ILOTA Communique December 2017 Communique | Page 18

Stephanie McCammon, MS, OTR/L
Reframing My Approach to Sensory Intervention
As occupational therapy practitioners working in
any practice area we are trained to observe supports
and barriers to functional performance. We have
many tools and resources to move a person toward
the life they most want to lead. In my current
role as the occupational therapist on an inpatient
psychiatric unit for children and adolescents, I
use a variety of tools to address and intervene
with primarily psychological barriers to function.
One of those tools is an evidence based approach
called Acceptance and Commitment Therapy
(ACT – pronounce like the word) whose aim is to
increase psychological flexibility. The research on
ACT tells us that when you increase psychological
flexibility it is likely to result in improved function
and sustained engagement in valued occupations.
An ACT approach focuses on developing awareness
and acceptance of thoughts, feelings, and sensations,
as well as intentional actions based on a client’s
values.
Another tool in my toolbox is the Sensory
Profile. I administer the Sensory Profile or Short
Sensory Profile to create a sensory diet and then
talk very specifically about ways to regulate sensory
inputs. In the past, using the sensory profile would
often focus my interventions on ways of reducing
or avoiding identified sensory sensitivities. As I
started getting familiar with ACT I struggled with
questions about how these two approaches might be
in conflict, might overlap, and might complement
each other. For example, the evidence underpinning
ACT would suggest that efforts to avoid or suppress
unwanted sensory experience would likely result in
reduced psychological flexibility.
Recent work with two adolescent clients raised
my interest in the interaction between sensory and
ACT approaches to support functional performance.
Could increasing the ability of the client to notice
and discriminate sensory experience lead to a more
psychologically flexible relationship with feelings
like anxiety and fear? Could I use ACT language
to build a framework that would help the client
to make choices not in the service of avoidance
of a feeling or sensation but instead to accept this
internal reality and take actions towards a more
value-driven life?
One of my client’s was a 14 year old girl who
was admitted to our unit for depression and anxiety.
When asked her about valued life roles and activities,
she indicated that she wanted to spend more
time with friends and family. Her self-identified
barriers to function included feelings of sadness,
hopelessness and anxiety as well as active avoidance
of sensory inputs. She reported her anxiety as the
reason she avoided eating in the cafeteria with
friends and attending church with family. I decided
to follow up by having her complete a Short Sensory
Profile to identify specific sensory experiences were
impacting her ability to engage in valued activities.
In reviewing results of the Short Sensory Profile
she was able to link her sensory sensitives to sound
and light to her difficulty participating in valued
activities and the impact on the relationships with
friends and family. Her response was interesting in
that she had never considered that by addressing her
sensory needs she could impact thoughts, feelings
and behavioral choices.
I had a similar experience with a 15 year old
girl who identified sensory sensitivity as increasing
emotional distress. When asked how she responds
when anticipating or experiencing more intense
sensory input, she described feeling anxious and
fearful when anticipating being in places where
she will have contact with strangers and when she
is without family contact. She identified going to
the grocery store, spending time alone at home and
going to amusement parks as places that she wants
to be able to go. On the Short Sensory Profile she
was in the definite difference range in the areas of
tactile sensitivity, movement sensitivity, low energy/
weak and visual/auditory sensitivity. The client
was eager to share this information with her family
as she reported feeling validated and empowered.
After this client was discharged from the unit,
her outpatient psychiatrist contacted me to ask
additional questions about addressing sensory needs
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