To start season two, we are extremely privileged to be joined by Dr Susanne Smith Roley. Dr Smith Roley is an occupational therapist with over 40 years of experience in paediatric practice. She has been at the forefront of Ayres’ Sensory Integration research and clinical practice for many years and along with Dr Zoe Mailloux, is a founding partner of CLASI (Collaborative for Leadership in Sensory Integration) and first-generation student of Dr Jean Ayres. With CLASI, she is providing a sensory integration certificate education program, offered in many countries around the world. In this episode Susanne discusses draws on her years of experience in OT and SI, how she got into OT in the first place, current research and the challenges within the school system for children with additional needs - amongst other things.
Throughout the chat, Susanne makes reference to aspects of SI research and the role of her organisation, CLASI. Links to some of these areas can be found here.
Understanding the Nature of Sensory Integration with Diverse Populations
Newell Kephart – brief biography
ISIC Program
https://www.cl-asi.org/program
International Council for Education in Ayres Sensory Integration
CLASI
Previous Podcast with Dr Susanne Smith Roley - OT school house
https://www.otschoolhouse.com/single-post/sensory-63)
ASI 2020 Vision
https://sites.google.com/site/2020asivision/home
2019 Article by Lane et al. on the Neural foundations in Ayres Sensory Integration
https://www.researchgate.net/publication/334103176_Neural_Foundations_of_Ayres_Sensory_IntegrationR
A selection of current evidence-based research regarding the use of Ayres' Sensory Integration for children with Autism Spectrum Disorders.
Bodison, S. C., & Parham, L. D. (2018). Specific sensory techniques and sensory environmental modifications for children and youth with sensory integration difficulties: A systematic review. American Journal of Occupational Therapy, 72, 7201190040.https://doi.org/10.5014/ajot.2018.029413
Bodison, S. C. (2015). Developmental dyspraxia and the play skills of children with autism. American Journal of Occupational Therapy, 69, 6905185060. http://dx.doi.org/10.5014/ajot.2015.017954
Hume, K., Steinbrenner, J.R., Odom, S.L., Morin, K.L., Nowell, S.W., Tomaszewski, B., Szendrey, S., McIntyre, N.S., Yucesoy‑Ozkan, S. Savage, M.N. (2020). Evidence‑Based Practices for Children, Youth, and Young Adults with Autism: Third Addieeration Review.Journal of Autism and Developmental Disorders.https://doi.org/10.1007/s10803-020-04844-2
Lamash, L., Grady-Dominguez, P., Mailloux, Z., Parham, L. D., Schaaf, R. C., Smith Roley, S., & Gal, E. (2022). Brief Report—EASI Praxis tests: Age trends and internal consistency.American Journal of Occupational Therapy, 76, 7602345020.https://doi.org/10.5014/ajot.2022.049145
Odom, S.L., Hall, L.J., Morin, K.L., Kraemer, B.R., Hume, K.A., McIntyre, N.S., Nowell, S.W., Steinbrenner, J.R., Tomaszewski, B., Sam, A.M., DaWalt, L. (2021). Educational Interventions for Children and Youth with Autism: A 40‑Year Perspective.Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-021-04990-1
Omairi, C. (2022). Effect of occupational therapy using Ayres Sensory Integration®: A randomized trial. American Journal of Occupational Therapy. https://research.aota.org/ajot/article/76/4/7604205160/23325/Occupational-Therapy-Using-Ayres-Sensory
Pfeiffer, B., Frolek Clark, G., & Arbesman, M. (2018). Effectiveness of cognitive and occupation-based interventions for children with challenges in sensory processing and integration: A systematic review. American Journal of Occupational Therapy, 72, 7201190020. https://doi.org/10.5014/ajot.2018.028233
Schaaf, R. C. (2011). Interventions that address sensory dysfunction for individuals with autism spectrum disorders: Preliminary evidence for the superiority of sensory integration compared to other sensory approaches. In B.Reichow, P.Doehring, D. V.Cichetti, & F. R.Volkmar (Eds.), Evidence-based practices and treatments for children with autism (pp. 245–273). New York: Springer. https://doi.org/10.1007/978-1-4419-6975-0_9
Schaaf, R. C., Benevides, T., Mailloux, Z., Faller, P., Hunt, J., van Hooydonk, E., . . . Kelly, D. (2014). An intervention for sensory difficulties in children with autism: A randomized trial. Journal of Autism and Developmental Disorders, 44, 1493–1506. https://doi.org/10.1007/s10803-013-1983-8
Schoen, S.A., Lane, S.J., Mailloux, A., May-Benson, T., Parham, L.D., Smith Roley, S. & Schaaf, R.C. (2018). A Systematic Review of Ayres Sensory Integration Intervention for Children with Autism. Autism Research, 1-14_._ https://onlinelibrary.wiley.com/doi/full/10.1002/aur.2046
Smith Roley, S., Mailloux, Z., Parham, L. D., Schaaf, R. C., Lane, C. J., & Cermak, S. (2015). Sensory integration and praxis patterns in children with autism. American Journal of Occupational Therapy, 69, 6901220010. http://dx.doi.org/10.5014/ajot.2015.012476
Michael: Hello, and welcome back for a second season of the integration station. Your go to pediatric occupational therapy podcast. Run by the OTFC group. The integration station strives to support and empower parents, caregivers, and therapists involved with the neuro divergent community and connect listeners from around the globe to explore and celebrate the role of Ayres' sensory integration and occupational therapy.
