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Kala Samayan,
Audiologist and
speech pathologist,
National Institute
for Empowerment of
Persons with Multiple
Disabilities, Chennai,
Tamil Nadu, India;
Kunju Dhanavendan,
Special needs educator,
National Institute
for Empowerment of
Persons with Multiple
Disabilities, Chennai,
Tamil Nadu, India;
Raut Nachiketa,
Associate professor of
speech and hearing,
National Institute
for Empowerment of
Persons with Multiple
Disabilities, Chennai,
Tamil Nadu, India.
Correspondence to:
Kala Samayan
E-mail:
kalasamayan21@hotmail.com
167
Research
Methods
Participants and setting
A convenience sample was used in this study,
comprising 30 allied health professionals
(physiotherapist=4; occupational therapist=4;
speech pathologist=2; paediatrician=1; physical
medicine and rehabilitation specialist=1;
psychologist=3; special needs educator=11;
social worker=3; vocational instructor=1) with
a minimum of three years experience working
with children with developmental and behavioural
disorders within a multidisciplinary team.
168
Procedure
A face-to-face interview in a one-to-one
setting was conducted in a quiet room using a
semi-structured interview questionnaire on
challenging behaviour. The questionnaire
was developed specifically for this study and
based on examples of challenging behaviours
in children with sensory processing disorders,
as identified by Sher (2009) (Appendix 1). The
included examples examined four main sensory
processing systemsvestibular, proprioceptive,
tactile and auditoryand were further classified
as either hypersensitivity (over-responsiveness)
or hyposensitivity (under-responsiveness) to
sensory stimuli. The questionnaire was validated
by six allied health professionals, including two
occupational therapists, two speech pathologists,
a psychologist and a special educator. A total
of ten questions were included in the final
version of the questionnaire: eight questions
related to behaviours exhibited owing to
sensory processing disorders and two questions
on behaviours exhibited not due to sensory
processing disorders (Figure 1).
Before beginning the interview, participants
were briefed about the purpose of the study.
Interviews were conducted by two of the authors;
one author conducted the interview while the
other noted down the participants responses.
Participants received the following instructions:
We are trying to elicit how different
allied health professionals perceive
the roles of different members of the
multidisciplinary team in managing
challenging behaviours. I will now read
out ten behaviours, which may or may not
be challenging behaviours in children.
Iwill now give you a list of the ten
behaviours. As I read out each behaviour,
please answer the four accompanying
questions that are listed, keeping in
mind that the behaviour mentioned is
observed in children aged between five
and eightyears. No additional information
about the child will be provided. You
are free to say I do not know, The
information provided is inadequate,
Iam not sure, or pass the question.
Results
Participant responses are presented in Table 3.
On average, less than a quarter of participants
could identify the cause (17%) and management
(19%) of behaviours due to sensory processing
issues, while a slightly larger proportion of
participants were able to identify the aetiology
(38%) and management (34%) of behaviours due
to non-sensory processing issues. With regard to
challenging behaviours due to sensory processing
disorders, the aetiology and management of
proprioceptive hyper- (B5) and hyposensitivity
(B6) and auditory hyposensitivity (B8) were least
understood by participants, while the aetiology
and management of antisocial behaviours (B9
and B10) were the most understood.
In the final section of the questionnaire,
over 67% of participants rated themselves
as confident and competent in handling
challenging behaviours. Although the majority
(81%) of participants had come across most of
the behaviours and considered most of these
as challenging behaviours, less than a quarter
(21%) of participants could identify the causative
role of sensory processing disorders and hence
did not identify the use of sensory integration
therapy in managing these behaviours.
Additionally, although participants demonstrated
Behaviours
(n=10)
Sensory
processing issue
(n=8)
Vestibular
(n=2)
Non-sensory
processing issue
(n=2)
Proprioceptive
(n=2)
Tactile
(n=2)
Auditory
(n=2)
Description
B1
Vestibular hypersensitivity
Yes
B2
Vestibular hyposensitivity
Yes
B3
Tactile hypersensitivity
Yes
B4
Tactile hyposensitivity
Yes
B5
Proprioceptive hypersensitivity
Yes
B6
Proprioceptive hyposensitivity
Yes
B7
Auditory hypersensitivity
Yes
B8
Auditory hyposensitivity
Yes
B9
Antisocial behaviour
No
B10
Antisocial behaviour
No
Rating
Expected answer
Mostly incorrect
Partly correct
Correct
169
Research
Type
Question
B1
B2
B3
B4
B5
B6
B7
B8
B9
B10
Yes/no questions
Percentage of
yes responses
76.6
86.6
90.0
63.3
80.0
90.0
66.6
83.3
90.0
86.6
90.0
100.0
96.6
73.3
90.0
93.3
70.0
56.6
83.3
83.3
Open-ended
questions
Percentage of
correct answers
24.4
26.7
36.7
20.0
3.4
0.0
23.4
3.4
50.0
26.7
30.0
30.0
26.7
26.7
10.0
10.0
10.0
6.7
34.4
33.4
Discussion
Sensory integration disorders vary between
individuals in their characteristics and
intensity. In some, the disorder is barely
noticeable, while others have trouble with
daily functioning. Children can be born
hypersensitive or hyposensitive to varying
degrees and may have trouble in one sensory
modality, a few, or all of them. Children who
receive the diagnosis of sensory integration
dysfunction should also be observed for signs
of anxiety problems, ADHD, food intolerances,
behavioural disorders and autism. Genetic
problems such as Fragile X syndrome should
be looked into as well (Baranek, 1999).
