OTS 25: How to Conduct An Evaluation Using the Ayres Sensory Integration Model feat. Zoe Mailloux
- Jayson Davies
- Mar 4, 2019
- 39 min read
Updated: Apr 17
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Welcome to the show notes for Episode 25 of the OT Schoolhouse Podcast.
In this episode, Jayson interviews Dr. Zoe Mailloux, OTD, OTR/L, FAOTA on the importance of completing a comprehensive evaluation in sensory integration. Since being a research assistant for Dr. A. Jean Ayres, Dr. Mailloux has gone on to author more than 30 published journal articles and has taught courses on Ayres Sensory Integration(®) all around the world. She is also a professor in the doctoral program at Jefferson University in Philadelphia and has worked with many organizations on understanding the importance of sensory integration in all individuals.
Listen in to learn more about Zoe and all of the incredible knowledge she has to share about sensory integration.
Links to Show References:
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The below references were mentioned throughout Episode 25
Articles and other Documents
Books By or Feat. Dr. Zoe Mailloux
Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs.
Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com
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Episode Transcript
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Jayson Davies
Celebrate good times. Come on. Doo doo doo doo doo doo doo doo Woo. More on that in just a second, but first Cue the intro.
Amazing Narrator
Hello and welcome to the OT school house podcast. Your source for the latest school based occupational therapy tips, interviews and research now to get the conversation started, here are your hosts, Jayson and Abby. Class is officially in session.
Jayson Davies
Hey everyone, and welcome to episode number 25 of the OT school house podcast. I hope you enjoyed my little singing right there that is in honor of marking our one year anniversary of this podcast. So we made it one year. That was my goal when I started this was to make it one year, and we have made it and well, I'm just gonna say now I don't feel like we're ever gonna stop. So thank you to everyone who has been listening for that entire year. Thank you to everyone who has been listening for one or two episodes. Thank you to everyone where this is your very first episode. Listening. Very much. Appreciate it. And well, I couldn't be more excited for our special guest today, in fact, so excited that we're just gonna skip straight to it, and I'm gonna give a quick introduction to Zoe Mayu, and then I let her give a little bit more introduction and background to what she's been doing and what she's up to. So I first met Zoe back at a conference in Pasadena several years ago, and I've been kind of admiring her work since she has published over 30 journal articles in her nearly 40 years as an occupational therapist. And what makes Zoe a little bit unique is that she actually studied under Dr aging airs. And so today we're here to talk about sensory integration, and more specifically, ASI, or air sensory integration, and the evaluation of air sensory integration within a school based setting. So without further ado, I'm just going to let her give a little introduction about herself, and then we'll continue on with the interview. So here's Zoe Mailloux.
Zoe Mailloux
My name is Zoe Mailloux. I'm an occupational therapist, happily working as an OT for more than 35 maybe 40 years, quite a while. And I've been really fortunate to work in pediatric occupational therapy most of the time that I've been an OT.
Jayson Davies
Awesome. And so what are you up to these days then?
Zoe Mailloux
currently, I'm on the faculty at Thomas Jefferson University, which is in Philadelphia, by the wonder of technology. I live in Southern California and teach online in their OTD program, and I've I teach quite a bit of continuing education courses for occupational therapists, physical therapists, speech and language therapists who are interested in sensory integration. Worldwide, I get to travel around the world. I've been to many countries sharing information about sensory integration.
Jayson Davies
Yeah, in fact, weren't you just saying you just got back from was it India?
Zoe Mailloux
I just got back from Turkey and Dubai, Istanbul and Dubai?
Jayson Davies
Oh, man, that must be an amazing experience, just kind of getting to know the culture and and all that.
Zoe Mailloux
What's really great is having the chance to meet occupational therapists from all over the world and see how they live and how they work and how they shop and pick up their children from school. Yeah, it's a great way to get to know the world and to see our profession all over the world.
Jayson Davies
Is there one particular story that like comes to your mind when you think of teaching outside of the country?