As some previous listeners may notice there is a different voice hosting the show. My name is Michael, and I'm an OT at the OTFC group. Dino and I will be joining guests to discuss a bit about their professional and personal life, share stories and engage in conversations to provide an insight into the people we are fortunate to meet every day to start season two, we are extremely privileged to be joined by Dr Susanne Smith Roley OTD, OTR/L, FAOTA
Dr. Smith Roley is an occupational therapist with over 40 years of clinical experience in paediatrics. She has been at the forefront of Ayres' sensory integration research and clinical practice for many years. And along with Dr. Zoe Mailloux is a founding partner of CLASI, the collaborative for leadership in sensory integration, and a first generation student of Dr. Jean Ayres. With CLASI, she's providing a sensory integration certificate education program offered in many countries around world. She has been able to successfully balance private practice and academic life. And most recently has been instrumental in the development of one of the most important contributions to Ayres' sensory integration, the sensory integration assessment, the EASI evaluation in Ayres' sensory integration.
She's the co-author of one of my favorite SI texts. Sensory integration for diverse populations and her list of publications, work history, honors and leadership positions are so numerous they warrant their own podcast. There were four major events that occurred in 1977.
The apple two was released.
Star wars hit the screens.
The great Elvis Presley died.
And Dr. Suanne Smith Roley became certified in sensory integration.
And like those mentioned above. Dr. Smith Roley's legacy continues today. She joins us before she goes off to take some of the OTFC staff for CLASI module six.
Susanne started with a story about an adult she recently assessed as well as giving her perspective on social isolation, the importance of movement as a developmental need and challenges for children with additional needs in the school.
Dino: I'm gonna let Michael start Susanne with a question then I'm gonna, I always butt in and ask different questions.
Michael: Ah, look, I, I just wanted to go back to what we were talking about what you mentioned earlier. So you, you have seen a recently had assessed an adult and we do see some teenagers and adults here. And particularly the, the plus clinic, seeing more of them. How have you, well, you mentioned that was new for you, but how have you managed to incorporate some of those elements into your, into your practice? Or how have you managed to assess someone like that and, and provide the, the feedback and, and support that's that's needed? What are you looking at there?
Susanne: Yeah, well to be honest, I use the same methodologies for the young ones and the older ones I just adapted. So. A little more age appropriate. She knew, I was asking her to do things. This was a 38 year old woman. She's college educated, who came to me understanding that my focus was in pediatrics, but really saying she wasn't able to find anybody who could give her insights into her sensory systems. And she knew that something was awry and. You know, I gave her the SIPT and I gave her the adult SPM. And now there's the SPM -2 where she has a self report and she was she was on board with having her mom also complete these questionnaires. And so we did an interview and, and we did activities in the clinic. And, you know, by the time she left it was actually so rewarding because we were asking him her to do. You know, some of the clinical observations and postural extension and things and, and, you know, she was pretty good at some of those. I said, you know, there, there are a lot like yoga moves and she goes, well, I used to like yoga and it's like, she goes, mom, so walk out. She goes, mom, let's, let's start those yoga classes again.
And this is a young woman who had lost a job about seven years ago, and then just doesn't leave the house much. So she, she didn't have whatever, you know, the stamina to go out and try to find another job. And then got, you know, the more she was at home, the less she wanted to go anywhere. And so ended up home bound and her mom is pretty worried about her and she's worried about herself.
So so I thought that that was, you know, just even after two hours of testing, you know, to you know, infuse some ideas about ways she could interact with the community in a way that felt safe to her, but also that she could be you know, to feel, feel competent.
Dino: Susanne, you, you mentioned that she hadn't left the home and I think one of the, one of the issues that we have, or one of the reasons why lots of parents will bring their young, you know, young adult to OTs because they don't get out and they are stuck at home. And we have this discussion about screen time. And, you know, in Australia it's something that's of greater concern. I, I think at the moment than COVID, but the, do you, do you experience the same with, with teenagers and even, you know, younger, you know, younger children as well that they are out less than they used to.
Susanne: Well, yes. I mean, and, and the IEP, the individualized education plan meeting that I had yesterday for a 15 year old and this 15 year old does not have the diagnosis of autism, but he was increasingly more he's he's very sincerely reactive has a lot of planning and organization issues, but he has selected not to go back to in person school, post COVID and he's home. So he's doing online learning and he has had increases in depression, self injurious behaviors and suicidal ideation. Okay. So that's the 15 year old that I just evaluated. And, and that was the other thing is this isolation, and even he's, he's a bright, handsome, articulate young man who's looking for some supports and you know, so I was talking about goals like, okay, what about you know, getting some self-regulation tools together and organizational tools and some of those could be, you know, electronic. And he said, I'm on board with that. And I said, and what about getting some projects that you can coordinate with peers? And he's like, mm, nah, no, not with peers too much. And I said, okay, it's too much. And I said, but you know, he has aspirations for vocations. And I said, you know, when you're in the workplace, You know, a lot of times you have to interact with others. And so, you know, how do you, how do you start that process and that comfort, cuz it, you won't be isolated in your home doing it by yourself.
Most likely now there is, there are tech jobs when that's possible, but, but then I think that feeds, you know, some of the mental health concerns, including the depression, is not having that community. You know, the stimulation, you know, of the social network. So, so I I'm, I'm seeing it more and more and more and more and more and more teenagers with, and without autism, with depression, self injurious behaviors, suicidal ideation.
And then, you know, the kind of the, the typical streams of intervention are, you know, behavior, okay. Psychology, behavior counseling or medication, and, you know, some, they you know, for some people they are effective, but for a lot of people, they're not, especially if that's not the origin of the problem.
Dino: Absolutely. I think we experience the same. Don't we, Michael, lots of our young people that just getting them occupied, getting them in the gym, doing something and, and you know what, some of, sometimes they can't hide the smile as much as they would like to. And you, and you think, ah, gotcha. You know, once you get that smile because a lot of them are resistant to, you know, even committing to trying a session and we, if we can get them to that point, cause it's very hard if they're not willing to I accept that there might be an issue because for some of them, they say there's nothing wrong with me being at home, not going outside, not having to talk to anybody, having my meals delivered by my parent to the door.
