AUTISM EXPLANATION

1. Practical Suggestions
Susanne Smith Roley OTD, OTR/L, FAOTA,
Arts and Autism Conference
Ohio State University, 2015

2. Positions Held:
•Collaborative for Leadership in Ayres Sensory
Integration® Founding Member
•Ayres Sensory Integration 2020 Vision, Founder
•Course Originator, past Project Director and Current
Instructor for the Sensory Integration Certification
Program, sponsored by USC/WPS
•University of Ulster, United Kingdom, Guest Faculty
Occupational Therapist (OT)
Private Practice, Orange County, CA.
Over 35 years of experience
Evaluation and Advocacy for Children, Young Adults and Families
Dr. Susanne Smith Roley
AWARDS
• AOTF A. JEAN AYRES AWARD, 2009
•AOTF VIRGINIA SCARDINA AWARD OF
EXCELLENCE, 2004
•AOTA ROSTER OF FELLOWS, 2004
•AOTA SERVICE AWARDS:
1996,1999, 2002, 2005, 2006, 2007, 2008
Publications on SI:
Co-editor of 2 books
Several booklets &
Over 35 published articles

3. A health and
rehabilitation
profession
Whose aim is to support
 health,
 well-being
 and participation
 through engagement in
 occupation (activities)
and
 co-occupations
(shared activities).

4. Restricted repetitive activity to
patterns of behavior, interests,
and activities
(at least two of the following)
 Stereotyped repetitive
movements, use of objects,
speech
 Insistence on sameness,
inflexible adherence to
routines, or ritualized
patterns or verbal nonverbal
behavior
 Highly restricted, fixated
interests that are abnormal
in intensity or focus
 Hyper-hypo
reactivity to
sensation or
unusual interests in
sensory aspects of
the environment

5. A neurobiological process
◦ Modulates the intensity of information
◦ Discriminates the detailed sensory
information
◦ Supports motor control, planning and
organization
Ayres Sensory Integration®
◦ theory and intervention method
◦ used primarily in occupational therapy
practice
◦ designed originally by A. Jean Ayres
Ph.D., OT
◦ with ongoing research

6.  Dr. Ayres designed SI
intervention in the 1960’s
– since then…
 OT’s working in pediatrics
commonly report using
sensory integration
methods
 95-99% OT’s working with
children with autism
reported using sensory
integration methods
(Case-Smith, 1999)

7.  8,000 parents reported
 the following therapies worked best
for their child
 rank-ordered by percent of
mentions
 1. Occupational Therapy – 39%
 2. Speech Therapy – 27%
 3. ABA Therapy – 15%
 4. Social Skills Classes – 8%...

8.  Baker, Lane,
Angley, & Young,
2010
 Baranek, David,
Poe, Stone &
Watson, 2006
 Dawson & Watling
2000; Kientz &
Dunn, 1997
 Lane, Young,
O’Neill & Jones
1997
 Tomcheck & Dunn,
2007

9.  Liss, Saulnier,
Fein, &
Kinsbourne,
2006)

10.  Crane,
Goddard,
& Pring,
2009
(Dept of
Psychology,
University of
London)

11.  Reynolds,
Millette, &
Devine, 2012

12.  Ben-Sasson, Fluss, &
Cermak, 2008
 Dziuk et al., 2007
 Marco, Hinkley, Hill,
& Magarajan, 2011
 Mostofsky et al.,
2006
 Siaperas, Ring &
McAllister, 2011

14.  Characterize sensory
integration and praxis
patterns of children
with ASD
 Discern whether these
patterns relate to social
participation
 121 children with ASD
ages 4 – 11 years
received OT evaluation
 69 (57%) completed at
least 11/17 SIPT
 45 completed SPM-H
 23 completed SPM-C
SMITH ROLEY ET AL., 2015

15.  SIPT and SPM standard scores used to
describe sensory integration and praxis
patterns.
 Correlation coefficients were generated to
discern relationships among sensory
integration and praxis scores,
 and associations with SPM Social
Participation scores.
SMITH ROLEY ET AL., 2015

