating each item. Therapist completes ratings after observing clients participate in activity within a meaningful social context. Therapists’ com- ments may supplement ratings. COPM Population: any ages (no specific range) Purpose: identify issues of personal importance to the client and to detect changes in a client's self-perception of occupational performance over time Type: outcome measure 3 areas: Self-care, productivity, leisure Identify occupational performance problems, then choose 5 Have client rate importance of occupation in life from 1-10, then performance [how well they do it], then satisfaction [how satisfied they are with performance]. GOAL- Goal Oriented Assessment of Life Skills Population: 7-17 Purpose: evaluation of fundamental motor abilities needed for daily living. consists of 7 activities, dynamic functional tasks that are markers for important activities of a child's daily life. Utensils: cutting, spearing, scooping Locks: keyed lock, combination lock, Paper box: coloring, cutting, folding, taping Notebook Clothes: dressing, undressing Ball play: dribbling, hand-to-hand, floor-wall, kicking Tray carry Type: Individual administration of 7 activities Adolescent Role Assessment Full Name: Adolescent Role Assessment Population: Adolescents with psychosocial dysfunction Purpose: To understand the adolescent’s history and present roles that they function in within their contexts. It covers childhood play, socialization in the family, school performance, peer interactions, occupational choice, work. It rates if their behavior was appropriate or not. Type: semistructured interview with rating system Beck’s Depression Inventory 13 to 80 Type of Assessment? Self report, 21 questions, scale of 0-3 Group/Population/Condition Useful? Adult mental health. Can self score easily Possible Setting. Group or individual intervention Administration Time and Special Conditions. 5-10 mins OCAIRS Occupational Circumstances Assessment Interview Rating Scale Full Name: Occupational Circumstances Assessment Interview and Rating Scale Population: Mental health, Forensic mental health and Physical disabilities. it is also appropriate for any adolescent or adult client who has the cognitive and emotional ability to participate in an interview Purpose: a structure for gathering, analyzing, and reporting data on the extent and nature of an individual's occupational participation. Gathers info on clients values, roles, personal causation, interests, habits, environments. (12 major areas: roles, habits, personal causation, values, interests, skills, short term goals, long term goals, interpretation of past experiences, physical environment, social environment, readiness for change) Type: Standardized assessment KELS Kohlman Evaluation of Living Skills (13-65+) Full Name: Kohlman Evaluation of Living Skills Population: used with any population/individual that has encountered a cognitive disability. Most often used with individuals who are entering or reentering the community with intention to live independently. Purpose: KELS is used to evaluate if the person is ready to live independently (Major areas:) Self care, safety and health, money, transportation and telephone, and work and leisure. Type: Standardized assessment, criterion referenced MOHOST (Model of Human Occupation Screening Tool) Purpose: This instrument was developed as a screening tool to determine the need for occupational therapy services and to document occupational functioning using concepts from the Model of Human Occupation Type: screening tool; Rating form based on observation, discussion Population: Clients with mental health problems who are unable to tolerate lengthy interviews, demonstrate poor insight or concentration, or have difficulty expressing concerns, also successfully used for clients with learning disabilities. Description: Consists of 24 items in 6 areas of occupational functioning: (1) Motivation for Occu- pation, (2) Pattern of Occupation, (3) Communication and Interaction Skills, (4) Process Skills, (5) Motor Skills, and (6) Environment. Several observations, both informal and formal, are made over several days to 2 weeks until sufficient data are collected from multiple sources to complete the data form. Data are also collected from discussion with clients, caregivers, and other professionals from record review and when completing other formal assessment tools. From Readings: Interviews Canadian Occupational Performance Measure (COPM) - This tool is used to elicit a person’s perception of and satisfaction with his or her performance in self-care, work, and leisure occupations and is based on the Canadian Model of Occupational Performance and Engagement. - Each of these interviews provides a set of semi structured questions that guide the interview process and each has a rating scale designed to help practitioners assess the data they gather. - A unique interview process was developed for use with the Kawa River Model, which uses the metaphor of life as a river to elicit the person’s perspective of his or her life circumstances and the impact of the social and physical environment on the person’s life story. - The practitioner guides the person through a process in which she or he creates an image of a river that depicts his or her life situation. An interview may not be the best choice for a person with cognitive impairments or with symptoms that interfere with cognitive processing or the ability to have accurate insights about his or her performance. Self Report Self-report tools, including questionnaires, checklists, and surveys, represent a method of data gathering that acknowledges the person’s expertise in his or her illness experience. Self-report tool is an assessment that requires a person to read an item and selevy or compose a response. When using self-report tools as a method of data gathering, the practitioner is providing a mechanism for the person to share data about his or her life circumstances, feelings, perspectives, attitudes, and beliefs about his or her performance or about aspects of the environmental contexts where he or she engages in occupation. Examples: The Child Occupational Self-Assessment (COSA) is a children’s version of the OSA. - Both assessments were designed to be person-directed that gather data on a person’s values and sense of competence when completing everyday activities of daily life. - The COSA is used to assess 2 things: how a child perceives his or her level of competence when completing everyday activities and the value the child places on these activities. - This tool is used to gather data while maximizing the child’s opportunity to identify and engage in planning for how to address prioritized and meaningful occupations. Another tool with both adult and child versions specifically on the sensory processing