And not, you know, not showering and not changing for a week. And my friends are yep. Bill and Todd who are online and they're, you know, 38 and 45 and they I've never seen them live, but I know, you know, about them in the games they play and that's, that's their world. And, and to some degree you have to accept that that's, you know, that's their reality, but it's not healthy long term.
It's not a, it's not healthy. We're social beings. We do at some point. Need to have some interaction and some stimulation as well. And, and that physical stimulation is so, so important to the mental health aspect as well. And I think, you know, we, we always talk about the, you know, the always remember this phrase that I'd learned when I was in mental health was healthy body healthy mind and, and continuing to have that through the lifespan, but people change and, and as adults we change as well, don't we, we don't, you know, you don't remember what it's like to jump on a trampoline and you know, to go on a swing and I.
We should still do that. I think I would, I would feel very I would feel very disappointed in myself if I still didn't physically engage with young people and get on things myself. And sometimes I find, I say, you sit down and I'll jump on the trampoline and you can watch and I'll think, no, this is not my therapy session it's Young person so, but there's that inherent need to do that. Like it, it keeps you, I think it keeps you young. Keeps your mind young anyway.
Michael: Yeah, I think, I think the other thing on that is play itself. And I talked about this with another OT works here. Who's been with us for over 10 years now who is sold on their SI the most effective therapy and we all are, but , he, he is so such a strong advocate of SI in, his biggest thing was that, you know, play does, does change through the years, but play so important so as an adult, it looks different to what it does as a child maybe, but that playfulness is why a lot of the OTs work here. And it's why we encourage that for it doesn't matter how old you are to find that, that outlet because it's such an important part and, and a lot of it can be quite physical. So a, a really important part of that as well.
Dino: So, Susanne, what do you do for play?
Susanne: Oh for me with play. Well, right now, I, I had, my daughter had a new baby two weeks ago, so that's alright,
Michael: Congratulations. Sorry. Forgot to congratulate you on that.
Susanne: So we that's just like a little love bubble. I mean, we're, just holding onto that baby and, and we, we live quite near the beach. So, you know, for me a good day is if I can go jump in the water once or twice a day. We've got a hurricane going on right here right now so there's isn't getting in the water this weekend. But yeah, we, we go down and, you know, we're beach people, so that, and kayaking, water, sports, and walking, you know, that's what we love to do.
Dino: Do you find with the amount of travel that you do that you, you don't, you know, like you, do you seek those, those well, doing that when you're out, when you're overseas and, or you're you know around the countryside in the us, cuz you don't have those accessible to you as easily as you do when you're home.
Susanne: No, when we're traveling, there's not a lot of that. So then it's, then it's a lot of walking and seeing the sites and immersing yourself in the culture. And when I was in, in Adelaide and went on a wine tour, that was quite fabulous. That was in my wheelhouse. So yeah.
Dino: Did you like Adelaide, Susanne? Like, you gonna to say yes, I'm sure. But we, we, we, the poor cousins, actually, we're not even a relative to Sydney or Melbourne, but you know, or the Gold Coast. So, you know, we're trying to promote Adelaide as a, as a wonderful state
Susanne: It was a, it was a great, great trip for me. Yeah. Really nice. Yeah. But of, of course, you know, there's, there's. You know, there's, there's an enchantment there with the novelty, you know, of the Australian culture for me, but then also there's some familiarity in terms of, you know, how we do things in California and how you guys do things in, in Australia. So, yeah, it was nice.
Well, you know, and, and what I did wanna make a comment about, you know, getting these teenagers up and moving and, and promoting healthy lifestyles. You know, because I do a lot of evaluations that are public funded through the educational system here in the United States. I'm constantly battling with getting the children.
Movement breaks and letting them move and letting them stand. And, and I think we really have to address something in terms of our child development at early, early childhood and school age, because it seems to be a priority to get the children, to hold still, to sit still in their chair, to do some academic or writing work hold still and they're reinforced for that.
I mean, so there's whole behavioral programs meant to reinforce them that they sit, sit still and sit in your own chair and, and, and sit by yourself and your hands to yourself. and, and, okay, so then the kids learn how to do that. And then we're saying, okay, now get up and go and, you know, find exercise, you know, and do it with your peers, but we've already kind of inculturated them to don't do that.
Cuz you're gonna get in trouble if you, you know, hold still. And then they hold still. But they're, you know, they're a bit lethargic with low tone in their posture and they're not engaging in those things that are gonna make them stronger. And I think that this is just really doing our kids a disservice, and it's not just in the United States, but certainly it's, it's prolific here that we, you know, teachers want the kids to sit still hold still for long periods of time.
Like even 30 minutes for, you know, preschool aged kids. I mean, that's just unreasonable in my mind.
Dino: So they're still not progressive. I mean, we, we always understand that we look towards, I guess, as a lot of you know, a lot of people do to the us for more progressive ways of doing things because. Because that's how it's been.
Like a lot of the innovation has come outta the us. So we, we are, we are getting there with our, with our education system here. There's, there's a lot more teachers, there's a lot more schools that are understanding that they're flexible, workspaces are needed for kids. They need more movement, particularly boys when they're younger as well. So, you know, the there's a lot less resistance and, I guess, well reluctance too than when I, when I started 20 years ago, a teacher, a getting through the door at a school was very difficult. Let alone then providing a recommendation for kids to get up and move about. Whereas now, you know, there is, there is a lot more education a lot more teachers who are seeing the value in, in what's happening for the students here. But I would've thought in the us that would've been, you know, implemented and successfully used a lot more than what you are maybe saying.