Zoe Mailloux
Well, you know, since I just got back from Dubai, and that's fresh in my mind, what was really amazing there, I had a course of about 25 people, and 14 different countries were represented in that one course. And so Dubai is a place where most of the people who live there are from other countries. So that is really sticking with me, because they're quite proud, and I think they should be. They're quite proud of their ability to collaborate and work together in just an incredible multicultural place environment, yeah, yeah. And they're really, you know, they, they have a lot of pride in the fact that people get along. It's a very safe place. And so that was inspiring to see that and to see that melding of cultures. So,
Jayson Davies
so you're saying they're from 14 different countries, but they all live in Dubai now.
Zoe Mailloux
They all live in Dubai, and yes, and they were originally from 14 different countries. And actually in Dubai, I think only about less than 15% of the population is considered local or Emirati, and everyone else who lives there is from somewhere else in the world. That's crazy. Yeah, some for long. And some more short term but occupational therapy is quite strong there. There's a lot of OTs there, yeah,
Jayson Davies
actually, I mean, just doing the podcast and having our online, you know, expression through the blog and through Instagram and and especially Facebook. I have a lot of people on Facebook that seem to be from that culture. They that like us on Facebook and reach out, and it just seems to be a growing ot community over there.
Zoe Mailloux
There really is. And you know, just worldwide, ot has developed so much over the last few decades. And that's, I think that's the other, just general thing that I appreciate about traveling, is seeing our profession in so many different places in the world and how it works in so many different places.
Jayson Davies
Yeah, that's awesome. All right. Well, I only have you for a short time today, so I'm going to try and squeeze in as much as I can for everyone listening, but to kind of get started in what way have you worked with kids in schools?
Zoe Mailloux
Well, so I'll just, I'll back up a little bit and just say that very early in my career, I was really lucky to work with Dr Jean Ayres, and so I'm sure most OTs know that she was the pioneer who developed the theory of sensory integration. And when I first started working with Dr Ayers in California, ot was not very present in the school systems. It wasn't until about the 1990s in California that ot became a real central part of school services. So at that time, when this these changes were happening in California, I was really involved in some of the first ot services in our state. It was a pretty scary time, I think, for everyone, for parents, for therapists and for the school systems, because they were not at all familiar with what OTs did or why they might be in school systems. But I think the work in sensory integration, Dr Ayers was always focused on the ways in which sensory integration function supports learning and behavior and attention, and then the corollary is how sensory integration problems can interfere with learning. So it was always really clear for those of us who worked in this frame of reference that sensory integration was a very pertinent part of understanding how children succeed at school. So over, yeah, over my career, then I worked in many, many I was part of a nonprofit practice. For many years, we would send therapists to over 200 schools, many different school districts.
Jayson Davies
So in a way, si has kind of been in schools since ot has been in schools.
Zoe Mailloux
Well, at least in California, occupational therapy was part of the school systems going back to the 1970s when the legislation occurred that brought ot into the schools. But California was a little behind, because we had another system here. We had a system called California Children's Services that was focused on children with orthopedic problems, and there was kind of the view that that was those were really the only children who would need ot and then some changes have and so other children with other diagnoses were receiving occupational therapy, may be physical therapy through other venues, not through the school systems, until about the 90s. So really, in California, yes, that's true, but not for the rest of the country.
Jayson Davies
Gotcha. That's actually one of the podcasts that I want to do in the future is just kind of looking back at the history of OT and schools, because it's still relatively new, in a sense. And I mean, education has been around a lot longer than special education, and especially ot in education and and just that, you know, 15 year gap of what you're talking about between OTs being in schools in California. Well, that was, like you said, a good 10 to 15 years after idea originally passed. And so it's all crazy how it works, yeah.
Zoe Mailloux
And it created a lot of localized traditions or customs. You know, depending on where you were in the country. OT services really vary. But I think in California, the fact that we did have sensory integration pretty well developed, maybe affected a little bit more about the way ot services have occurred, great in this state.
Jayson Davies
Yeah, all right, well, it wouldn't be right to have you on and not talk a little bit about Dr Jean Ayres, as you know, you've worked directly under her so, but you also really can't talk just about Dr Ayers without giving a little background slash intro into sensory integration theory. So would you mind sharing with us a little bit about Dr Ayers and si Sure.