that may impact occupational function is the Adolescent/Adult Sensory Profile (11-90 years old) - This tool is designed to measure a person’s sensory processing preferences and his or her responses to sensory events that occur in everyday life. - The A/ASP is intentionally designed as a self-report and ideally completed by the person you are working with as opposed to an informant. Performance Assessments Performance assessment, especially in natural environments can help practitioners to assess the frequency, strength, and pervasiveness of both problem and positive behaviors. The use of specific performance assessment tools allow the practitioner to set a baseline of performance and compare a person’s performances through time or compare one person’s performance with another's or against a benchmark that constitutes skilled performance. The AMPS is a performance assessment and rating scale that is designed to simultaneously measure motor and cognitive processing skills of an individual while engaged in routine activities of daily living. - A practitioner using this tool systematically observes the person completing tasks choses by the person being evaluated and completed in a relevant, natural environment. - Part of the process of administering this assessment is working with the person to select standardized tasks that the person is familiar with yet which also challenge the person’s performance capabilities. - The practitioner observes the person completing these tasks and uses the AMPS four-point rating rubric to assess occupational performance across 16 motor and 20 processing skills. - A school ASMPS v erosion has been designed to specifically assess a student’s performance in common school-related tasks such as cutting, drawing, or completing computations. The Volitional Questionnaire (VQ) was originally designed to assess volition in older children who could not participate in interviews or self-reports because of cognitive, physical, or verbal impairments, but it has been used with any older child or adult who is not able to participate in interviews or self-reports. - A practitioner uses the structured observational rating tool of the VQ to systematically make observations. - The rating form is composed of 14 different items that assess actions reflecting the person’s intrinsic motivation, sense of competence, interests, and values. - The person’s behavior in these environments is rated as passive, hesitant, involved, or spontaneous. - Observations are made in at least 2 environments and can be as brief as 15 minutes or as long as half an hour. - It is important to note that the focus of the observation is not on what environmental supports may be necessary to elicit behavior but rather on the degree to which the person spontaneously exhibits behaviors that reflect his or her volition. Brainstorm Video- Applications People use the term adolescents synonymously with the term “teenager” which is not true. The adolescent period can be defined as a period between childhood and adulthood; it is distinct from childhood and distinct from adulthood. During adolescence, there are changes in the brain that identify that this period is more than just going through puberty, which is sexual maturation, but is a developmental time period when you are not just dependent on adults, but you are not just working with adult responsibilities of raising a family or having work. By identifying the myths associated with adolescence you can celebrate this time period. These myths include: - The adolescent period is not just the teenage years. - Changes in adolescence are not due to raging hormones, it is a time when the brain is changing (remodeling). - Many adults and therefore adolescents who hear adults say this, approach adolescence with trepidation (fear) instead of celebration. When really it is a period that you can cultivate well if you understand what is happening in the brain because you can intentionally build these circuits and make them stronger intentionally. - The adolescent period is a period of risk, which is true, but only because adolescents are impulsive (true during the beginning years). Adolescents are three times more likely during the period of 12-24 to be seriously injured or die from preventable causes. Another cause, besides impulsivity, is hyper-rational thinking, which is driven by two processes (1- the limbic process and the evaluative process of it 2- changes in dopamine-reward circuitry. There is a circuit distributed up from the brain stem, the limbic area, and the cortex, called the reward circuit driven by a neurotransmitter called dopamine. Doing something new gets dopamine to be released, which is another way nature gets adolescents to do risky things). When parents learn about this and understand there is a natural drive for novelty (trying new things) they can do it in a constructive way, rather than have the adolescent do it in a dangerous way. Dopamine is involved in addiction, which is why adolescents are so vulnerable to addiction. - Adolescents do know about the dangers, their limbic area just skews the balance; they just do not care about the danger. - There are parallel distributed processors (PDP) around the intestine and heart that have a deep wisdom. Kids that literally “listen to their gut” will care more about the dangers even though their cortex will try to skew this information, so they do something dangerous. Changes in the brain happen around 12 years of age, more or less, a little bit younger in girls, a little bit older in boys, but around the same time, before the teenage years begin, and it ends in the mid-20s. The ending is a period of brain change called remodeling. This remodeling period happens into the mid-20s. The way neurons get connected influence how you think, feel, and behave. The structure of the brain influences its function, and the function of the brain influences, in part, mental life. The nervous system, including the brain, is always about the interface of the inner and the outer (e.g., how can what is going on inside the body and outside the body be brought together?) Brainstem: regulates basic bodily processes like what is going on in the heart, the lungs, the intestines. It also has clusters of neurons that control the reactive states of the four F’s: fight, flight, freeze, and faint. Old Mammalian Brain: Regions: - Amygdala - Hippocampus - Hypothalamus Limbic Area: Has five big functions: - Interacts with the cortex above it and the brain stem and body below it. It is like a way station that allows all of these different inputs to be coordinated. - Important in working with the brain stem and the body in creating emotion. When you feel an emotion, it is coming from the body, the brain stem, and the limbic area, because all of these are below the higher area of the