Susanne: Well, I mean, I think that there is some acknowledgement. One of the things that has really changed in the last 10 years is taking recess away from children. I've been a really strong advocate of that's punishment with, with no positive outcomes at all. There's no research knowing that anything beneficial comes out of removing recess from kids. And, I've put that in all my reports for the last probably 20 years, but I've seen that that's something that has modified a little bit, but now when I do see that, that they're using these methodologies, we're calling out the teacher and the principles that, you know, it's, it's abusive especially children with special needs. And so, so that has changed and the idea of movement breaks, but, even then the way that's implemented, I mean, in, you know, in terms of people say, oh yeah, we give the kids movement breaks, but what does that actually mean?
And you know, we go in there and we see it and it's like, oh, well, I'm asking the child to take deep breaths. well okay it's good to take deep breaths, but that's not the same as really actually moving their body and then, oh, we're gonna take a walk, like, okay, you're gonna take a walk. Will that takes them out of the classroom so, so the way that it's implemented still is quite course in terms of, you know, the lack of nuance in really understanding you know, central nervous system and child development and what could actually be much more effective while keeping the children engaged and alert in their academic program.
Michael: You raise a very valid point. I in Australia, they're talking about changing the, the schooling system and, and looking at a more in integrated schooling system for those with additional needs being integrated into the mainstream system over a period. So if, if we are looking at that approach here, I mean, how important is understanding the needs of those children in that, that mainstream setting and how, how would you incorporate that? Obviously from what you are saying, there would be like, that would take a lot of time and a lot of support and is that, is that the biggest problem that there isn't enough, one awareness and two funding for that to occur effectively?
Susanne: Yeah. I mean, inclusion is an amazing concept and I'm, I'm fully on board with inclusion. That being said there. You know, I mean quick, cuz I I'm old enough to have seen, you know, no inclusion, full inclusion, you know, modified inclusion. And I, I think the risk that you have I in full inclusion is that the children are, are not truly included that they're, they're sitting in an isolated pod within an environment with general education children or neurotypical children, but not particularly included because the pace is too great. The behaviors need a lot more attention. The dysregulation is disruptive. And so yeah, and, so there there's a need for education of the students, as well as the staff. And then there needs to be specialized staff that understand what to do. To facilitate true participation, not just, you know, physically being in a place where someone's completely overwhelmed with what's going on.
They don't understand the pace. The other children really aren't, you know, they're running off without them because. They don't know how, or, they're, you know, they're, they're not fitting in with the kids. So, I think true inclusion is, is a magnificent ideal and needs a lot of support to implement it well.
Michael: Having been an OT for over 40 years, Susanne reflects on how she got into O. As well as the inspirational and life changing experience, that was sensory integration and what it was like knowing Dr, Jean Ayres and finally giving her insight into how she balances academia and private practice.
Dino: It's not, not always easy Susanne, when a parent has to in some ways make a decision in. In south Australia, at least the recommendations are made, but if a parent chooses to engage a child who not be at the level where they could possibly cope in a, what we call a mainstream school. They still have the right for their child to access the mainstream school.
And that creates a huge burden at times on the school and the support systems within that school. And, you know, I'm very blunt and I, I say it's babysitting most of the time for those young people in those education systems. Whereas we have specialist schools that have the skills and the extra training that really do support young people.
And we are talking children that are in the borderline IQ and lower range that they actually do progress and learn in those systems exceptionally well, but it doesn't always fit for every single child. And so, you know, at times we do have a mix of, of children who are, you know, quite severe in mainstream schools and there it's a lot of pressure and it's difficult to then change that when, you know, when in the end we're doing things like bandaid and we're providing more support, but those support workers or support educators don't have the right training either.
So on that point, our recently appointed premier of our state is going to pass legislation or I think they already have for an autism advisor to be placed in, sorry, to be trained in every school in the state, which I think is a huge step forward in terms of supporting you know, especially young people with autism spectrum disorders, but I have questions about how that, what that training looks like and how, you know, how are they going to support all the children in those, those schools? Because there's so many in there and, you know, we, is it going to be a, on a needs basis who is the most severe who gets the most support and what advice do they give and how do we train them and where do we find them as well?
So, but, you know, hopefully we'll get there. Michael. Do you wanna ask Susanne about this amazing question that I, I think that, sorry, Susanne. I've, I've cut you off because we have, we have some questions we need to ask you and Michael's gonna ask you I'm gonna let him ask this one.
Michael: No, no, I, think to be honest, that the whole conversation there is a really interesting one about the school system. So if we don't get to all the questions, that's fine. And I'm hope it's still okay, Susanne, but you've offered to chat to us again in, in a, in a couple weeks time. So I'm happy to have the conversation going.
Dino: I wanna know the nitty gritty bits. I want to, I wanna understand. Susanne more than just what we read and what we learn and what interactions we have and our opinions about, we need to know the bits and pieces that you're not willing to give up so freely.
Michael: I actually, so I was just gonna bring up a point that you raised, in another podcast which was in the interview, you mentioned you, you fell into OT.
So I often ask this which is, which is interesting. When I'm talking to other OTs, they've said something something similar. They weren't too sure about what they wanted to do. You know, I, myself fit into that category with my sister, fell into OT. I saw what she did. I liked it and I got into it as well. So, you know, is that is that. In your case, was that how it started? Was it you wanted to do something in, in health or with people or, how did you fall into OT and is, is that true or did I mishear that ?
Susanne: Yeah, no, that's true. You know, it was, you know, in college and not really knowing, you know, who you are, what you're gonna do, but I had to pick a major and I had the catalog open and I had my mom was a nurse. I knew I did not wanna be a nurse, but I had volunteered at mental health hospitals in high school and I quite loved psychology and mental health. And I thought, okay, I'd like to do that. And then, you know, my sister's an artist and my dad's in finance. Okay so I thought, oh, well and then, so I opened up the catalog and then, oh, you can do something in, in health and mental health and it there's a lot of art there.