16.  Motor planning problems
(1965, 1966, 1969,1972,1977 & 1989; 1998; 2011, 2015)
 Visual perception + visual praxis problems
(1965, 1966, 1969,1972,1977 & 1989; 1998; 2011, 2015)
 Vestibular, postural & bilateral problems
(1965, 1966, 1969,1972,1977 & 1989; 1998; 2011, 2015)
 Tactile defensiveness (sensory reactivity/modulation)
(1965, 1966, 1969, 1972; 2011)
 Somatosensory perception problems
(1969, 1972, 1977, 1989, 1998, 2011, 2015)

17.  Relative strengths
◦ Visual Perception
& Visual Praxis
 Significantly low mean
scores
1) Imitation Praxis
2) Vestibular Bilateral
Integration
and Sequencing
3) Somatosensory
with Tactile and
Kinesthetic
Discrimination
4) Praxis on Verbal
Command
SMITH ROLEY , ET AL 2015

18.  SPM - Home
◦ Definite Differences
in Social
Participation
◦ Some Problems in
 Total Sensory
 Ideas and
Planning
 SPM – Classroom
◦ Some Problems in
 Social
Participation
 Total Sensory
 Ideas and
Planning
SMITH ROLEY ET AL., 2015

19. SPM
H-Home
C-Main Classroom
SIPT
Vis
Perc
Vis
Praxis
Imitation
Praxis
Vestib
Bilateral
Somato
Sensory
Praxis
Verbal
Com
Social – H
** * *
Social – C
*** ** *
Planning-Idea-H
Planning-Idea-C
*
Total Sensory–H
Total Sensory-C
**
Correlations Among SIPT functions and SPM scores for Children with ASD
Smith Roley et al., 2015

20. •Sample of convenience
•Retrospective chart review
•Diagnoses are via parent report
Critical Finding:
Praxis, vestibular and somatosensory functions
better predictor of social participation
than sensory reactivity
Includes:
Relating to and interacting with peers
Meals, bedtime, grooming & hygiene, getting
ready to go somewhere
Family engagement in neighborhood and
community events

22.  Ayres & Tickle, 1980
 Ben-Sasson et al., 2009
 Dunn, Myles, Orr, 2002
 Crane, Goddard, &
Pring, 2009
 Lane, Young, Baker, &
Angley, 2010
 Liss et al. 2006
 Schoen, Miller, Brett-
Green, & Nielsen, 2009
 Tomchek & Dunn, 2007
 Watson et al., 2011
 Woodard et al., 2012

23.  Adaptability during daily routines
 Remains organized during structured and unstructured
tasks
 Ability to divide attention between two or more focused
tasks
 Ability to monitor own behavior before it becomes a
problem
 Ability to filter and adjust the intensity and duration of
sensation in order to cope in a busy environment
 Ability to sustain homeostasis under varying environmental
demands.
Schaaf, R. and Smith Roley, S. (2006)

24.  Difficulty forming attachments
 Feeding and nutrition problems
 Delayed play and environmental exploration
 Aggressive outbursts / Withdrawal
 Caregiver feeling of incompetence due to unresponsiveness
or excessive irritability of child
 Sleep deprivation interferes with daytime functioning
 Restricts lifestyle of caregivers
Schaaf, R. and Smith Roley, S. (2006)

25. Sensory Perceptual
and Motor
Concerns
in ASD
“We must be able to internally represent objects and
events before play ability, language, and stable emotional
relations can develop. Ayres, 1985”

26.  Decoding information to know what is going on within
the person and in the environment
 Improves motor control with increase sensory feedback
 Initiates engagement in new and novel materials,
setting, activity, people
 Imitates others
 Times and sequences interactions

27. muscle tone
eye hand body coordination
balance & equilibrium
sitting still and upright
attention
speech & language

28. Attachment/Affection
Eating/feeding
Refined touch during fine
motor activities
Exploration of
environments
Attention
Hygiene/toileting

29. Strength & endurance
Graded force and
direction of movements
without running into
things or breaking
something
Using appropriate force
with hand grip or grasp
Gross motor
coordination

30.  Slow to respond
 Inaccurate responses
 Poor awareness of
body, self, others
 Confusion
 Errors such as
mistaking words

31.  Disinterest in fine
motor activities
 Does not engage in
active play during
recess
 Tends to engage in
running or physical play
to the exclusion of
more organized games
or ball play
 Tires easily
 Falls often
 Hits head
 Poor sitting – falls out
of chair
 Leans on people or
desk

