Investigation of Sensory Modulation Dysfunction in Children in Congregate Foster Care

PURPOSE: To explore the extent to which youth in congregate foster care present with atypical patterns of sensory modulation and determine if these patterns correlate with behavioral challenges. Rationale: Fourteen percent of children in foster care live in congregate group homes (Fritz, 2017), and present with subclinical behavior problems that impact their participation in daily life activities (AOTA, 2017). Youth who reside in congregate homes are at greater risk of developing physical, emotional and behavioral problems (Williams-Mbengue & Ramirez-Fry, 2017). However, little data is available on these children despite the known impact of trauma on behavior. Many of these children could benefit from occupational therapy services but are not yet identified due to lack of assessment.

DESIGN: Data was analyzed retrospectively from de-identified protocols obtained by occupational therapy doctoral students.

PARTICIPANTS: Participants were recruited from nineteen congregate foster group homes from four different agencies. There were a total of 41 participants, 17 males, 15 females and 9 whose gender was missing. None of the children had previously identified special needs, diagnoses, or developmental delays and were therefore considered to be ‘typically developing’.

MEASURES: The Sensory Profile (Brown & Dunn, 2002; Dunn, 2014) caregiver and self-report measures were used; the Child Sensory Profile 2 (CSP-2) or the Short Sensory Profile 2 (SSP-2) for children 3-14 and the Adult Adolescent Sensory Profile (AASP) for individuals 11-17.

METHODS: Percentages were calculated to determine the number of individuals who had atypical sensory scores within each age group. Percentage by pattern of each quadrant score (Seeking, Avoiding, Sensitivity and Registration) in the total sample and within each age group was also computed. Associations between quadrant scores and behavioral problems were examined within the child sample only using scores on the CSP-2 and the SSP-2.

RESULTS: Both samples had sensory symptoms that were more or much more than typical. Within the child group, 88% had an atypical sensory pattern or sensory processing score, 63% of whom scored as Sensitive. Within the adolescent group, 92% presented with atypical sensory processing, 47% scored as Avoiding and 41% as Sensitive. Quadrant scores were associated with conduct problems, social emotional challenges and attention difficulties in 53% of the child sample.

DISCUSSION: This study found children 4 to 17 years of age, living in congregate foster care, had patterns of sensory modulation that were discrepant from typical. Atypical scores were present across all four of Dunn’s quadrant patterns. Sensitivity was most common in the child sample while Avoiding and Sensitivity were most common in the adolescent group. Behavioral manifestations (e.g. conduct, social-emotional and attention) were differentially associated with sensory modulation patterns; highest correlations were Avoiding and Sensitivity with social emotional difficulties (R ² = .50 to .88).

CONCLUSION: These findings reflect the importance of evaluating children in group homes for sensory modulation challenges, especially those children who present with behavioral problems. Occupational therapists should be included in the multidisciplinary team serving the needs of children and youth in the foster care system.

IMPACT STATEMENT: This is the one of the first studies to examine sensory modulation dysfunction in children in congregate foster care. This study provides evidence that many youth experience sensory difficulties which can impede development. It also offers critical information to advocate for occupational therapy services in the foster care system.

References

American Occupational Therapy Association. (2017). Occupational Therapy’s Role in Mental Health Promotion. Retrieved from https://www.aota.org/∼/media/Corporate/Files/Practice/Children/SchoolMHToolkit/Social-and-Emotional-Learning-Info-Sheet.pdf

Brown, C., & Dunn, W. (2002). Adolescent/Adult Sensory Profile user’s manual. San Antonio: Harcourt Assessment.

Dunn, W. (2014). Sensory Profile 2 user’s manual. Bloomington, MN: Psychological Corp.

Williams-Mbengue, N., & Ramirez-Fry, K. (2017, February 10). Congregate Care, Residential Treatment and Group Home State Legislative Enactments 2009-2013. Retrieved May 28, 2020, from https://www.ncsl.org/research/human-services/congregate-care-and-group-home-state-legislative-enactments.aspx