It was like, oh, well that, that looks good to me. bingo. I, applied, I didn't know if I'd get in. I got in, I don't know how, and then I was completely dazed and confused about what was going on and what this curriculum was because I, you know, it was at the Indiana university medical school, so I expected it to be, you know, extremely rigorous and so they said, read the first two chapters of your core text. And I looked and I thought, well, okay, it was w something. And I thought, well, it must be Williamson Wilkins, which is Gray's anatomy. So I read the first two chapters of Grey's anatomy. turned out to be Willard and Spackman!
Yeah, but I, but I studied cytology and embryology I like, you just wanna talk about what people do and you know how old they are? What they do? This is medical school?? I was like, I maybe I'm not cut out for this. And there were no men by the way I showed up the first day and there were, there were all women. Where's the dudes, what , where am like, okay, I don't know what I've done to myself, but I'm not sure I fit here, , but, you know, then I heard about sensory Integrion and I was immediately captivated. I was captivated with the neuroscience. I was captivated with the concepts and the emergent concepts that were so far beyond you know, the standard things we were learning in physical disabilities and crafts and , you know, this was back in the seventies, right?
So once I found out about that, that, you know, that it, it, you know, I didn't, I didn't leave OT, which was an option I thought, okay, I'm just gonna go into plants. I maybe bought me, you know. But no, that was not. Meant to be my path. And, and I, you know, now I have a bachelor's master's and a doctor at OT. My husband's an OT. My daughter's an OT. She has a doctor at OT where, you know, I'm, I'm all on board with OT. I just think it's the most magnificent profession, but yeah, thank goodness, that the profession tolerated my early years and wanderings.
Dino: Susanne when, and at what point following you finishing your degree, did you meet, or did you come in contact with Jean Ayres and start you know, I guess working alongside or working with, or under her as in that capacity, can you give us some cuz because that's fascinating for anybody that studies You know, SI and, and goes through the certification, understanding that, you know, both yourself, Zoe and Anita and, and others had that personal contact with her is amazing because it's like, because she's obviously not around anymore it's like this figurehead that we hear about but never, never knew, but you actually. One of the generation that knew her. So can you, can you give us some background there?
Susanne: Yeah. So Sharine Farber was teaching us neuroscience and she was very well known at the time. And she was at, at, at the university where I was at and she would, she and Joy Hass were studying sensory motor foundations and it was the same time as Bobass were working on it and Ruud was working on it. And then you had Kephart and you had all the perceptual motor theorists coming into to play. So it was a, it was a new sort of explosion of inquiry in this way.
And so I knew about DrAyres' work. From Dr. Farber. And then when I went to do my internship, one of my internship, you know, my field work, you know, or level twos or, you know, whatever that is it was canceled. And so I said about going well, I heard of this really cool you know, three months internship that was necessary that was in the school systems doing Ayres' work Cincinnati and they let me in and, and they let me do it, which was really pretty Avantgarde cuz you had to do three months in physical disabilities, three months in, in mental health. That was it. So pediatrics and school based practice wasn't a thing back then. But they let me do that in lieu of my physical disabilities field work and. Was life changing and she was in touch. She had done her master's degree with Dr. Ayres and she was in touch with her rather constantly, Jenny Scardina. She was training people all the time. And so she was inviting Dr. Ayres to come and do lectures. And if Dr Ayres was doing a lecture, she'd haul all of us students up and. And, you know, and it was a pretty magnificent time in there because the, the other students who were with me not necessarily at exactly the same timeframe, but they were Shelly Lane and Mary Schneider and Charlotte Green
and I mean, I could go on , you know, There were some pretty heavy hitters there, Jane Kumar that were all, we were all kind of Jenny's kids studying back then. And then we were in contact with the California crew, which was, you know, Diane and Zoe and Florence , and another whole magnificent team that.
You know, so I was a baby OT, creating those relationships with people that we still interact with. And then I went did my master's degree. And Anita Bundy was my supervisor for my clinical rotation and my master's degree. So yeah, so , it was, it was pretty magnificent. And Sharon Ceermak, always have to mention her. She was my thesis advisor at BU and my doctoral advisor at USC.
Dino: How do, how do you do it? How do you do all of the academic side of things and, and the research, and, and then you still, you still work and run. Tell, tell us about your clinic. You, do you own a own, a practice? How big it is? How many staff or how many OTs do you have? What do you provide? Is it just OT speech as well? What can you give us a bit of background about what you currently have in terms of your commitments, both academically and in private?
Susanne: Yeah, well, you know, my daughter owned center point for children at practice, but it was a re recent acquisition, Suzanne Greenwood, another therapist own and ran this, you know, and it's a small practice.
And I, can't even really tell you how many, but it's like five therapists and you know, it's not, it's small compared to what you're (at OTFC) doing. But it's a lovely little place and it's close to my house. And so Susie Greenwood invited me to come and do evaluations there now. You know, I identify as being a practitioner, you know, that first and foremost, when, you know, I feel most like an OT and in. OT skin when I'm with the families and the kids. That's what I love the most. But you know, I was drawn to administration and, and then researched by my interactions with sensory Integrion international. I was the director of education and then that kind of and went its own way. And then I directed the USC WPS program and that kind of changed and went its own way and then now CLASI. So, so, you know, I have that administrative education arm and a commitment to getting good information out to the world on sensory integration, but then I always kept a foot and mostly it's evaluations. I mostly doing in depth evaluations with kids and, and how do I ever get to do research? And I, I really don't identify as being a researcher. I think that that's, you know, that's a whole other level of expertise. But, but I'm, I'm in practice doing very systematic data collection in my practice. And I keep really good records and I have really good friends.