cortex, it is called the subcortical source of emotion. There is kind of an emotional spark in adolescence if you compare a 10-year-old to a 14-year-old, the subcortical areas of the 14-year-old will be more active. - Motivation: Limbic area works with the brainstem to motivate people to do different things. The limbic area changes dramatically during adolescence for good and important reasons. Parents tend to clamp down on these changes instead of supporting them. Brainstorm approach can change our whole cultural conversation, so we recognize what is happening in the brain and support adolescents rather than try to imprison them. - Appraisal: Evaluate the significance of something happening. So the first later of appraisal says is what is happening something that I should invest energy and time in? Paying attention to something. The second thing is the thing that I am paying attention to good or bad? The third is, if it is good, how do I get more of it and if it is bad how do I get less of it? These are the basic appraisal functions of the limbic area. The fourth is that are also different kinds of memory are mediated through the limbic area (hippocampus plays an important role in creating factual memory or autobiographical memory rather than just kind of the visceral memory called implicit memory. The fifth function is attachment, which becomes extremely important in adolescence. Attachment is where, as a kid, you rely on another person, usually your parent to give you four S’s: they see you, they keep you safe, they soothe you, and they give you an internal feeling of security if you have the first three. - Being seen means someone identifies what is going on beneath your behavior, thinking about your feelings and what you are thinking about, not just seeing your external movements. - Safe means they protect you from harm and are not a source of terror (if they are they repair that rupture very quickly) - If you are seen and if you are safe and if when you are distressed, you are soothed. - Important for adolescence, because when you are a kid and you are distressed, you go to your parents for soothing. When you are an adolescent, you tend to go to your peers, which is a healthy and natural change. The parent may feel rejected, but overall, the adolescent is preparing to leave home. Changes in the brain prepare the adolescent for this change, such as revving up emotions, limbic area attachment changes. Cortex (new mammalian area): - Prefrontal cortex: allows you to think, conceive of things, program, think about history, etc. This area matures last - In utero, the brain stem is well developed, limbic system is partially developed, and the cortex is undeveloped at birth. This means that once the baby is out, interactions with the world in addition to genes will influence the way neurons connect to each other. Neurons firing leads to neurons rewiring. - During childhood the brain is like a sponge soaking in adult knowledge. What you do with your mind can change the structure and the function of the brain. - The brain, instead of to continue to develop synaptic connections, actually starts destroying them, called pruning. The brain starts to eliminate not only the synaptic connects that were laid down, some of them, but it actually starts destroying neurons themselves. You get less synaptic connections and even less neurons. - As adolescent years progress, a second part of remodeling starts to happen. You get rid of basically connections you do not need. The second part of remodeling is you start to lay down myelin in a big way, so the adolescent brain is going to be more specialized by getting rid of circuits it does not need and then more efficient in its coordination and balance by taking the remaining connections and allowing them to be better at communicating. - Remodeling of the adolescent brain takes place starting around 12 and it goes on to the mid-20s. This is why adolescence does not end when the teenage years end. What is the ESSENCE of adolescence? E-S: Emotional Spark. The subcortical regions, the body, the brain stem, and the limbic area, nature has made more active in an adolescent. The downside with this more motion is that adolescents can be moody and irritable. The pruning process is one reason we believe that all of the major psychiatric disorders like schizophrenia or depression have their onset in adolescence because the pruning is carving away vulnerable circuits. Good news is that we can reverse this in many ways through early intervention. Upside: Period where adolescence can become passionate about something which can fuel a sense of vitality. Unfortunately, many adolescences get crushed by adults’ responses at home, school, and society which can be demoralizing. There is an opportunity to shift the culture of conversation about adolescents and the way we as a culture approach this period of time. S-E: Social Engagement. The adolescent because of limbic changes is driven to be more with their peers than their parents, which is healthy to survive out in the world. The downside is, if you give up morality for membership then peer pressure will crush your internal sense of values. Upside of social engagement is that every research study on medical health, mental health, and on how long you live, and your happiness, without exception, every single one shows the number one factor is supportive relationships. Social skills can last a lifetime and support your independence and be very positive. N: Novelty. The dopamine system change gets you to try new things, but the downside is you can do risky things and increase your risk of getting hurt. Upside is that novelty is exciting and allows you to be driven to try new things, to do new things, to take risks, and be brave. Have to find a way to manage this novelty seeking drive. C-E: Creative explorations. The creative exploration of the adolescent brain is to try to push against the adult status quo. Nature has designed this from a large evolutionary point to try to find your niche in the world. If we did not have the adolescent time we would never be as adaptive as we are to an ever-changing world. You need to have a continual source of individuals, children, now turned adolescents, who approach the status quo and say, “I don’t buy it.” “I am going to adapt to the world that’s here and make my own new world.” Downside is as a child you say, “hey this is the world I am being given, I am learning to deal with it.” But then when you get to be an adolescent, you go, “this world I am being given is not so good and I should try to change it.” Which can be a burden and disorienting especially with the amount of information that can be shared so rapidly. Upside is it allows us to create a new world. If we change the cultural conversation around adolescence, two big things