Zoe Mailloux
So Jean a jean Ayres was an occupational therapist. She was also a psychologist, and she was quite unique, I think, not only for our field, but just in general, in that. She was a researcher, an educator and a clinician throughout her career, and that's kind of unusual. A lot of times professionals focus in one realm or another, but she always ran a clinical practice and at the same time, conducted research studies, and did you know conducted education as well. She had some really unique ideas that were born out of her interest in how the brain functioned and what happens when things don't work well. She was especially interested in some of the lesser known functions of the nervous system, and so through that process of inquiry. She would have children who would be struggling in school in learning and behavior, and she sought, then to understand them through her study of the nervous system. What was really key in the development of sensory integration theory was the development of assessments. So she was always someone who really valued assessments and developed her own tests so that she could understand what was working well for the children what wasn't working well, and then she would know how to treat them. So I guess in a nutshell, and sensory integration is not the easiest thing to explain. Simply, no, but it's really about how we take in information through all of our sensory systems, and kind of process and coordinate and integrate that information so that we can interact successfully in the world. And so much of the theory of sensor integration is related to functions that we all take for granted, that it makes it sometimes especially challenging to explain, because when all of us have sensory integrative systems that are working, we don't have to think about them. Yeah, when we have especially developing children who are missing some of the foundational sensory functions. They are easily misunderstood. They're thought of as children who are not paying attention, who are not trying, maybe who are willfully misbehaving, but really we're expecting them to operate with functions that you know should be happening more automatically.
Jayson Davies
Yeah, and I'm glad you mentioned some of those expressive behaviors, or those behaviors that we see being expressed by students or kids with just sensory difficulties, and we'll get into that in a minute. But just while you're talking, something that popped up into my mind is obviously SI is known like OT, or SI belongs to OT quote, unquote. But who else is looking at Si? Obviously, it can't just be OTs that are doing all this research and stuff. Who else is out there, kind of looking into the brain, looking into the behaviors and stuff like that.
Zoe Mailloux
So that's a great question. I mean, I think it is important to recognize that sensory integration theory, and much that we know about this work is really core occupational therapy, because Dr Ayers, as an OT was interested in how we interact in the world, how we do things and how we participate. She really was that was her concern. How do children participate and engage in their occupations? And so that's why it's so strongly part of OT other therapists, other therapies, physical therapy, speech and language therapy, have also become quite interested in this approach. And I think since the advent of autism as autism, as the autism diagnosis, increased and sensory integration difficulties are so prominent in that diagnosis, then the interest in sensory integration become, became much wider. So autism experts, researchers, teachers, you know, psychologists, I think in recent years, especially because of that diagnosis, have been more interested in sensory integration?
Jayson Davies
Absolutely. Have you ever worked with, like a neuro, neurologist or neuroscientist to kind of look at the brain a little bit more while doing si or so?
Zoe Mailloux
Absolutely, in fact, right now, I'm part of a study, an intervention study to compare occupational therapy using sensor integration for children with autism, to compare this approach to applied behavior analysis. And we're about midway through this study right now, and part of the study does involve imaging, brain imaging, to look at if we can see any changes in the brain that correspond with some of the changes that we see in function. So there's been quite a few neuroscientists and neurologists who've been interested in this approach.
Jayson Davies
Awesome. So the whole point of today's podcast, we wanted to get into evaluation and sensory integration. But. So real quick, I do kind of want to, I'm pretty sure I've heard you speak, and I feel like anyone who worked under Dr Ayers always has a good story about Dr Ayers. And so before we jump into the evaluation, do you have a story about Dr Ayers that you'd like to hold in your memory?
