The Sensory Perception Quotient (SPQ) and autism

Today I'd like to bring to your attention the paper by Teresa Tavassoli and colleagues [1] (open-access) who talked about the development of the Sensory Perception Quotient (SPQ), a new tool designed to assess "basic sensory hyper- and hyposensitivity" across our basic senses, specifically with the autism spectrum conditions (ASCs) in mind. For those who follow the IMFAR meetings, you might have already heard something about the SPQ in previous years (see here).

The purpose of the Tavassoli paper was three-fold: (i) assess how valid and reliable the SPQ was against a rival tool looking at the sensory domain: the SensOR Inventory [2], [ii] "to investigate if adults with and without ASC show differences on the SPQ" and (iii) to look at whether/how sensory issues linked to the signs and symptoms of autism, via use of another quotient, the Autism-Spectrum Quotient (AQ).

The results: well, bearing in mind everything was done on-line: "The SPQ shows good internal consistency and concurrent validity and differentiates between adults with and without ASC". Also: "greater sensory sensitivity is associated with more autistic traits".

Obviously there is quite a bit more to do on the SPQ before anyone gets too carried away, including the possibility of examining a broader sensory phenotype if the findings by Mirko Uljarević and colleagues [3] survive replication. The fact that participants were all adults and all able to self-report is an important point to make about the Tavassoli study, as were their scores on the [adapted] Raven's Progressive Matrices looking at cognitive functioning putting those on the autism spectrum in the typical range on a par with control participants. As an aside, I'm happy that Raven's was used in this trial given some conversations I remember having with the late Ann-Mari Knivsberg who was a big fan of this schedule.

As the authors note, the inclusion of sensory issues into the revised DSM-5 diagnostic schedule means that there is going to be a lot more focus on these issues as and when the DSM-5 starts picking up diagnostic momentum around the world. More than that though, the authors importantly talk about how the SPQ might be a useful aid to those archetypal all-rounders, the OTs, in "assessing the sensory needs of people with autism". Surely anything that helps them do their job more efficiently and person-centred has got to be a good thing.

To close, a new Flash Gordon movie potentially due? How can they possibly improve on the last one... Flash, ah, ah... (by Queen).

----------

[1] Tavassoli T. et al. The Sensory Perception Quotient (SPQ): development and validation of a new sensory questionnaire for adults with and without autism. Molecular Autism 2014, 5:29

[2] Schoen SA. et al. Pilot study of the Sensory Over-Responsivity Scales: assessment and inventory. Am J Occup Ther. 2008 Jul-Aug;62(4):393-406.

[3] Uljarević M. et al. First evidence of sensory atypicality in mothers of children with Autism Spectrum Disorder (ASD). Molecular Autism 2014, 5:26.

----------

Tavassoli, T., Hoekstra, R., & Baron-Cohen, S. (2014). The Sensory Perception Quotient (SPQ): development and validation of a new sensory questionnaire for adults with and without autism Molecular Autism, 5 (1) DOI: 10.1186/2040-2392-5-29

Qigong and the Jedi massage

Please do not take any offence with the title of this post. I merely pass comment that Qigong, the practice of 'aligning breath, movement and awareness to restore balance', looks on paper similar to Qui-Gon (the Star Wars character played by Liam Neeson). Indeed I wouldn't be surprised to learn that George Lucas hadn't invented the character's name on purpose to be so similar given that ever-so skillful martial art-type philosophy and movements the hapless Jedi employed during the Star Wars saga. To any followers of Jediism, may the force be with you.

As you might imagine, some of the tenets of Qigong theory 'clash' with the more contemporary medical model of health and illness. I don't want to go too deeply into the reasons why (peer-reviewed evidence, etc) but it is perhaps as a result of this clash that Qigong and related schools of thought are often looked down on in comparison to the usual body-medicine-health evidence-based model. The word 'woo' tends to be used quite a bit.

Things seem to be changing however. A recent peer-reviewed paper caught my eye with regards to Qigong massage and autism which, I have to say, has slightly altered my opinion of the whole mind-body aspect. I should point out that I was never particularly adverse to the message of such things, particularly given the seemingly-evolving body of published work on 'mindfulness' in relation to psychology. A friend of mine, Chris Mitchell whose blog appears at the foot of this blog, has also written and talked quite a bit about his experience of mindfulness in relation to Asperger syndrome, which has also contributed to my interest in such concepts. Whether the effect is real or due to something else, I don't know, but if it works, it works.

