The Effect of A Two-Week Sensory Diet On Fussy Infants With Regulatory Sens
The Effect of A Two-Week Sensory Diet On Fussy Infants With Regulatory Sens
The Effect of A Two-Week Sensory Diet On Fussy Infants With Regulatory Sens
Score
Postgraduate Student Occupational Therapy Department, School of Therapeutic Sciences, Faculty of Health
Science, University of Witwatersrand
Paediatric Occupational Therapy Practice: Sensory Matters Inc.
Adjunct Professor and Head, Dept of Occupational Therapy Department, School of Therapeutic Sciences,
Faculty of Health Science, University of the Witwatersrand
Senior Lecturer, Occupational Therapy Department, School of Therapeutic Sciences, Faculty of Health
Science, University of the Witwatersrand
ABSTRACT
28
This study investigated the effectiveness of a two-week programme of parent education and a sensory diet to reduce signs of fussiness
in infants identified with Regulatory Sensory Processing Disorder (RSPD). The sensory diet was viewed as a complementary programme
and was based on the Sensory Integration theory of Jean Ayers. The sample consisted of twelve infants who met the diagnostic criteria for
RSPD. Data were gathered using the Infant Toddler Symptom Checklist and a parent interview. Infants were divided into two combined
age bands as prescribed for the administration of the Infant Toddler Symptom Checklist. One group fell into the age band of 7-12
months of age and the other into the 13-24 months age band. Pre and post intervention measures allowed for comparison of data to
determine the effect of the programme.
Findings for this sample indicated a significant reduction in signs of fussiness in both groups (p0.00), with a greater change evident
in the 7-12 month group. The most significant changes were seen in self-regulatory and attachment behaviours. Difficulties with tactile,
vestibular and auditory sensitivities related to sensory processing persisted indicating the need for further sensory integrative therapy.
Parents reported a lack of knowledge and recognition of Regulatory Sensory Processing Disorder in infants by health professionals and
as a result, there had been no referral to occupational therapists for sensory integration therapy in this sample group. Despite the small
sample size, the results contribute to the emerging understanding of the influence of sensory modulation on dysfunctional infant behaviour.
Key words: Regulatory Sensory Processing Disorder, Sensory Integration, Sensory diet, Infant Toddler Symptom Checklist, Fussy infants
INTRODUCTION
LITERATURE REVIEW
Sensory Integration was described by Ayers in 1972 as the neurological processes that organises sensation from ones own body
and from the environment and makes is possible to use the body
effectively within the environment10:103.
Sensory integration intervention has been said to emphasise
an approach which addresses the sensory needs of the child in
order for the child to make adaptive and organised responses to a
variety of circumstances and environments11:17. Ayers theory of
SA Journal of Occupational Therapy
South African Journal of Occupational Therapy Volume 43, Number 3, December 2013
South African Journal of Occupational Therapy Volume 43, Number 3, December 2013
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to fall and stay asleep was influenced by specific sensory modulation difficulties related to auditory, tactile or vestibular processing.
METHODS
Research procedure
A telephonic screening interview was carried out with the parent
that contacted the researcher to ensure that infants met the inclusion criteria and to obtain informed consent for participation in the
study. If this was the case the parent was invited to participate in the
study. Appointments were made at their convenience at their home,
work or the researchers private practice for interview purposes.
Three data collection tools were used to collect the preintervention data. Firstly a questionnaire was completed by the
parent that detailed demographic information, medical details of
the pregnancy and birth of the child.
The researcher interviewed the parent to explore the infants
history and symptoms of fussiness. Survey questions about the
parents knowledge of RSPD, what help the parent had sought
regarding their childs fussiness and the effectiveness of this help
were included in the interview. Finally the parent was asked to
complete the parent self-report Infant-Toddler Symptom Checklist
(ITSC)2, which was then scored and reviewed by the researcher.
The ITSC assesses self-regulation, attention, touch, movement,
listening and language, looking and sight as well as attachment and
is a valuable tool for occupational therapy as it focuses on occupational performance areas like sleep, eating or feeding, dressing,
bathing, in which the parents experience their infants fussiness.
The ITSC was designed for the 7- to 30-month age range, with six
checklists that cover five different age bands, 7 to 9 months, 10 to
12 months, 13 to 18 months, 19 to 24 months, and 25 to 30 months.
Cut off scores which indicate regulatory and sensory disorders are
provided for each age band2.
The intervention consisted of two parts namely parent education and the provision of the sensory diet. Parents were educated
about RSPD and sensory modulation. The impact of the condition
on occupational performance in sleep, feeding and attachment were
presented verbally using supporting diagrams.
The two-week sensory diet home programme was prescribed
for each infant and designed to address each infant participants
specific sensory and behavioural dysfunction based on information
obtained from the ITSC and the interview questionnaire.
Following the intervention, the parent completed the second
ITSC and provided feedback on the effects of the implemented
sensory diet. The ITSC was scored by the researcher and the parents progress report was reviewed.
For analysis purposes the sample was divided into two groups
(7 - 12 months and 13 - 24 months) due to the clustering of the
behavioural domains assessed and the at-risk criteria for dysfunction which differ for the age bands on the ITSC2.
The pre and post-intervention total ITSC scores were compared
to the RSPD criteria indicating dysfunction2. Non-parametric statistics were employed due to the small sample size (n= 12) and the
Wilcoxon Signed Rank Test was used to analyse whether change
had occurred30.