Zoe Mailloux
I probably have a lot of stories about her. You know, she was a very, very down to earth person, very humble person, extremely scholarly and dedicated to her work. So the stories we have about her not exactly kind of like funny, you know, flipping stories. I think what really stands out in my mind is what an gifted clinician. She was, I mean, her research is well known. Anyone who ever heard her lecture knows that she was a gifted educator, but not that. Many people got to see her with the children and with the children, she was extremely playful. They loved her as soon as she came into the room, they just knew that she was someone they could trust, and she was not at all afraid to get down on the floor, to get on a scooter board, to jump on a swing, to jump off of something. So that's really what stands out to me, is when I think about what I learned from her. I learned obviously, so much, but the way that she could observe children and completely relate to them is what I remember most about her.
Jayson Davies
Yeah, I can't remember if this is I've seen the picture several times. I don't know if it's on the cover of one of the books, but it's her on the scooter board, like kind of slightly behind one of the kids, and she just has the biggest smile on her face. The kid has a huge smile on his face. And, yeah, that's kind of what I think of when I think of Doctor of Dr Ayers.
Zoe Mailloux
So yeah, and she, you know, she knew from her own body how important the sensory integrative processes were, like she knew how, and she engaged in the therapy activities so that she could understand what the children were experiencing and what they needed. Yeah, all
Jayson Davies
right, so earlier you did mention you know that the DR Ayers really understood the importance of the assessments. And now I know you very much appreciate and understand the importance of assessment. So when it comes to schools, why is assessing sensory integration so important?
Zoe Mailloux
Yeah, so, I mean, this has really become my passion, especially in more recent years. I mean, I think my early training with Dr Ayers taught me this at a really core level, but I'm not really sure what happened to occupational therapists, but we seem to have moved away from careful, comprehensive assessment. And maybe it's the pressures of funding or just other administrative pressures, and as a field, I wonder sometimes if we're not quite assertive enough, because when I travel around the world, maybe even more so in the US, I hear things like, Well, I'm only allowed 20 minutes for an assessment, or I'm not allowed to use that test. And I never quite understand those kinds of comments, because I feel like, well, we are trained professionals. It should be up to us before we treat a patient. It should be up to us before you know, before we start intervention, to decide what we need to know. So I think it seems to me that OTs have been a little bit too willing to jump into treatment without fully knowing what they need to treat so and then again, back to Dr Ayers. I mean, she was so clear that you would never try to treat a child if you didn't fully understand what their problem was. I mean, a young, developing child is a fragile thing in a way, you know, they're developing. We have to be so careful. So the idea that we might just take a checklist or make some observations and then treat a child, sometimes for weeks, months, years, and that, I think, has always been sort of the confusion to me, that if a therapist, for whatever reason, feels that they cannot take an hour or two or even three to complete a full assessment. How can they justify treating a child for weeks or months or years? I mean, we're guessing. We're spending a lot of that time and effort and somebody's money on trial and error, and we would never accept that for ourselves. We would never accept that if we were injured or ill, we wouldn't allow our health professionals to do a trial and error approach to help us. Yeah,
Jayson Davies
I totally agree, and I think sometimes in the schools, it almost feels like we're doing an assessment. Judgment as a formality, I think, sometimes, and that's totally how it should not be. And you're right. We need to put that time in to focus on really figuring out what the student really has difficulties are, or what the student has difficulties in. We need to know what the strengths are too obviously. But how can we treat a student if we don't fully understand the difficulties they're having.
Zoe Mailloux
And a comprehensive assessment should illuminate the strengths as well. I've worked in the schools a lot, as I mentioned, and I've taken full case loads. I've spent time in school systems where I have a full caseload, and I just can't imagine trying to provide any kind of therapeutic intervention program to those children. So I would, when I had that role, I would conduct the assessments I thought were needed if they took longer than the traditional time. So be it, you know, and I would make a case for it. I found that in a school system, if I had a strong rationale, and I talked to the administrators, and I talked to them about cost. Think that's another thing that sometimes, as OTs, we're not so accustomed to thinking about the financial aspect of things. So I would always talk about cost effectiveness, you know, talking to the parents and administrators, you do not want me to take this child's time and this system's funding unless I know what I'm doing. And the same thing with our outcomes, I don't think we've been strong enough about demonstrating what our outcomes are and how they relate to cost. Occupational therapy has a very, very close relationship to long term cost. If we help a child in early intervention, the cost of the school system go way down. If we help a child in the school years, long term support costs go way down, you know? And I think there's actually quite a bit of research about investment in years zero to five and how much that saves from years five to 85 but we don't, as a profession, I think we could do a better job of communicating about that.