can happen: - For adolescents themselves, if we change the way the curriculum addresses this and say, “let’s build on the emotional spark, the passion, and have kids approach the world’s problems of what they feel compelled to try to improve. For the social engagement piece, instead of having them compete against one another, lets compete with the world problems and collaborate. We should empower them. - For your own life, think about adults who made it through adolescence but lose their essence. What you do with your mind keeps your brain strong (neuroplasticity). Adults need essence too. Adults may, deep down, be angry at adolescence because they have this essence that they, the adults, have lost. Application of ESSENCE: Quiz question: Describe the ESSENCE of adolescence described in the Brainstorm video: - Adolescents are driven by emotion as they are limbic system centered. They crave social experiences and connections with others Through this they develop their social selves and their place within their community. Adolescents crave novelty and new experiences and because of this, it is the most creative time in human development. Discussion board question: Identify one way Sam’s ESSENCE is impacted by his autism STAR FOR/Sensory Processing The STAR Model and Sensory Processing in Adolescence Sensory Processing FOR’s Ayres Sensory Integration (Dunn’s Sensory Processing) STAR Model ^ all connected in ways but have differing features Terminology Ayres SI (basis for Dunn and STAR) – foundation of SI Dunn’s model of sensory processing (quadrants, threshold, patterns/preferences) STAR Incorporates both things but used different terminology and adds in a few pieces not included STAR FOR Founder: Dr. Lucy Jane Miller Parent centered Relationship focused (attunement as mode of self-regulation) Coaching Sensory based strategies Sensory integration DIR floortime – relationship and engagement Focus on the interaction rather than activity Process vs product (process points that make it stand out rather than intervention points) Flow as paramount (engaged and losing self within the session) Joy (joie de vivre) Theoretical Base (KEY FACETS TO STAR) Regulation Relationships Sensory Integration Regulation Self-Regulation Co-Regulation “Self-regulation and co-regulation are circular, causal processes….” “Only in the context of safe, attuned, and co-regulated relationships can children fully realize the paradox of feeling together and becoming unique (Lictenburg, 2015) Co-regulation, attunement, and then attachment Patterns of dysregulation stem from not attaching to parents Relationships “Human development occurs in the context of relationships…” Don’t live alone in this world especially as children Relationships are often disrupted with sensory challenges Sensory processing challenges affect relationships (leading to challenges in co-regulation relationships) = complex system. Sensory Integration The integration of sensory information is foundation to development - learning, behavior, and attention Uneven Development - All develop differently – because of sensory processing challenge (visual motor) may not have developed the cognitive skills due to lack of visual motor integration that led to challenges in academics, BUT may have found strategies to regulate emotions in environment Arousal Regulation Three types of sensory processing disorder 1. Sensory craving: can never be satisfied to meet their thresholds. 2. Sensory modulation 3. Sensory Discrimination: not over or under responsive, but bodies cannot efficiently process the information regarding a specific sensation. May look like over or under but really a discrimination challenge. - Auditory processing: not discriminating the auditory information in an effective manner - See overreactive child to siren driving by but actually that they can figure out where it is coming from – can’t distinguish frequency or spatial orientation of that sound (frightening) - Sensory modulation challenges (internal and external sensations and threshold to responding to those) and discriminations are what allow us to have motor plans, actions, and outcomes Impact of Sensory Processing Challenges on Regulation “Modulation challenges often result in dysregulation” Sensory Over responsive Sensory under-responsive Sensory cravers Dr. Daniel Siegel’s Hand Model of the Brain (Siegel & Bryson, 2011) Arousal Regulation - Optimal arousal state is important for quality of life How Relationships Impact Regulation: Co-Regulation/ Attunement - An attuned relationship can impact regulation Sensory Processing in Adolescence · Research has shown that sensory processing and integration challenges: · Persist across the lifespan · Continue to benefit from sensory-based intervention in adulthood Common Impact Areas of Sensory Processing and Integration Challenges in Adolescence · Client Factors, Performance Patterns & Skills · Emotional maturity and self-regulation skills · Self-concept and sense of self · Sense of agency and confidence · Mental health & well-being · ADLs & IADLs · Self-care and adaptive behavior · Responsibility and independence · Rest & Sleep Common Impact Areas of Sensory Processing and Integration Challenges in Adolescence · School, Work & Play · Participation and learning · Identifying career interests · Physical activity level · Social Participation · Relationships with parents · Friendships and romantic interests · Leisure · Interests and participation *Pause and Practice – SMD /impact on performance skills; performance patterns; occupations - under responsivity - IADL- safety- hot water - social interaction skills – poor affectivity or positive emotions - motor skills – flaccid or weak - processing skills – slow moving Common Co-occurring Conditions: · Attention deficit/ hyperactivity disorder (ADHD) · Autism spectrum disorders · Borderline personality disorder · Conduct disorders · Dissociative disorders · Eating disorders & feeding challenges · Fibromyalgia · Criminality · Giftedness · Learning disabilities · Misophonia · Mood Disorders: · Anxiety · Bipolar disorder · Depression · Disruptive mood dysregulation disorder · Substance abuse & addiction · Trauma · Risky Behaviors/Sex Do sensory processing challenges contribute to mental health challenges? OR Do the mental health challenges affect the persons sensory processing? And does it really matter? Goal: Joi de verve - Many children with anxiety and depression have or had sensory processing issues as a child and as the developed into adolescents it became anxiety, substance abuse, addiction, and depression as well as risky behaviors. Comprehensive Evaluation (here) 1. Standardized/Normed Clinical Assessments 2. Standardized/Normed Parent/Self-Report Measures 3. Clinical Observations- AS IMPORTANT AS STANDARDIZED ASSESSMENTS 4. Occupational Profile