The paper (full-text) by Silva and colleagues* describes results from a randomised-controlled trial (RCT) of Qigong massage delivered by parents to their young children with a diagnosis of autism (n=24) compared with a life-as-usual autism comparison group (n=18). There were a few other points of analysis regarding the use of home and dual programmes but I won't on this occasions travel too far into the wheres and whys because the paper is open-access and I don't have the time to make this a mega-post. Suffice to say, allowing for the relatively small participant groups and the possibility that more focused attention from parents on children might have played a role, the results did suggest some significant effects in the intervention group.

There are a number of potential messages to take home from this and other papers (admittedly from the same author group) suggestive of some effect. First is the role of occupational therapy to conditions like autism. I have previously sung the praises of good occupational therapy on this blog, which I assume is going to be the best discipline to help with such manual practices. Second is that like in other chronic conditions such as CFS, massage therapy and all that goes with it, is not necessarily the same as other complementary therapies. My coming from research which has looked at dietary intervention in relation to autism, I know a little bit about the 'label' of complementary medicine and the often 'negative' connotations that it brings. In this case, I offer no opinion on whether things like mind-body, energy or homeopathic schools of thought work or not for autism or anything else; rather that the patting, shaking and pressing movements of Qigong massage might produce tangible benefits for some children with autism (and probably their parents well-being also). Finally, I think there is a need for more experimental investigations of such hands-on therapies. Massage and autism to many conjures up images of Temple Grandin and her squeeze machine. I do also wonder whether some of the processes of Qigong massage could be incorporated into other early interventions and onwards what the cumulative effects on symptom presentation might be. Research and scientific method are the watch-words.

For now... deep breaths, relax those muscles and try to listen to your body.. your breathing, your heart beating, shutting out everything around you. Take it away** (but perhaps don't drive or operate heavy machinery anytime soon after this).

*Silva LM. et al. Early intervention for autism with a parent-delivered Qigong massage program: a randomized controlled trial. Am J Occup Ther. 2011; 65: 550-559.

** Renata Scotto & Mirella Freni "Canzonetta sull' aria".

Occupational therapy and autism: the archetypal all-rounder

I will readily admit that I have always been a little bit confused when it comes to occupational therapy (OT). Confused because the name 'occupational therapy' does not really provide the most satisfying answer as to what occupational therapy involves and in what ways occupational therapists can help. There are various definitions on the web about OT; probably the most satisfying that I have found is this one from NHS careers, although I tip my hat to the Wikipedia entry also.

Basically OT is all about enabling people who otherwise might be described as disabled. OT covers a lot of ground in terms of who therapists work with (people with physical and mental health problems, older people, etc), but generally their role includes: (a) looking at everyday tasks and seeing how they are carried out and might be done differently to either make life easier or fit in with a persons strengths and weaknesses, (b) providing advice and help in making referrals to other support agencies, (c) providing advice on speciality equipment, adaptations or training which might improve a person's quality of life. I was quite surprised when I read this job description because in my ignorance, I had always assumed that solving problems with mobility and movement was the mainstay of the profession. I admit I was wrong and apologise to occupational therapists everywhere.

Given the job description for an occupational therapist, one could perhaps see how the profession might be of some use to people diagnosed with an autism spectrum condition for various reasons. Lisa Jo Rudy at About.com provided a good overview a few years back of some of the ways that OT might help, coupled with quite a few 'glowing' reports on the use of OT available on the web. The American Occupational Therapy Association also have a good overview of OT and autism. When it comes to the research-side of things, there are quite a few studies that have utilised facets of OT and produced some quite surprising data. Various areas of interest have been reported on including:

• Sensory issues (see here and here)
• Motor and movement abilities (see here)
• The use of animal-assisted therapies (see here and here)
• Employment issues (see here)
• Relationships and social interactive behaviours

I get the impression that OT is the hidden 'all-rounder' for many different conditions including autism. An all-rounder because OT seems to be the group which are supposed to provide the 'overview' of what might be best practice to bring out the best of an individual, day-to-day. Making day-to-day living easier is the goal of many interventions related to autism, for early behavioural and speech and language therapy, through to things like dietary intervention, although often any benefits are more generalised. OT is perhaps at the coal-face because of its emphasis on practical daily living skills and tangible benefits from things like a person learning to dress themselves or using assistive technologies to communicate. Another issue that strikes me from looking at the various information on OT is that whilst having being evaluated for effectiveness, many of the strategies used are quite individualised, hence quite difficult to empirically test under normal experimental conditions (n=1 perhaps?). This combines with the fact that OT normally works alongside other professions such as speech and language therapy; deciphering what is having an 'effect' is perhaps secondary to the cumulative effect from such combined efforts.

I end this post therefore with a salute to occupational therapy; the archetypal all-rounder.