The Adolescent/Adult Sensory Profile

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

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

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

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

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

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

7. Sensory Sensitivity • passive response to a low threshold • easily respond to sensory stimuli • notice things other people don’t notice • highly aware of their surroundings • distractible

8. Sensation Avoiding • active counteracting a low threshold • intentional withdrawal or blocking of sensation • use of rituals and routines • overwhelmed by sensory rich environments • good at creating structured and supportive environments

9. Low Registration • Passive response with a high threshold • miss available sensory input • spacey, clumsy • under-responsive or slow to respond • can focus in distracting environments • flexible, comfortable in wide range of environments

10. Sensation Seeking • behavioral response to counteract a high threshold • enjoys sensory rich environments • creates sensation • easily bored • trouble tolerating low stimulus environments

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

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

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

14. Fill out and score the A/ASP

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

16. Uses normal distribution

17. Support for Reliability • Internal consistency for quadrants range from .65 - .78 • Each item on a subscale correlates best with its intended subscale • Standard error of measurement ranges from 3.58 – 4.51

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

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

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

21. Considerations • Scoring different than child, infant/toddler versions • All preferences have advantages and disadvantages • Consider all quadrants together • Consider meaning of low scores (particularly for seeking and avoiding behaviors) • Consider patterns within sensory categories

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

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

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

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

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

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

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

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

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

31. Let’s analyze an environment

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

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

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

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

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

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

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

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

41. Other strategies……

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

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

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

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

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

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

48. Findings related to specific populations

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

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