Assessment of Sensory Processing and Integration Function in Adolescence · Sensory Processing Three Dimensions Scales (SP-3D, in development) · Non-standardized administration of the SIPT · Motor or functional skill assessments (e.g., BOT™-2, COMPS-2, GOAL™) · Auditory processing screening tools (e.g., SCAN-3: A, TAPS-4) · Visual motor/perceptual assessments (e.g., DVPT-A, MVPT-4, S-VMPT, TVMS-3, TVPS-4, VMI-6, WRAVMA) · Interoceptive Awareness Assessment · MAIA-2 Assessment of Adaptive Skills related to Sensory Processing and Integration Function in Adolescence · Adaptive behavior/life skill rating scales (e.g., ABAS-3, Vineland-3) · Sensory checklists (e.g., Adult/Adolescent Sensory Profile®; Spiral Adolescent Sensory Questionnaire · Behavioral assessments (e.g., BASC-3) · Executive function/attention rating scales (e.g., BRIEF-2, Quality of life- QOLI · Social Participation · COMPS Assessment of Sensory Processing and Integration Function in Adolescence · Clinical Observations · Arousal state changes in response to sensations · State of alertness · Attention · Balance, strength, and endurance · Visual tracking and ocular motor screening · Imitating complex novel movements · Repetitive motor patterns · Environmental awareness · Observations Based on Sensory Integration Theory by Erna Blanche Occupational Profile · Parent/child interviews · Roles/relationships · Self-concept · Strengths · Functional impact areas Postulates Regarding Change: Regulation A therapist must direct intervention initially toward facilitating an optimal level of arousal if a child is dysregulated. If the therapist supports the child's experience of joy, then the child will be more likely to participate fully in the intervention If the therapist acknowledges the child's emotional state, builds emotion awareness and grades emotional interactions, the child will experience greater emotional regulation. If the therapist uses graded affect and anticipation and responds to child's cues the child will be more likely to engage in circles of communication (peek a boo, hide and seek) If the therapist keeps discipline to a minimum, ensures safety and uses visual cues and routine for transitions, the child will likely experience fewer power struggles If the therapist supports just right success the child will be more likely to achieve self-confidence and self esteem Postulates Regrading Change: Relationships If the therapist attunes to the child, then the child will be more likely to engage in high level play, social problem solving, and joyful interactions. (Be present) If the therapist establishes trust with the parent, the parent will more likely accept coaching strategies and participate in therapy sessions. If the therapist collaborates with the parent or caregiver or family member in treatment the child will be more likely to achieve carry over into the home, school, and community environments. If the therapist supports, the child's engagement and relationship with significant others then the child will be more likely to attain higher-level capacities across their developmental profile. (Incorporate parents to also have fun in the session with the adolescent to relationship build) If the therapist follows the child's lead, focusing on what the child is most interested in then therapy is more likely to sustain engagement in the process. Postulates Regarding Change: Sensory Integration If the child addresses modulation, posture, discrimination, and praxis challenges with graded support from the therapist during therapy, the child will be more likely to acquire functional skills in daily life. If the therapist provides sensory opportunities specific to the child's responsivity challenge, then the child will be more likely to learn to self-regulate. If the therapist utilizes principles from sensory integration, then the child will be more likely to show improved sensory modulation, postural control, praxis, bilateral coordination, and discrimination. If the therapist shares the sensory experience and varies affect, tone, and volume of voice based on the child's sensory responsivity pattern, then the child will be more likely to engage in playful interactions. Postulates Regarding Change: Sensory Integration If the therapist provides the child with opportunities to develop interoceptive discrimination, the child will likely develop emotional awareness and control of his or her body. If the therapist provides ongoing postural challenges (alignment, weight bearing and weight shifting, balance, antigravity control, core stability, strength, and endurance}, the child will be better able to perform age-appropriate gross and fine motor activities If the therapist encourages repeated opportunities with graded support for conceptualization planning and sequencing and execution, evaluation of results and problem solving the child will develop foundational abilities that will ensure better organization of behavior in daily life ASECRET Attention Sensation Emotion Regulation Culture Relationship Environment Task Example pg. 200 STAR Process Fidelity Measure Treatment Methods for Adolescents · Goal Identification · TUOS/partnership/safety · Client Education/Problem solving · Guided Sensory Exploration · Playfulness · Co-regulation · Sensory Integration Activities · Self-Regulation Strategies – identification and practice · Sensory Lifestyle Planning · Physical Activity · Advocacy for Accommodations and Adaptations · Collaboration with Parents, partners, friends Compare and contrast of ASI vs. STAR: - Ayres developed a sensory integration model, which is the theoretical base for the ASI FOR. This model demonstrates the body’s sensory systems, including; the vestibular, proprioceptive, and tactile systems, and how they affect learning and behavior. - Although the STAR FOR’s theoretical base includes sensory integration theories, it also provides regulation and relationship theories. - In both FOR, the parents express their child’s and family’s needs. One key difference is the degree of parent involvement. Parents are involved in STAR, being that it is a parent-centered approach that stresses the parent-child relationship and parent education. ASI applies to clients across the life span depending on the condition. When using ASI, parents may sit in and observe during the intervention, while in STAR, parents will be active participants, motivating their child during therapy. ASI views the child’s inner drive as what motivates change, whereas the STAR FOR views parents as the primary change agent, motivating their child toward desired goals. - In the STAR FOR, parent-only education sessions occur along with parent-child sessions. The parent-only education sessions allow the parents to gain knowledge that will enable them to better understand their child. The parent-child relationship