In this study, four behavioursvestibular
hypersensitivity (B1), tactile hypersensitivity
(B3), proprioceptive hypersensitivity (B5) and
auditory hypersensitivity (B7)were identified
as being caused by sensory hypersensitivity.
Hypersensitivity is caused by an over-reaction
of the normal protective senses, resulting in
social and emotional problems, including hypervigilance, anxiety and aggression (Wilbarger,
1995). Symptoms vary widely and include:
n A dislike of being touched
n Feeling discomfort or pain from clothing
rubbing against skin
n Dislike for foods with mixed textures
n Discomfort when one looks directly into the
eyes of another person
n Exaggerated startle reflex
n Dislike of complex visual stimuli, such as fastmoving objects or colours.
A further four behavioursvestibular
hyposensitivity (B2), tactile hyposensitivity (B4),
proprioceptive hyposensitivity (B6) and auditory
hyposensitivity (B8)were identified as being
caused by sensory hyposensitivity. Hyposensitivity
is characterised by an unusually high tolerance
for environmental stimuli, and a child with
hyposensitivity might appear restless and seek
sensory stimulation (Ben-Avi et al, 2012).
170
Limitations
The results of this study cannot be generalised
to all allied health professionals who work with
children with developmental and behavioural
disorders given the small size of the sample.
Additionally, as only staff from the National
Institute for Empowerment of Persons with
Multiple Disabilities, India, were recruited to
participate in this study, it cannot necessarily be
inferred that all allied health professionals have
the views expressed in this study.
ConclusionS
Although the majority of the participants had
come across most of the behaviours identified
in the questionnaire and considered nearly all
of these as challenging behaviours, less than
a quarter of participants could identify the
correct aetiologies or treatment strategies. Thus,
there is an urgent need to develop training
programmes focusing on sensory integration
and basic applied behavioural analysis. This
would facilitate multidisciplinary working and
IJTR
improve professional understanding.
Key points
n Challenging behaviours in children with developmental and behavioural
disorders may be observed due to sensory processing disorders
n Sensory-based therapies have been used increasingly by occupational therapists
in the treatment of children with developmental and behavioural disorders
n There is an urgent need to develop training programmes focusing on
sensory integration to facilitate multidisciplinary working.
Function
B1
Trampoline
B2
Therapy ball
B3
Sand bath
B4
Visual stimulation
through lights
B5
Ball pool
B6
Balancing board
B7
Ladder
B8
Vibrator
B9
Tunnel
B10
Swing
Alerting activity
Calming activity
Touch
Vestibular
Proprioceptive
Visual
Hearing
Smell
Taste
171
Research
Appendix I. Participant questionnaire
SECTION 1 BACKGROUND INFORMATION
Name:
Age/gender:
Professional qualification:
Years of experience:
Designation:
SECTION 2 PERCEPTIONS ON BEHAVIOURS
For each behaviour, please answer the four accompanying questions listed below. When answering these questions,
keep in mind that the behaviour mentioned is observed in children aged between five and eightyears. No additional
information about the child will be provided. You are free to say I do not know, The information provided is
inadequate, I am not sure, or pass the question.
Behaviour 1
The child does not like getting into the lift or sitting on the seesaw and does not like being carried.
Behaviour 2
The child constantly rocks his body, is constantly moving and loves swinging.
Behaviour 3
The child does not like to be touched or wearing body-fitting clothes. The child avoids doing any activities that involve
touching semi-solid materials such as clay and gum.
Behaviour 4
The child likes to chew toys and will indicate if he gets hurt.
Behaviour 5
The child has difficulty with feeding and dressing. The child often spills her food and cannot manage zips and buttons.
Behaviour 6
The child has the habit of grinding her teeth and hitting her head on the wall whenever she is unoccupied.
Behaviour 7
The child shows feelings of distress when loud music is playing and does not seem to be able to understand oral instructions
well in a noisy environment.
Behaviour 8
The child enjoys listening to music constantly.
Behaviour 9
The child keeps disturbing the child sitting next to him.
Behaviour 10
The child steals things that belong to other children.
SECTION 3 ABILITY TO MANAGE CHALLENGING BEHAVIOURS
172
On a scale of 04, how comfortable are you working with children with challenging behaviours:
Not at all
Very comfortable and
comfortable
and confident
0
1
2
3
4
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