Purpose:
The purpose of this poster is to demonstrate how Sensory Profile data informed occupational therapy sleep interventions for two participants as part of an Interprofessional Tailored Behavioral Intervention study

Bull, OTS, Eric D.

Doria, OTS, Denise G.

Dumont, BS, OTS, Rachel L.

Frank, OTS, Jamie A.

Grady, OTS, Jenna R.

Kauper, BS, OTS, Sarah E.

Miller, BS, OTS, Amy L.

Schaaf, PhD, OTR/L, FAOTA, Roseann C.

Sinko, MS, OTR/L, Rebecca

Souders, PhD, CRNP, Margaret

Truong, BS, OTS, Phoi

Name not available

An Interprofessional, Tailored Behavioral Intervention for Sleep Problems in Autism: Use of Sensory Data to Inform Intervention

Jefferson Digital Commons

Thomas Jefferson UniversityJefferson Digital CommonsDepartment of Occupational Therapy, Presentations Department of Occupational Therapy4-18-2015An Interprofessional, Tailored BehavioralIntervention for Sleep Problems in Autism: Use ofSensory Data to Inform InterventionRebecca Sinko, MS, OTR/LThomas Jefferson University, rebecca.sinko@jefferson.eduSarah E. Kauper, BS, OTSThomas Jefferson University, sarah.kauper@jefferson.eduPhoi Truong, BS, OTSThomas Jefferson University, phoi.truong@jefferson.eduRachel L. Dumont, BS, OTSThomas Jefferson University, rachel.dumont@jefferson.eduAmy L. Miller, BS, OTSThomas Jefferson University, amy.miller@jefferson.eduSee next page for additional authorsLet us know how access to this document benefits youFollow this and additional works at: http://jdc.jefferson.edu/otpresentationsPart of the Occupational Therapy CommonsThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andRecommended CitationSinko, MS, OTR/L, Rebecca; Kauper, BS, OTS, Sarah E.; Truong, BS, OTS, Phoi; Dumont, BS,OTS, Rachel L.; Miller, BS, OTS, Amy L.; Schaaf, PhD, OTR/L, FAOTA, Roseann C.; Souders,PhD, CRNP, Margaret; Bull, OTS, Eric D.; Doria, OTS, Denise G.; Frank, OTS, Jamie A.; and Grady,OTS, Jenna R., "An Interprofessional, Tailored Behavioral Intervention for Sleep Problems inAutism: Use of Sensory Data to Inform Intervention" (2015). Department of Occupational Therapy,Presentations. Paper 26.http://jdc.jefferson.edu/otpresentations/26AuthorsRebecca Sinko, MS, OTR/L; Sarah E. Kauper, BS, OTS; Phoi Truong, BS, OTS; Rachel L. Dumont, BS, OTS;Amy L. Miller, BS, OTS; Roseann C. Schaaf, PhD, OTR/L, FAOTA; Margaret Souders, PhD, CRNP; Eric D.Bull, OTS; Denise G. Doria, OTS; Jamie A. Frank, OTS; and Jenna R. Grady, OTSThis poster is available at Jefferson Digital Commons: http://jdc.jefferson.edu/otpresentations/26An Interprofessional, Tailored Behavioral Intervention for Sleep Problems in Autism: Use of Sensory Data to Inform Intervention Rebecca Sinko¹, M.S., OTR/L, Sarah Kauper¹, B.S., OTS, Phoi Truong¹, B.S., OTS, Rachel Dumont¹, B.S., OTS, Amy Miller¹, B.S., OTS,  Roseann Schaaf¹, PhD, OTR/L, FAOTA, Margaret Souders², PhD, CRNP, with contributions from:  Eric D. Bull1, OTS; Denise G. Doria1, OTS; Jamie Frank1, OTS, Jenna Grady1, OTS  ¹Thomas Jefferson University, Department of Occupational Therapy; ²University of Pennsylvania, School of Nursing Background   Prevalence of ASD has increased to 1 in 68 children (CDC, 2014). Chronic severe insomnia (sleep disturbance) is one of the most common co-occurring conditions in children with ASD  ( 60-80% ) (Liu et al., 2006; Souders et al., 2009; Wiggs & Store, 2004). Causes are multi-factorial including behavioral, biological and cultural mechanisms (Kotagal & Broomall, 2012; Malow & McGrew, 2008). Parents report that both sensory sensitivities (to the environment) and anxiety may be contributing  factors (Souders et al., 2009). Occupational therapists can address these factors and help improve sleep quality by implementing sensory and environmental strategies. Methods Acknowledgements: This study is funded by the U.S. Department of Defense  Grant # AR120166 - Tailored Behavioral Intervention for Insomnia in Children with Autism Spectrum Disorders.  Principal Investigator, Margaret Souders Comparative Effectiveness Design  Eligibility Criteria:  •  Autism Dx (ADOS) •  Insomnia (CSHQ, Actigraphy) •  Ages: 6-10                         Sensory Profile Subscales Typ. Perf. Prob. Diff. Def. Diff. Specific behaviors noted from parent report on Sensory Profile Strategies used to improve sleep Auditory Processing     ✔ Sensitivity; Distracted around high levels of noise  Quiet sleep environment Visual Processing  ✔       Vestibular Processing     ✔ Movement seeking behaviors Heavy blanket;  Calming Module activities during hour before bed: Observing Your Breath, Yoga Poses for Insomnia, Progressive Muscle Relaxation  Touch Processing     ✔ Sensitive to tooth-brushing and some fabrics;  Seeking behaviors for certain textures Earlier nighttime hygiene routine to offset arousal  Multisensory Processing     ✔ Attention difficulties; Unaware in busy environment; Hangs on people or objects  Decrease stimuli in sleep environment (minimal toys) Oral Sensory Processing   ✔   Sensory processing related to endurance/tone     ✔ Decreased endurance; Tires easily Increase activity level during day/after school Modulation related to body position and movement ✔       Modulation of movement affecting activity level ✔     Modulation of sensory input affecting emotional