is essential to this FOR, as the parent is the child’s primary change agent. STAR utilizes a play approach referred to as Sensory Motor Attuned Relationship-rich Time (SMART) play that focuses on therapeutic play activities that encourage emotional control and socialization. Central to this FOR is the concept of Attention, Sensation, Emotion Regulation, Culture, Relationship, Environment, and Task (ASECRET). ASECRET is a problem-solving strategy introduced to parents to facilitate their understanding of their child’s needs to develop a sensory lifestyle. This helps parents transfer strategies learned in therapy to different contexts. Interoception INTEROCEPTION Role in emotions, social emotional skill building, emotional regulation, and overall self-regulation What is Interoception? Information that we get from the internal organs body cues: state of our body (hungry? Cues from stomach, headache? Cues from head) 8th Sense How our body cues relate to our emotions and help us self-regulate What does interoception have to do with emotions? Our body cues tell us about how we are feeling Baby is hungry, they cry and tell us something is happening in their stomach] How do I know when I feel sad or angry? We need to be able to identify when our body feels these emotions Angry: face flushed (PERSONAL) everybody has different ways of expressing their emotions or feeling their emotions. We must have a pretty good understanding of our body cues to connect to our feelings Identify what is going on in your body to identify our emotions and how we feel What does interoception have to do with self-regulation? Interoception provides the motivation for purposeful self-regulation - Feel sad one day because chest feels heavy, muscles feel droopy, eyes feel sad (personal to cathy) if she wants to feel better, she knows what to do (call a friend or go for a run) Interoceptive Process - Steps taken in intervening when seeing challenges with interoception awareness “Interoceptive awareness is the bridge between co-regulation and self-regulation” - Health and well being - Needs to be talked about more regarding well being What does interoception have to do with relationships? Attunement Co-regulation Empathy Perspective taking Need interoception to connect with emotions Emotions are personally and you need to be aware of what those emotions feel like Having a good understanding of what our feelings are allows us to have empathy and connect with others skills supported by interoceptive awareness Language: “I feel sad” Communication: communicate needs and wants (if you can’t there is dysregulation) Health management: “I feel sick” “I need water” = pieces to manage health. Gut and intestinal issues that they can’t communicate. BUILD INTEROCEPTION to enhance overall health “Reading the context of life” Forming and keeping Relationships: our body cues, connect to ourselves to then connect to others Happiness Interoception challenges Too big: feel too much all the time Too small: don’t feel enough Distorted: don’t know what you feel or think you feel something, but it really is something else Modulation: difficulty to regulate interoception signals- too big or small or not feel or experience the interoception cues until it “explodes” Bodies don’t respond until a lot of information and the respond interoceptive awareness challenges (behavioral challenges) Meltdowns Gets really upset for “no reason” Forget to eat – hangry Overeat Frequent urination Toileting accidents Difficulty with potty training Doesn’t notice when is sick Can’t identify where pain is coming from Even small injuries/ailments cause a lot of distress – ie: hang nail, runny nose Does not notice when tired- becomes over tired and cranky Intense emotions come on quickly Difficulty making and keeping friends Difficulty with intimate relationships Poor self-awareness- does not understand why people become upset with them Difficulty finding FUN Difficulty experiencing joy Apathetic Arousal/alertness Interoceptive awareness challenges Autism Theory of mind ADHD OCD Eating disorders Sensory Processing Disorder Trauma PTSD Anxiety Panic Disorder Depression Addiction Chronic Pain Suicide Assessing Interoception Interoceptive awareness assessment MAIA-2 Cognition and insight to answer Body Perception Questionnaire Cognition and insight to answer Clinical observations Building interoceptive awareness Identifying body cues Draw attention to the body part of focus – increasing sensory cues Start with easier body parts Practice Can be practiced during everyday activities Connecting to an emotion Putting body cues together to connect to an emotion Identifying what caused that feeling The way a person experiences an emotion is specific to them Acting to self-regulate Feeling okay vs feeling uncomfortable I can change the way my body feels Feel good menus How is building interoception different from mindfulness? Use visual supports – less abstract Written words to identify how body is feeling Feel good memories Printing out emotion charts to see what emotions looks like and connect it to feelings Makes mindfulness interactive and playful Opportunities for daily practice during everyday activities Breaks it down into small steps Self-regulation Self-Regulation and Co-Regulation Regulation involves not only self-regulation, but co-regulation in the STAR FOR. “Self-regulation and co-regulation are circular, causal processes….” “Only in the context of safe, attuned, and co-regulated relationships can children fully realize the paradox of feeling together and becoming unique. Depend on co regulation from parents. We depend on our parents to be attuned to our needs (e.g., baby cries and mom picks it up). By picking them up and providing them with vestibular input, this regulates the baby. Over time the baby, as they grow, understand that if they are feeling a certain way they can do this to regulate themselves. Self-regulation begins with: - Coregulation - Attunement - Thereby, attachment Patterns of dysregulation and sensory processing challenges stem from not attaching to parents. Impact of Sensory Processing Challenges on Regulation Modulation challenges often result in dysregulation, such as: - Sensory over responsiveness - Sensory under-responsiveness - Sensory cravers Interoception and Self-Regulation: Role in emotions, social emotional skill building, emotional regulation, and overall self-regulation What is Interoception? Information that we get from the internal organs Body cues: state of our body (hungry? Cues from stomach, headache? Cues from head) 8th Sense How our body cues relate to our emotions and help us self-regulate What does interoception have to do with self-regulation? Interoception provides the motivation for purposeful self-regulation - Feel sad one day because chest feels heavy, muscles feel