RESULTS
South African Journal of Occupational Therapy Volume 43, Number 3, December 2013
Table 1: Initial and post intervention scores on the Infant Toddler Symptom Checklist for the total sample (n=12)
Initial Scores
Post Intervention Scores
Mean(SD) Mean (SD)
Self Regulation
6.25(3.05)
3.00(2.30)
Sleep
2.50(1.93)
1.42(1.83)
Feeding
0.50(1.24)
0.33(0.78)
Tactile stimuli
2.42(1.98)
2.08(2.61)
Vestibular stimuli
1.00(1.35)
1.17(1.34)
Auditory stimuli
1.00(1.60)
1.42(1.51)
Visual stimuli
0.83(1.03)
0.67(0.98)
Attachment
2.75(1.54)
1.08(1.31)
Concentration
1.67(1.97)
0.40(0.89)
TOTAL
18.83(6.27)
16.58(8.72)
p value
Effect size
0.01
ns
ns
ns
ns
ns
ns
0.05
ns
0.00
1.59
0.80
0.13
0.21
-0.12
-0.26
0.16
1.08
0.64
1.47
31
Figure 1: Change in total scores on the Infant Toddler Symptom Checklist for 7-12 month old participants (n=6)
compared to the 13-24 month old participants (n=6)
Significant improvement was found for self-regulation (p 0.01)
and attachment (p 0.005). Effect size for self-regulation after the
intervention was 1.59.
Parents were asked to identify when signs of RSPD were first noted
in their infant. Six reported that their infant was fussy from birth
and three from six weeks old. Another two reported the fussiness
starting between four and six months and one parent stated that
the fussiness was only noted from 7 months. When asked to rate
their greatest concerns in relation to RSPD, parents were most
concerned about sleep (35%), self-regulation and feeding (13%),
followed by attachment (8%).
The parents sought advice from multiple sources to deal with
their infant with all parents having sought advice from their paediatricians and clinic sisters (Figure 2 on page 32).
Only one parent reported that they had heard of RSPD and
nine other parents felt that knowledge about the condition and the
possibility of intervention would have resulted in relief and a more
positive response. Three sets of parents preferred that their infant
not be given a specific diagnosis.
None of the infants in the study had been referred for occupational therapy but three parents had heard of Sensory Integration from colleagues or experienced it in therapy with their older
children.
DISCUSSION
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South African Journal of Occupational Therapy Volume 43, Number 3, December 2013
CONCLUSION
Although this study was conducted on a small sample, it demonstrated a significant change after the two-week intervention
period. It also provided valuable information for current practice in
South Africa regarding the lack of awareness of RSPD and knowledge of Ayres Sensory Integration based occupational therapy
as a therapeutic intervention to assist in managing this condition.
This study obtained valuable information pertaining to RSPD
in infant participants, regardless of the small sample size. The
study showed that parents recognised children as being unusually fussy within a very short period after birth (75% before 6
weeks), but they did not recognise it as a condition which might
require intervention. This might be because these infants were
confirmed by paediatricians as being medically healthy. Other
health professionals did not recognise that unusual fussiness may
be indicative of RSPD and therefore did not know how to advise
parents or refer them to an occupational therapist. The fact that
the diagnostic manual describing RSPD is not commonly used in
South Africa contributes to this problem.
The results of this study contribute to the emerging understanding of the potential benefits of a sensory diet as an early
intervention to reduce fussiness in infants. Despite the fact that
the results cannot be generalised before further research with a
large sample, it may guide occupational therapy Sensory Integration practice to explore the use of similar strategies required
for infants presenting with RSPD in clinical practice. The study
suggested that infants presenting with high attachment and poor
self-regulation scores may benefit from parent education and a
sensory diet home programme to manage RSPD. Those presenting
with specific and severe sensory-based processing difficulties may
require individualised Sensory Integration therapy by a certified
occupational therapist.
References
South African Journal of Occupational Therapy Volume 43, Number 3, December 2013
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Corresponding Author
Jacqueline Jorge
[email protected]
Senior Lecturer, Department of Occupational Therapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of
the Witwatersrand
E Learning Co-ordinator, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand
ABSTRACT
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The Sensory Profile is useful in assisting with diagnosis of certain conditions which present with different sensory processing patterns.
The purpose of this study was to compare the Sensory Profile for children with Specific Language Impairment (SLI) (n=22) to a typical
pattern, as well as the reported profiles of samples with autism and Attention Deficit/Hyperactive Disorder (ADHD). The SLI sample
had significantly more sensory processing difficulties than the typical population in all aspects. The Sensory Profile for both the autism
and ADHD samples differed significantly from that of the SLI sample for H. Modulation Related to Body Position and Movement and
Factor 6: Poor Registration. The SLI sample showed fewer sensory processing problems except for J. Modulation of Sensory Input Affecting
Emotional Responses, M. Behavioural Outcomes of Sensory Processing and Factor 9: Fine motor/perceptual indicating that this small
sample of children with SLI did present with a unique Sensory Profile pattern.
Introduction
Literature review
The development of the Sensory Profile progressed from the
ground breaking work that was initially done by Jean Ayres on
South African Journal of Occupational Therapy Volume 43, Number 3, December 2013