Date Presented 04/04/19
Current research indicates that a correlation exists neurologically among anxiety, sensory over responsively, GI dysfunction, and behavior. To gain better understanding of correlations among SPD and GI dysfunction, and how they impact family occupations, assessments were given to parents of children 18 months through 12 years who were seen for GI dysfunction at Children's Hospital of Philadelphia. Preliminary results indicate positive correlations among SPD, GI dysfunction, and parent stress.
Primary Author and Speaker: AnnMarie Murphy
Additional Authors and Speakers: Amy Lynch
Contributing Authors: Katherine Bevans
PURPOSE: When triggered by internal or external stress, the emotional motor systems pathway activates one of the branches of the autonomic nervous system – the hypothalamic pituitary adrenal axis. This triggering can lead to emotional feelings, autonomic responses, sensory modulation difficulties and/or neuro-endocrine responses (1, 2). Clinically, it is often noted that children with GI dysfunction have sensory processing difficulties and increased anxiety/stress levels, and that sensory processing difficulties negatively effect family relationships (3). Although this is understood neurologically, there is little research to support these findings clinically leading to limited evidence based support for occupational therapy clinicians when working with this population. This study aims to explore the relationships between GI dysfunction, sensory processing, and parent stress through parent reported assessments.
DESIGN: This exploratory study used convenience sampling to recruit parents of children aged 18 months to 12 years of age who were being treated for GI dysfunction at Children’s Hospital of Philadelphia (CHOP). Inclusion criteria required participants be the direct caregiver, that the child be within 18 months and 12 years of age, they be currently under treatment at CHOP for GI dysfunction, and that English be the primary language of the participant. Exclusion criteria included children younger than 18 months or older than 12 years old, not having English as a first language, children in foster care due to difficulties with consent, and children not currently under treatment for GI dysfunction at CHOP.
METHOD: The assessment tools used for this research included the Short Sensory Profile 2 and Toddler Sensory Profile 2 dependent on the child’s age, Parenting Stress Index – Short Form, PROMIS Surveys: Psychological and Physical Parent Proxy, and Family Quality of Life Scale. Data was analyzed and compared graphically to see if any correlations existed.
RESULTS: Parents of 6 males and 3 females ranging in age from 3 years 5 months to 11 years 1 month participated in this exploratory study. Of the participants, 67% had a primary diagnosis of constipation, and 44% of children had a secondary diagnosis of ADD/ADHD. Results of the Short Sensory Profile-2 (SSP-2) indicated that of the participants, no parent reported their child was under responsive regarding sensory responses in comparison to children their age. The SSP-2 also indicated that 66% of the children had a behavioral response much more than others their age. Of these children, 100% had a primary diagnosis of constipation. In analyzing parent stress through the Parenting Stress Index Short Form, 67% of parents fell within clinically significant levels of stress. Of the parents with clinically significant stress levels, 5 of 6 had children with a primary diagnosis of constipation. Further, 100% of these parents fell into the subcategory of having parent-child dysfunctional relationships, and 83% fell within the category of having a difficult child.
CONCLUSION: Due to a limited sample size in this exploratory study, the data does not offer statistically significant results. However, at this time results indicate that there may be a positive correlation among children with GI dysfunction and difficulties with processing sensory information. It also suggests a positive correlation between sensory processing difficulties and increased parent/child stress. The distress reported in parent-child relationships is indicative of negative impacts on daily occupations and occupational engagement for families. Improved understanding of these diagnose through evidence based research, can provide therapists with the tools they need to better serve and understand this population.
References
1. Mayer, E. A. (2000). The neurobiology of stress and gastrointestinal disease. British Society of Gastroenterology, 47, 861-869. doi:10.1136/gut.47.6.861
2. Mazurek, M. O., Vasa, R. A., Kalb, L. G., Kanne, S. M., Rosenberg, D., Kiefer, A., Freedman, B. & Lowery, L. A. (2013). Anxiety, sensory over-responsivity, and gastrointestinal problems in children with autism spectrum disorders. Journal of Abnormal Child Psychology, 41, 165-176. doi:10.1007/s10802-012-9668-x
3. Demchick, B. B., Escow, K. G., & Crabtree, L. A. (2014). Autism and transitioning youth: A pilot study of sensory processing and family quality of life. Journal of Occupational Therapy, Schools and Early Intervention, 7, 54-69. doi:10.1080/19411243.2014.898492