And so we're part of a research collaborative. So we've been able to work collaboratively with university based and funded researchers and I've been able, I've been so privileged to be able to contribute in that way to keep that scholarship alive. And I, and you know, and I've always had that commitment to contributing to the research. I, I haven't done much on my own with that. It's always in collaboration with these other amazing minds who are, are able to do things. And then, you know, and, and it's nice to have an extra pair of helping hands, you know? So, so when we're working on a team, you know, I'll take a chunk, you know, I can do this piece and so I think that that's what all of us can do, who are in practice, who wanna contribute is get those partnerships together and contribute. Where you can, even if it's data mining. So that you have, you know, cuz the university, they don't have the kids coming through like we do and the access to families. So, so that's a big benefit.
Dino: I, I think that the challenge that we face here is having that relationship with the university and it's not through want of trying. Because we have data that's, you know, spans 20 years of using I've been using it the, the SIPT for 20 years. So the data's there, it's just difficult. I, think the question we, you know, we like to ask you is why maybe not so much in the us, but more so in Australia and you know, the struggles that we've had. I don't understand why. Sensory integration has had so much, oh, it's been so difficult to particularly get the university to accept and understand the theory and the practice and and to be on board with this as well and even, even to the point where I'd, we'd love to see it taught in the university as well, but it's not do, do you have any understanding? I mean, there was that 15 years ago, I think Anita wrote some wonderful pieces in the, in the Australian journal that refuted some of the some of the research that was saying that SI was ineffective, but do you, do you remember that time, or do you have any understanding about what, what we could do to improve that?
Susanne: Yeah, I, I think it's been a conundrum and it started right with Dr. Ayres. In fact, she had a bit of bitterness about the criticisms that she was getting from the OT community and beyond because she was out on a limb doing. Things, nobody had ever done before establishing. She established the first evidence based practice in occupational therapy.
Nobody else had done that kind of work before. And then they used her model, you know, as that became an imperative and they, oh, well, what, what was it that Jean Ayres was doing? And so, and, and I think that in my opinion, one of the reasons she was criticized because there was something to criticize, right? So she was putting work out into the professional community and there was something to kind of push against.
Whereas so much of OT, we have no, there there's very little foundation or evidence or, you know, a scientific, there's not a scientific theory for a lot of the things that we do as OTs. I'm not saying that we shouldn't be doing them. I think that sometimes that's emergent and the science follows practice, but I think, and then there's, you know, the professional, I think suppression, I, call it. So there are jealousies and competitions in academia that I think would try to compete or to try to promote their work over airs. And she had enormous popularity. And so I think there was competition with that.
And then I, I think the other piece is that. If, if you are a more concrete thinker, Sensory integration is going to seem like it's a preparatory set of activities that just get you in the ballpark for doing more complex set tests. That is not sensory integration theory, and it's not practice, but what she proposed was a very complex transactional set of ideas between neuroscience, the basic drive, an individual has trusting, and, and this was one of your questions I wrote, you know, What drew you to Ayres' work? It's she trusted that there's a biological imperative for children to grow. And what we need to do is trust that and then give them the environment, you know, support them with an adequate environment and then scaffold their ability to be adaptive within that environment. And if we do that, that level of trust, they flourish.
Now that that's a loss of control. So there's a bit of loss of control, but that, that dynamic with sensory integration is a transactional process between those more complex interactions and the more, more basic sensory motor functions. And, and it, and it, it's not top down or bottom up, it's transactional it's and it's all the time.
It's 24 7 in every human nervous system. So, so I think that that level of complexity is lost. If you have a superficial view of, oh, play with Play-Doh and that's tactile, or, you know, swing on a swing and that's vestibular. And, but that does not get. Does doesn't even scratch the surface of the complexity of multisensory processing and that, that the demands and the working load in terms of those multisensory perceptual demands that people have in filtering and selecting and de decoding and choosing and laying down.
Those actions and interaction, those memories that then you can retrieve in terms of practice. And so that level of complexity, I think, and then I think people, if they don't have that kind of divergent thinking, then it just all seems like jumbled and, and they don't take the time. And then they don't know, or don't keep
Michael: when I talk about sensory integration, I often mention a story about an academic who cautioned me about SI using the analogy. If you had an elephant in a house. Using SI is like looking at the elephant through only one window. The analogy does make some sense as it is certainly best practice in clinical or academic pursuits to consider many sources of information or as it were looked through as many windows.
However, I reflect on this comment even more so now, because the more I work in SI the more I believe it is not a single window, but rather adoor. The front door in fact, the one and only door that opens the house and gives you the most complete sense of the elephant.
SI has been so well researched over the past 15 to 20 years, and it is even more appreciated with the advancements in neuroscience and an understanding of brain plasticity. An article from 2019 in the journal of brain sciences outlined the neural foundations of Ayres' sensory integration and reinforced how Dr. Ayres' theory and practice is only strengthened by what we know today and about how the brain works. From the SIPT to the EASI sensory integration theory in practice is grounded in strong neuroscience.
Dino, myself, and many other ASI therapists in Australia. Almost find ourselves as SI apologists defending the theory and practice and educating others. However, it was Susanne who told us when training some of our team in Australia in 2017. We are OTs first and SI therapist. Second, we use SI as our main framework, the front door as it were, but we must always remember there are other methods, or windows around the house, and OTs will always aim to be as holistic as possible when working with their clients.
There is an art and science to SI. Research has certainly helped strengthen the scientific basis. And we posed to Susanne the question of the art and science, and also the impact of recent research, which was showcased at the 2022 international sensory integration Congress.