responses     ✔   Behavioral intervention Modulation of visual input affecting emotional responses and activity level     ✔   Environmental adaptation Emotional/social response     ✔   Parent education  Behavioral outcome of sensory processing     ✔ Difficulties with changes in routine Use of visual schedule & bedtime pass Items indicating thresholds for response      ✔   Use of visual schedule and behavioral intervention Purpose   The purpose of this poster is to demonstrate how Sensory Profile data informed occupational therapy sleep interventions for two participants as part of an Interprofessional Tailored Behavioral Intervention study. Measures: •  Anxiety Measures: Pediatric Anxiety Rating Scale •  Sensory Measures: Sensory Profile •  Sleep Measures: Sleep Diary, Child Sleep Habits Questionnaire (CSHQ), Actigraphy  Sensory Profile Subscales Typ. Perf. Prob. Diff. Def. Diff. Specific behaviors noted from parent report on Sensory Profile Strategies used to improve sleep Auditory Processing     ✔ Sensitivity; Distracted around high levels of noise Reinforce quiet sleep environment Visual Processing ✔    Some difficulty with visual discrimination Simple visual schedule; Use of verbal cues Vestibular Processing     ✔ Movement seeking behaviors Increase activity level/heavy work exercises after school; Deep pressure massage before bed;  Calming Module activities during hour before bed: Observing Your Breath, Yoga Poses for Insomnia; Quiet Reading Touch Processing    ✔ Multisensory Processing     ✔ Attention difficulties; Unaware in busy environment; Hangs on people or objects  Decrease stimuli in sleep environment (minimal toys)  Oral Sensory Processing   ✔   Smells non-food objects Use of scented candle during massage Sensory processing related to endurance/tone    ✔ Modulation related to body position and movement ✔     Modulation of movement affecting activity level ✔     Modulation of sensory input affecting emotional responses     ✔  Rigid rituals and routines; Difficulty with changes Use of visual schedule; Bed time pass; Behavior chart; Social story Modulation of visual input affecting emotional responses and activity level  ✔     Emotional/social response     ✔  Poor frustration tolerance; Anxious Parent education  Behavioral outcome of sensory processing ✔   Items indicating thresholds for response      ✔  Deliberately smells objects Sleeping with mom’s pajamas around pillow Case 1 Outcomes Pre Intervention Sleep Behavior  •  Sleeps with parents •  Increased sleep latency (28 minutes to fall asleep) •  Wakes during night/restless (477 sleep minutes; 117 wake minutes) •  Wakes at 5am   Pre Intervention Sleep Behavior  •  Sleeps in brother’s room with mom •  Increased sleep latency (47 minutes to fall asleep) •  Wakes during night/restless (209 sleep minutes) •  Early bedtime/early wake time  Post Intervention Sleep Behavior  •  Sleeps in own room •  Decreased sleep latency (21 minutes) •  Decreased waking during night  (485 sleep minutes; 65 wake minutes) •  Wakes at 5-6am with dad   Post Intervention Sleep Behavior •  Sleeps in own room •  Decreased sleep latency (12 minutes) •  Decreased waking during night (511 sleep minutes) •  Later bedtime/later wake time   Actigraphy Example  (National Sleep Foundation, 2015) Case 1: Male, 9 years-old   Case 2: Male, 8  years-old   Case 2 Outcomes References Center for Disease Control [CDC]. (2014). Prevalence of autism spectrum disorder among children aged 8 years—Autism and developmental disabilities monitoring network, 11 sites, United States, 2010. Morbidity and Mortality Weekly Report, 63(SS 2), 1-21. Retrieved from http://www.cdc.gov/mmwr/PDF/ss/ss6302.pdf Kotagal, S., & Broomall, E. (2012). Sleep in children with autism spectrum disorder. Pediatric Neurology, 47(4), 242-251. doi:10.1016/j.pediatrneurol.2012.05.007 Liu, X., Hubbard, J. A., Fabes, R. A., & Adam, J. B. (2006). Sleep disturbances and correlates of children with autism spectrum disorder. Child Psychiatry and Human Development, 37(2), 179-191. doi:10.1007/s10578-006-0028-3 Malow, B. A., & McGrew, S. G. (2008). Sleep disturbances and autism. Sleep Medicine Clinics, 3(3), 479-488. doi:10.1016/j.jsmc.2008.04.004 National Sleep Foundation (2015). Sleep assessment & evaluation: Sleep center / lab tools. In J. A. Kram, M. H. Kryger, J. Ojile, J. F. Pagel, & E. M. Wickmire (Eds.), The sleep disorders (Chapter 1). Retrieved from http://sleepdisorders.sleepfoundation.org/chapter-1-normal-sleep/sleep-assessment-evaluation-sleep-center-lab-tools/ Souders, M. C., Mason, T. B. A., Valladares, O., Bucan, M., Levy, S. E., Mandell, D. S., Weaver, T. E., & Pinto-Martin, J. (2009). Sleep behaviors and sleep quality in children with autism spectrum disorders. Sleep, 32(12), 1566-1578. Wiggs, L., & Stores, G. (2004). Sleep patterns and sleep disorders in children with autism spectrum disorders: Insights using parent report and actigraphy. Developmental Medicine & Child Neurology, 4(6), 372-380. doi: 10.1017/S0012162204000611  

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An Interprofessional, Tailored Behavioral Intervention for Sleep Problems in Autism: Use of Sensory Data to Inform Intervention

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