droopy, eyes feel sad (personal to cathy) if she wants to feel better, she knows what to do (call a friend or go for a run) Building interoceptive awareness - Identifying body cues - Connecting to an emotion - Acting to self-regulate Feeling okay vs feeling uncomfortable I can change the way my body feels Feel good menus Trauma and Self Regulation Children who are not raised in a safe and supportive environment, may develop alternative strategies for coping with distress These alternative strategies include, withdrawing, isolation, hyperactivity, self-harm, sleeping problems and difficulty managing bodily function Younger children often lack the vocabulary needed to express themselves when they are overwhelmed. Trauma, stress, resilience Trauma stress and disease Links between trauma stress and disease Trauma results in wide scale effects and leads to chronic inflammation Supportive and nurturing interventions have. Healing influence ○ For every one point increase in positive affect there is a 22% decrease in the rate of developing heart disease Resilience, Occupational Participation and Health Resilience: ability to recover and thrive in the face of trauma, stress, or adversity. Resilient characteristics: ability to experience positive emotions, feel a sense of self efficacy, and demonstrate flexibility when adapting to change. One's beliefs before the trauma and one’s neurobiology also play an important role. Situational and contextual factors as well as the degree of support an individual has influences resiliency and the recovery process. Protective factors: individuals positive qualities and skills (cognitive, social, emotional, environmental, and spiritual) and perceived support and resources that when combined work together in a way to empower the person to work through the adverse experiences. OT’s work at helping individuals develop, identify, and utilize their protective favors for prevention and treatment. In this way a resilience focused, client centered approach helps individuals develop the capacity and skills necessary to help counter the influence of stress, trauma, and ACE’s. OT’s help individuals explore the interrelatedness of the mind- body connection and coping modalities. Family Resilience Family resilience: successful coping of families during life transitions, stress, or adversity. Family resilience has a dual focus of building protective and recovery factors as well as reducing environmental risks that threaten family functioning Families can use their internal resources (values, spiritual beliefs, coping skills( or external resources (emotional and practical support from other) to problem solve, develop new solutions, and institute effective changes It may be helpful to consider family resilience as a balance between hope and hopelessness- helping families to maintain an overall family balance can foster resilience through time The concepts of family focused recovery and family resilience have a natural alignment with the principles of OT ○ Resilience is built when an effective match between family skills, resources, and environmental challenges is present Quiz Question: Explain the relationship between trauma, stress, and resilience (make sure to include protective factors) Trauma develops from the experience of one or more events which are physically and/or emotionally threatening to an individual, and impact their physical, social, emotional, and/or spiritual well being. Stress is different from trauma, since it does not develop as a lasting response from an experience, but instead it is a state of anxiety or worry as a natural response to a stressor. Traumatic stress is where trauma and stress overlap, and occurs when an individual's ability to cope and participate in occupations is affected after exposure to a traumatic experience. Resilience is the ability to recover (and flourish) in spite of the barriers that trauma, stress, and other adversities present. Biological, personal, and environmental factors such as a sense of self-efficacy, neurobiology, an individual's positive qualities and skills, support network, and ability to adapt to change can protect an individual from the lasting negative impacts of trauma and stress by supporting their resilience. Trauma responsive care/schools Trauma Informed Care A national and international mental health initiative that advocates for understanding that individuals experiencing trauma related sequelae are doing the best that they can , are resilient, and the attempts to cope and adapt may have worked in the past. When implementing TIC professional must 1. Understand the high prevalence of trauma in people seeking mental health care services 2. Become a education about the pervasive neurophysiological, social, emotional and functional influence of trauma 3. Ensure that professionals provide services that will help to address each clients specific needs TIC understand the need to promote a trauma informed approach as a universal precaution in effort to prevent and or address trauma and retraumatization Six key principles of TIC 1. Safety 2. Trustworthiness and transparency 3. Peer support 4. Collaboration and mutuality 5. Empowerment voice and choice 6. Cultural, historical, and gender issue competence Collaborative and client centered approach to help empower individuals Quiz Question: What does it mean to use a trauma informed care (TIC) approach to therapy? Trauma-informed care is a national and international health initiative that advocates for understanding that individuals experiencing trauma-related issues are doing the best they can, are resilient, and that one’s attempt to cope and adapt may have worked in the past, but is no longer adaptive or supportive of health, wellness, or occupational participation. A trauma-informed approach helps organizations and individual practitioners respond to the needs of individuals who have experienced trauma on multiple levels. 