Dino: It, it is the most researched area in OT. Isn't it? I you'd have to say that. Yes. And then, and this is the issue that we have is that it continues to be scrutinized as at times in, in Australia, mostly as non-evidence based practice. And we keep producing the amount of research that I guess you've collaborated and I've seen a huge amount in the last 15 years compared to prior to that, and doesn't matter how much you push in front of people or they're maybe unwilling to see themselves. They still continue to say not evidence based, not evidence based. And I'm, I moved beyond that now. I'm not, I'm not bothered anymore. I, I think I was, I was disillusioned myself bef not disillusioned. Maybe I was looking at another path before I stumbled across SI and it made sense and it, and the more I read, the more I, I worked in the practice, it made more and more sense. The more that I kept doing it. And every time every year you learn something else and you build on that knowledge and you build on your skills and it keeps you motivated. And when you're working with young people and children in, in particular, who are really struggling and then you see them improve over a long period of time, because some don't forget, sometimes it takes a long time. For children to improve and you know, to remediate a lot of the processing deficits that they have. It's not always easy work, but when they get there, I guess that's the drive and it's that long term relationship that can really be a part of that as well. So we, we have to keep pushing don't we?
Michael: Mm. Absolutely. I think, I think just how you were describing that, that process and. Understanding of the research and Dino's right. I don't know any other field in pediatrics that is as well researched as SI and every time I scroll through journals across different, you know, the British journal of occupational therapy or AJOT or whatever it is, there's, if I'm looking pediatrics, something SI would come up and I think, but what you were describing before, just about that research base of that science, I think, I don't know if that's what you were describing, but to me it sounded like that the art and science OT, it's, it's that, that ability to understand how as a clinician you treat and then how you ensure that you are using the neuroscience. And you're absolutely right. I think someone could go, oh, well, we've got a swing here. Or we could send them to the, the local trampoline place and it's doing the same thing. Isn't it. And, and us as OTs are going. Who's who's facilitating that. What, what is the basis of that play? What is the basis of that engagement and what are you getting out of it? And, my question is, as, as someone who's as experienced as you are, how do you explain what you have just told us then to a parent, how do you get them to understand the importance of that art and science?
Susanne: Well, it's the difference between enrichment and therapy. Right? So, so what is the act active ingredient of change? I mean, if, if the environment is adequate, as it is in most typical development, they don't need therapy. We don't advocate that people need sensory integration therapy for every child. They don't they're cuz they're doing it on their own and you can hardly stop them in, in typical development. I would've loved to have my two boys stop climbing every wall and jumping.
You know, it was like, that was not what they were doing. And now, now the young ones training for an iron man are like, okay. And the other one scales walls to get over into jumping into the big waves. So yeah, I mean, it's so that's enrichment and yes. And if enrichment is fabulous, it's wonderful, but it is not the same as therapy.
And so therapy is, is guided. It's it's specialized through assessment. You, you you're looking at where the areas of concern are and through a very informed therapeutic process, you are supporting children to be more adaptive. And so that that's not the same as enrichment. So if, and, and sure if parents think, okay, enrichment, we'll go ahead and try it.
If that doesn't work. Then bring them back and, and, you know, we do have have research that looked at just having children in a sensory motor environment without the therapeutic interaction. And guess what it didn't work, you know, especially when you have special needs that that's not effective, neither is just giving a child a fidget toy or a yeah or a brush or a sit, move cushion. I mean, those individual tools are not proven to be effective. So, so it's sort of a bandaid when you really you know when you need a surgical center. So, I mean, sometimes the Band-Aid's enough, if that's enough. Okay. Go for it. But sometimes it's simply not enough.
Michael: I think the other thing I did wanna mention is when you're talking about some research, I know you're at the forefront. Of ASI and obviously with, with CLASI and doing things around the world to promote SI and, you know, the fidelity measures and, and you recently had the the 2020 conference while it was in 2022, but it was the, for the hundredth birthday of Jean Ayres but how do you feel. ASI 2020 vision is, is progressing and with the addition of the easy how do you think that will change? How ASI is assessed and delivered worldwide?
Susanne: Yeah, well, that, that's a good question. I mean, first of all, I just wanna thank everybody who contributed to the ISIC Congress. I know it was a long wait and it was an international Congress and we had, you know, it's science, you know, so, so everyone who presented and all the posters were linked to a, a research project and, and we had several neuroscientists you know, looking at the relationships, including one researcher, who's specifically testing children with the EASI and then doing brain imaging studies back in the university. Yeah. And then we have Lisa, who, and, and Grace Baraneck, who are working on sensory mode or models of development and, and doing, you know, some of that neuroscience as well as the behavioral science. So, so it's, it's really, it's a new day. For us in terms of those kinds of presentations, including one by Liz Torres. Who's phenomenal. And she, I think she's a mathematician who. Contributes a lot to engineering. It's a spec specific kind of mathematics that, that started volunteering with adults with autism. And then she goes, what are you doing? What, what are people doing with them? And so she's now been publishing and advocating for individuals with autism and talking about, you know, this the science all wrong here, that this is a sensory motor mality where there has to be a sense of agency. And, and how would you ever just tell somebody what to do and guide them through that?
How are they gonna ever have, you know, build up those intrinsic models, neuronal models and action models. And, and she, you know, she compared ABA to conversion therapy like, whoa, whoa. Okay. Yeah, whoa. , that's what I said. Whoa, she's she, you know, she's taken no prisoners on this, but she's coming from solid science, you know, she's, she's solid science and looking at, at the algorithms for this and saying, okay, this here's what we need to do with our, our friends with autism.
So anyway, the ISIC Congress was really great and yeah, one of the things that we were able to do is the sensory integration research collaborative is this group of people with Shelly and Anita and Zoe and Roseanne and I, I better say everybody, Theresa and Sarah and did I get everybody I might have missed Diane I don't mean to miss.
Michael: Anybody that's on those textbooks
Susanne: Yes, well, our, our group. Yeah. So, so we had the 2020 vision and we've enacted the 2020 vision, which was scholarship and getting more peer reviewed journal articles out there. And it was assessment development and we have several assessments underway or, you know, been published.
And then the third was education and having international standards for education. We've accomplished all of those goals. Not a hundred percent the way we had hoped, but you know, pretty close. So now we have a 2030 vision and the 2030 vision is carrying on. We're going to be promoting that through the international council, international council for education in Ayres' SI.