32. Praxis Concerns
in ASD
“If one has to think about actions, one is
probably motor planning” Ayres, 1985

33.  Iarocci &
McDonald, p.81

34.  Use of body as a tool
◦ Anticipation
◦ Use of hands
◦ Imitation - Body
◦ Imitation Facial gestures
 Use of Objects
◦ Creative use of objects
◦ Construction
◦ Organization
 Following directions
 Creative ideas

35.  Isolation from peers
 Poor organization
 Poor safety awareness /
increased injuries
 Decreased initiation of
activities
 Poor material management
 Messy with clothing and
personal belongings
 Repetitive play / Less
challenging play
• Increased need for control
• Decreased flexibility and
adaptability
• “Wandering”
• Fearful reactions to new/novel
situations and activities
• Decreased participation and
occupational engagement
Copyright Schaaf, R. and Smith Roley, S. (2006)

36.  4 years 7 month male
 autism
 introverted, sensitive and
intelligent
 avoids being in the
spotlight
 lacks social play skills
with peers
 good at visualizing how
things are put together
 teacher reports concerns
re: speech and language,
behavior and social skills
 parent concerns are
attention to task,
communication, and
social abilities

37. 4 year 7 mo
boy

39.  Autism 1 –16
 © The Author(s) 2014
 Reprints and permissions:
 sagepub.co.uk/journalsPermissions.nav
 DOI: 10.1177/1362361313517762
 aut.sagepub.com

40.  Day 2 – exhausted, slept well
 Day 3 – had such a good time, wanted to
come back to OT
 Day 4 – had a good week at preschool, more
compliant, better transitions, sleeping well
 Day 5 – so much better organized, improved
language, seems like he understands better,
gets himself dressed without much help
Smith Roley, 2015

41. REPORTED BY FAMILIES OF CHILDREN
WITH AN
AUTISM DISORDER

42.  2009 survey sent to all PTN families
 210 total parent responses
 57 indicated child’s diagnosis autism
spectrum and received OT in past year

43. Response
Percent
Response
Count
19.1% 9
21.3% 10
38.3% 18
4.3% 2
27.7% 13
38.3% 18
19.1% 9
36.2% 17
40.4% 19
47
10
skipped question
feeding
grooming
Answer Options
allergies
answered question
bowel and bladder patterns
bathing
If your child has significant difficulties within any of the areas listed below,
please check all that apply.
digestion
dressing
sleep patterns
emotional state/mood

44. Ha s yo ur child ’s p a rticip a tio n in o ur p ro g ra ms ha d a p o sitive
imp a ct o n yo ur fa mily life ?
Yes
No

45. Ha s yo ur child ’s p a rticip a tio n in o ur p ro g ra m ha d a p o sitive
imp a ct o n yo ur child ’s life ?
Yes
No

46. Response
Percent
Response
Count
53.6% 30
42.9% 24
75.0% 42
44.6% 25
58.9% 33
37.5% 21
42.9% 24
46.4% 26
33.9% 19
33.9% 19
56
1
Contributed to feeling hopeful about my child’s future
Helped me explain my child’s behaviors & needs to
Answer Options
Increased my understanding of my child
Assisted me in developing realistic expectations for
Contributed to my greater enjoyment of my child
skipped question
If yes, please check all that apply:
Provided ideas for modifying our home environment to
Decreased my family stress
Provided strategies for managing my child’s behavior
Made it easier to take my child into the community
answered question
Made parenting my child easier
Has your child’s participation in occupational therapy had
a positive impact on your family life?

47. Response
Percent
Response
Count
35.7% 20
57.1% 32
48.2% 27
41.1% 23
28.6% 16
46.4% 26
50.0% 28
26.8% 15
26.8% 15
42.9% 24
56
1
My child is more willing to take risks and try new things
My child is less irritable
Answer Options
My child spends more time engaged in positive
My child has increased confidence
My child is more accepting of variety of textures,
skipped question
If yes, check all that apply:
My child spends more time engaged in positive
My child receives better reports from his or her teacher
My child is more a part of family activities
It is easier for my child to make transitions in his or her
answered question
My child is improving in his or her school performance
Has your child’s participation in occupational therapy had
an impact on your child’s abilities or skills?

48. Response
Percent
Response
Count
42.6% 23
51.9% 28
35.2% 19
51.9% 28
31.5% 17
46.3% 25
35.2% 19
25.9% 14
54
3
My child's handwriting is better
My child has an easier time making and playing with
Answer Options
My child is more organized
My child is doing better at school
If yes, please check all that apply:
My child has increased attention
answered question
My child has improved balance
My child’s language has improved
skipped question
My child has improved coordination
Has your child’s participation in occupational therapy had
an impact on your child’s abilities or skills?