6 principles for instituting TIC approaches include safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment, voice, and choice, and cultural, historical, and gender issue competence/sensitivity Quiz Question: How can occupational enrichment be used to support participation in school aged children. Occupational enrichment uses environmental modification to promote participation in occupations. Occupational enrichment supports engagement by expanding opportunities by manipulating the environment to suit the needs of the client. Occupational enrichment can be used to support participation in school aged children by designing occupations that lead to the experience of positive emotions, highlighting aspects of activities which focus on a child's strengths and that support enjoyment. Assigned ATYPICAL episodes (Episode 1 and 4) Episode 1 - Ash: Identify 2 ways that Sam’s development is similar to neurotypical adolescents. Make sure to reference. The Netflix show, ATYPICAL, is my favorite show. A common theme throughout the first episode is Sam’s desire to have a girlfriend. Sam’s therapist, Julia, told him it was possible for him to date just as his peers do. This is one way in which Sam relates to his neurotypical adolescents. Dating and romantic relationships play a key role in adolescent development in both neurotypical and atypical adolescents (Manning et al., 2014). Another similarity between Sam and neurotypical adolescents is the difficulty his mother has in “letting him go,” or in better words branching out and beginning to date. Sam’s mother has trouble with this concept for various reasons, mainly because of his autism. According to Giordano et al. (2016), parents that express negative attitudes and opinions regarding their adolescents dating come from a place of protection and not wanting their child to experience unfortunate dating experiences but appear to be ineffective in preventing the adolescent from dating. As many adolescent mothers, Sam’s mother has difficulty with the idea of him dating because of his social interaction difficulties and not wanting her son to get hurt. His mother even states that “he is a little too young for that,” as in dating, meanwhile many adolescents his age do begin to form romantic relationships (Rashid et al., 2017). According to Manning et al. (2014), by the age of 18 69% of male and 76% of female respondents in the study indicated they were in a romantic relationship. Identify 1 way that Sam’s ESSENCE is impacted by his Autism Social Engagement: Sam’s autism impacts his social engagement in various ways; however, he has a strong social connection to his younger sister, mother, father, and best friend Zahid. On the contrary, he has difficulty reading social cues, nonverbal communication, and exchanging small talk due to his autism, making peer group acceptance and engagement challenging for him (Rashid et al., 2017). Sam’s social interaction difficulties impact his ability to form connections with his classmates and his ability to find a girlfriend in episode 1 (Rashid et al., 2017). Episode 1 - Chelsea: Identify 2 ways that Sam’s development is similar to neurotypical adolescents I truly enjoyed watching the first episode of Atypical. I believe the show did a great job portraying Sam and the impact that a diagnosis of autism spectrum disorder (ASD) can have on the adolescent with ASD and their family. Throughout the episode, there were ways in which Sam’s development was similar to neurotypical adolescents. The show opens with Sam explaining to his therapist that he desires to begin dating (Rashid & Gordon, 2017). This is a typical desire for a neurotypical adolescent, as by middle or late adolescence, an interest in dating typically begins, and Sam is 18 years old (Rashid & Gordon, 2017; Rasho, 1995). The adolescent peer group typically encourages the transition into dating, which could be seen through Sam’s coworker, who encouraged him to ask a girl out on a date while at work (Rashid & Gordon, 2017; Rasho, 1995). Sam’s coworker provided him with the encouragement and emotional support needed to give him the confidence to ask this girl on a date (Rashid & Gordon, 2017). It is typical for adolescents to look to a peer for emotional support and guidance as they look to sort out who they are and who they should be at this point in their lives (Rasho, 1995). Another part of Sam’s development that is similar to neurotypical adolescents is his engagement in work. Adolescence is typically a time of exploration and participation in activities outside of school, such as sports, clubs, and paid work, which help formulate their own occupational identities (O’Brien & Kuhaneck, 2020). Sam is also independent in his ability to navigate public transportation, which altogether is similar to a neurotypical adolescent (O’Brien & Kuhaneck, 2020). Overall, it appears that Sam is seeking his sense of self, as he commonly refers to Antarctica and penguins as a metaphor for himself and how he feels he is misunderstood (Rashid & Gordon, 2017). This desire to formulate his own identity, seen through his desire to date and ability to work, is typical for an adolescent, as each infers some degree of independence from his parents to develop his own place in the world (Rasho, 1995). Identify 1 way that his ESSENCE is impacted by his Autism Although Sam’s development is similar to that of a neurotypical adolescent in some ways, his diagnosis of ASD impacts his ESSENCE. The S-E of Sam’s ESSENCE, his social engagement, is impacted by this diagnosis as seen through various challenges Sam faces throughout this episode when communicating with others, especially girls (Rashid & Gordon, 2017; Talks at Google, 2014). This part of Sam’s ESSENCE involves a drive to be more with his peers than his parents, which is important to survive independently in the world (Talks at Google, 2014). However, Sam experiences difficulties socializing with both girls he goes on a date with; he has challenges interpreting social cues, reading nonverbal social cues, and responding to light touch (Rashid & Gordon, 2017). When he smiles at a girl at work, he smiles very wide and stares at her in a way that appears to make her uncomfortable. Sam expressed to his therapist that he did not understand what he did wrong, although she explained how to appropriately smile and make eye contact that communicates that you like someone (Rashid & Gordon, 2017). Sam also appears to have difficulties reading nonverbal cues, as expressed by Sam himself following his date at the coffee shop, as he indicated he did not know how to communicate effectively with his date (Rashid & Gordon, 2017). This date also portrayed how his diagnosis makes it difficult for him to be in a loud, unfamiliar place, as seen through his decision to wear noise cancelling headphones to improve his ability to function in this social setting (Rashid & Gordon, 2017). Sam’s diagnosis also impacted his ability to engage physically with his date in her dorm room, as he prefers deep pressure touch. When his date begins to touch him with light pressure, he pushed her off the bed, indicating how this difference in pressure influences his ability to physically interact with her (Rashid & Gordon, 2017). Overall, Sam’s diagnosis influences his ability to engage socially, impacting his ESSENCE through his challenges communicating effectively with his peers, especially girls he desires to date. Episode 4 Ash: How does Sam’s sensory processing differences impact his relationship with his peers? Sam's sensory processing differences were evident in this episode. Sam demonstrates sensory hyper-reactivity, an unusually strong, n

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