So it will be on their website and it's, it's moving forward in terms. You know, promoting this in terms of deep scholarship. I think the easy is going to have an enormous impact. We've, we've run into delays because of COVID and, and things that are completely out of our control. But we're so close to having this accessible set of assessments. I've already been using some of them in my practice. The kids love them. It's really nice. Even the sensory reactivity test, we save it to the end and even our really fussy kids are like, they're kind of intrigued. And they're like, I don't like that. I like that. Like, no, but we're kind of having fun with it because it's, you know, pretty innocuous and.
So, yeah, I think the EASI is going to be a game changer because it's, you know, it's not going to be as onerous in terms of the materials that are going, be accessible online. In terms of the cost, there is a cost to this. We, we don't know what it's going to be, but it's gonna be maintenance. It's not going to be, you know, for profit.
Dino: It can be considerably less than what I've been paying.
Susanne: It'll be, it'll be feature just to keep, you know, just to keep the platforms alive and things. So yeah, I think it'll be a game changer and, and so far so good in terms of us getting the, the data and having it hold up, you know, we've, we've tested a few kids.
We've tested, you know, the scores, do they, you know, they seem to hold up and. Yeah, and it'll be more modern, more modern statistics. We'll have, hopefully we'll have, you know, the start point and the end points too. So it, it, hopefully I know at first it's not gonna go faster in terms of administration, but eventually it will, I believe go faster.
Dino: Yeah. It, it certainly when having a base in in the SIPT certainly helps, but it, it did take a while, but I think you, you know, by the, I think by my eighth one, I was much, much better organized and, and moved through the much faster rate. And I could see it getting there, but that was the same with the sip that took longer. And then eventually you get quicker and quicker and you know what you're doing more and you can move, you get the momentum with the child and it's I think it's fantastic. I think they, whoever came up with some of the assessment items and new ones, particularly for the proprioceptive ones, I would've never have come up with those.
Michael: Oh, the rolling, the, the rolling, the, the, the rolling the water bottle with, with the rice. Yeah. Love that. Just the ideational Praxis for me is one of the, is that, how do you assess for that? Like, it's something that I think, oh, I see so many kids struggle with and it's like, I talk about the, the, you know, the, the blank canvas conundrum, where a kid comes in and trying to get them to come up with an idea and they just, it's almost like they've got this, this blank page and they don't know what to do, and they can't generate an idea. And the ideation praxis one for me was one that I just, I loved as something to just assess that, you know, just, just get some, get some data on that. How do kids come up with ideas?
Susanne: Something to be aware of that we found in our pilot and the field testing is that the kids who had been in therapy for a while. Sometimes did better than the typical kids. Ah, cause, cause I realized. We're constantly in there with the kids going, well, what else could you do? What could you do with this? And it's part of our therapeutic process and the, and the typical kids were like, I don't know, you know, and like maybe a little shy so that that's something to be aware of. And, but I thought, well, isn't that good? Cuz we're working on it. Yeah, yeah, absolutely. We're working on it and the children start to come up with their own ideas. So yeah, that's a fun one. And the, the silly room. I love that one.
Dino: Well, I'm surprised at how. When I was doing the, the, like the, they. You know, they did well, but there were always a few things that were off . I think, you know, these are typically developing children that I assess for the, for the normative data collection I'm think, but, you know, I guess that's normal for that, or was normal for that age or typical for that age.
Michael: It's so interesting. Going back to some assessment stuff was that I was recently looking through and this is. This is not a a dig to OT Australia. Who's our organizational body, which a fantastic organizational body. But just looking through the list of assessments for, for pediatrics and, and, and there are some, you know, ones in there that's sensory processing measure for different ages is in there. You know, the the Millers assessment for preschools is in there, but, but there's no SIPT. There's no mention of a comprehensive, thorough sensory integration Praxis assessment. There's things like the M fun and the few other ones, but. The BOT-2 and, and, you know, we sit here at, at our practice and maybe we're biased I don't know. But we think how is something like the SIPT not included as by far one of the most comprehensive assessments and, and with the EASI coming on board, how could that not be considered as one of the most comprehensive assessments you can provide for a child?
Susanne: Yeah. I don't know I'm addicted. I mean, because when I see a sick profile on a child or an adult, You, you know, you know, what's going on with them, even in the process of administration, you, you get a real feeling for how they're functioning across the board and I don't know any other assessment or set of assessments that give me the same insights. And of course that's what an assessment is meant to do to sample behavior that gives you insight. For me you know, we're gonna keep going. We, you know, we've got a lot of referrals and I think we get the kids dialed in. I think we figure them out. And, and so that, you know, that's something we're quite proud of is I don't. Sometimes I have people, you know, on the in the teams debating how much service or where she's to go, but I rarely have anybody debating our finding. Oh, you seem to have them dialed in. It's like, okay, well that's because I've got, I use good assessment tools.
This was so enjoyable. Thank you guys.
Michael: oh, not a problem. Oh, look. I've, I've got some other, other, I don't know if I send you to questions about some, you know, things like your favorite toy .
Dino: We're gonna surprise you
Michael: if you're okay to, to chat again next time and in a couple of weeks, we'd love to ask you a few more things. A bit more lighthearted, some lighthearted stuff,
Dino: but that this information is, is so important for our families to hear from somebody like you, because we, we are not, you know, we, we are. We're not having to fight the fight, good fight anymore. We're just continuing to support. People's understanding of what you know, SI is and what we are doing and how we're helping their, their children as well. And even for this is great for educators, because there are a few people that listen to this podcast,
Michael: there will be more hopeful after this it was so lovely talking to you.
Dino: I hope you have a good day with the rest of the stuff this today.
Susanne: Thank you, you too. Okay. Thanks so much. Bye.