49. Response
Percent
Response
Count
13.0% 6
41.3% 19
19.6% 9
41.3% 19
34.8% 16
4.3% 2
46
11
More explanation (rationale) for selection of
Other (please specify)
Increased participation in actual treatment sessions
skipped question
Answer Options
No additional information needed
On-going consultation with therapist to monitor and
answered question
What, if any, additional information would assist you in helping your child
appropriately participate and cope with every day activities at home and
Provide written schedule of recommended activities

50.  Try to understand the sensory contribution to
behavior
 Reduce extraneous sounds and visual clutter
in the home & classroom
 Infuse body-centered sensory motor activities
into daily routine
 Refer to an Occupational Therapist
Certified in Sensory Integration evaluation &
intervention

52. 0
20
40
60
80
100
In-seat awake
In-seat asleep
0
20
40
60
80
100
In-seat
0
20
40
60
80
100
In-seat
Chairs Balls Chairs Balls
Mon
Mon
Mon
Mon
Mon
Mon
Mon
Mon
Mon
Mon
Mon
Mon
Mon
Calendar Days
Mon
Mon
Mon
Mon
Mon
Mon
Mon
Mon
Mon
Mon
Mon
Mon
Mon
Calendar Days
Mon
Mon
Mon
Mon
Mon
Mon
Mon
Mon
Mon
Mon
Mon
Mon
Mon
Calendar Days
Figure 1
Percentage
of
Intervals
Seated
Percentage
of
Intervals
Seated
Percentage
of
Intervals
Seated
John
Emily
Mike
Novelty
Week
Novelty
Week
Novelty
Week
Schilling & Deitz, 2003

53.  While at school, recess is a critical part of the day and
must not be taken away due to missed work or other
consequence. Vigorous physical activity such as
jumping jacks or push-ups will be a better
consequence and help regain energy and focus on her
work. During breaks, encourage your student to
participate in physically active games with other
children.
 Mobile seating devices such as a peanut ball, ball
chair, sit-n-move cushion or therapy ball
 Visual and kinesthetic supports for all learning
activities in addition to language
 Opportunities to do her work in various positions such
as standing, in bean bag chair, on large pillows
 Zones of Regulation or the Alert Program for Self-
Regulation

54.  Positive behavior support strategies
 Providing chew or fidget toys such as rubber erasers
and stress-balls.
 Heavy work activities such as scooter board, pushing
book carts, performing errands such as carrying boxes
or supplies, playing “tug-of-war,” and climbing on
playground equipment.
 Frequently scheduled activity or callisthenic breaks
 Prepare student in advance for transitions and
expectations in new circumstances such as classroom
changes or social requirements during field trips or
assemblies. Preparation may include understanding
where she needs to go, what will happen, what other
people will be doing, what she is expected to do, how
long it will last, and what happens when it is finished.

55.  Become involved in physical activities during socially
appropriate times, before, during and after school and
through each and every day. This will enable him to
feel like he is solidly in his body, raise his energy level,
and increase his attention and ability to focus.
 Swinging, moving, and spinning are all advised. If he
is having difficulty sitting still, or prior to this demand,
it may help to have him go out and swing for 5
minutes or run around the building. Allow him to
swing and spin as long as he can stay organized.
 Encourage tactile play with a variety of textures and
temperatures and wrestling play with a lot of deep
pressure. He may enjoy being sandwiched in pillows,
wrapped up in a blanket and rolled out, or held snugly
while reading a book, which may feel good to him and
help him increase his body awareness.

56.  Create spaces that he can burrow into such as a tent with pillows and
blankets. He may enjoy playing with a 4 yard length of 60 inch wide
Lycra spandex fabric. He could wrap up in it or use it as a hammock to
swing in. Provide heavy bean bag chairs that he can crawl between and
jump into.
 Jumping, climbing, hanging, pushing and pulling activities will also be
organizing for him. These are particularly useful if your child is feeling
anxious, frustrated, sluggish, or inattentive. Provide opportunities for
him to play on bouncing equipment such as trampoline, bungy swings,
pogo sticks, or jumping boots. Weight bearing games are integrating
such as during wheel-barrow walking.
 Increase awareness of time through use of clocks and stop watches
during fun activities in which he is not required to perform, such as
timing how long it takes to make dinner or start the car.
 Interactive and cooperative games in which different children can make
up and change the directions while maintaining their engagement in the
game will be beneficial.

57.  Provide your child opportunities for jumping and skipping during outside
play. He may like to draw large circles with chalk either on a blackboard
or cement using both hands simultaneously.
 Prepare your child for transitions in advance. He may be more
independent if there is a visual chart of activities that are necessary in
the daily routines such as the elements needed before going to bed or
what is involved in meal preparation and table setting. Set a timer to
give him the temporal cues about how much time he has to complete
independent tasks such as dressing.
 In a neutral atmosphere, explain social expectations and how other
people react in a variety of circumstances. Prepare him in advance for
social situations so that he knows what to expect and how to behave. He
may prefer to either be the first or last one to arrive.
 Active, physical, community based activities such as swimming,
gymnastics, horseback riding, and martial arts are encouraged.
 In order for your child to develop optimally and feel healthy and happy, it
is important that he maintains an active life-style throughout his life.

58.  Sensory Reactivity
◦ Over responsiveness
◦ Under responsiveness
◦ Fluctuating responsiveness
◦ Poorly regulated behaviors
 Vestibular-Proprioceptive
Processing
◦ Security with Movement
◦ Seeking rotation and watching
things spin
◦ Ocular Control
 Head/neck/eye control
 Gaze shifting
◦ Postural Control –
 Head lag
 Asymmetry
 Righting and Equilibrium
 Somatosensory
Discrimination
◦ Seeking touch
◦ Seeking heavy
work/proprioception
◦ Body awareness
◦ Hand use
◦ Graded force and direction of
movements
 Praxis
◦ Transition Movements
◦ Tool use
◦ Exploration of novelty
◦ Exploration of body in space
◦ Imitation
◦ Sequencing
◦ Ideation and complexity in play
◦ Following unfamiliar instructions

59.  Heightened sensitivity to sound, light, touch, smells, and movement, may
misinterpret accidental touch by peers
 May be fussy or irritable, especially with noise or unexpected events
 Diminished sensitivity to pain, certain sounds, and pressure; may be
passive, lethargic or unresponsive. May not communicate about pain
 Peculiar interest in certain sensations like looking at lights, spinning
objects, feeling lint or twirling around. Seeks sensory information which
limits awareness of everything else.
 Self stimulating behaviors such as head banging or rocking that interfere
with social interactions or play, may injure self

60.  Decreased initiation of social contact, making sounds,
bringing toys, movements or indicating desire to share
excitement
 Picky eater, gags with certain textures or smells
 Difficulty visually following people or objects, difficulty
shifting gaze in the classroom

61.  Difficulty orienting self to a person or objects
 Diminished anticipation of caregiver interaction
 Decreased response to someone calling his/her name
 Preference for looking at forehead or mouth instead of eyes when looking
at people
 Difficulty maintaining an upright sitting position, often “props up” head
while leaning on arm
 Poor sitting balance, falls easily, hits head often
 Decreased tendency to look where others look or to use pointing to
engage others’ interest
 Difficulty visually following people or objects
 Difficulty shifting gaze to look where other people are looking

62.  Poor social communication, turn taking and understanding
others’ interests and points of view
 Decreased imitation of games such as peek a boo or hand
gestures in songs
 Delayed use of gestures such as waving bye, bye or blowing
kisses
 Limited repertoire of facial expressions
 Poor tolerance for two- way, back and forth exchanges
 Difficulty accomplishing multi-step routines such as grooming
and managing clothing and backpacks
 Poor tool use such as eating with utensils or drawing with
crayons
 Decreased speech and language abilities
 Difficulty with transitions in place or activities

63.  Sensory Integration & the Child by A. Jean Ayres
 Sensory Integration: Answers for Parents
 Sensory Integration: Answers for Teachers
 Sensory Integration: Answers about Autism
 Sensory Integration: Answers for Mealtime Success
 Applying Sensory Integration Principles Where Children
Live, Learn & Play (DVD)
◦ www.pediatrictherapynetwork.org

64. Susanne Smith Roley OTD, OTR/L, FAOTA
susannesr3@gmail.com
website: www.occupationaltherapyforchildren.net