Jayson Davies
Yeah. And I would love if you have those potentially on file somewhere. If you can dig them up, I'd love to have those to put onto the website for everyone, just to kind of be able to have access to that'd be great. Because you're right. I've heard from a lot of OTs that, you know, either they don't want to or they just don't like that's not the real their realm. The business world is not their realm. The money they just kind of wanted. We want to assess and we want to treat we want to treat we want to have fun with the kids, and we want to help them. But you're right kind of thinking about the business side of it is not something that we're that we're very good at.
Zoe Mailloux
So go ahead, but even just back to the assessment, you know, I'm not sure how this happened. That OTs just, you know, thought it was okay to do a very cursory assessment and then move into intervention and even, or even consultation, I mean, maybe even at least as much, if not more, so that if you are going to try to help a teacher or someone else help the child, you really need to understand what The underlying issues are. And I think it there's been, you know, some Criticism and controversy around sensory integration as a whole. I think a lot of that comes from this problem that OTs have often thought or said that they were using sensory integration without a full understanding of what was going on with the child, and then picking techniques that were maybe just the same techniques over and over, but not carefully chosen in an individualized way. And really, that's why, you know, that's why the term Ayers sensory integration started being used. Dr Ayers would never have put her name on her work. She was not that kind of person, but those of us who work in the field recognized that we had a problem, that a lot of stuff was being called sensory integration, all kinds of sensory whatever things. And so in order to be more clear about her work, her family was able to trademark the term airs sensory integration. It's not for financial purposes. It's not for anyone's financial benefit. It's only for the purpose to be clear about what do we mean when we're talking about sensory integration as developed by Gene airs versus sensory stimulation approaches, or just the use of sensation in some way, yes, and as part of air sensory integration, it is required that a comprehensive assessment take place. I mean, one of the examples, I mean, a common example, is that occupational therapist in school systems work a lot on. Handwriting, you know, I think we wonder how we became handwriting teachers sometimes. But okay, so it's a common referral. And how do we assess there are so many different reasons why a child might struggle with writing. Some of them maybe are visual perception or visual motor difficulties. But there are many, many other reasons why a child might struggle with writing, and if we don't know why, and we just continue to practice and practice writing and use techniques to teach handwriting. You know, anyone can teach handwriting. Yeah, we don't need an OT for that. What we need an OT for is to understand fully the underlying difficulty that's contributing to that problem at school, and then being able to offer specific, individually tailored intervention that addresses what that child needs. I have a story I commonly tell about a little girl in a school system who had the same goals year after year after year. When I came in to see her, she'd been in occupational therapy, I think, for about five years, and her goals were very similar. She was about an eight or nine year old girl. She'd never had. The only assessment she had was a VMI, a visual modern integration test and maybe some checklists.
Jayson Davies
And let me guess, she had a goal to space her letters out, to put them on the line appropriately.
Zoe Mailloux
something about her grip. And this little girl had actually almost absent tactile perception. Her ability to use her tactile system was so dysfunctional that it was it would be impossible for her to have an adequate grip on a pencil or do some of the other things that were in her goals, like buttoning. You know, our use of the Touch system is so critical to everything we're concerned about an OT and I think if you went to the school systems today and surveyed to find out how often in the school system, OTs are truly assessing tactile perception, I bet it would be less than 10% of the time. You're probably right. And you know, I know that many, many children who have learning disabilities, attention problems, some kind of coordination difficulties, autism, speech and language problems, a huge majority of those children have poor tactile perception. And so if the OT doesn't even know the child has poor tactile perception, how would they know to work on it? And how will that child's function in these occupations that require good tactile perception? How are they going to improve? And there's just so many different examples of that that's just one little piece of sensor integration. We could pick many different functions that are not assessed. And then, you know, just really create obstacles for children to be successful at school. Yeah,
Jayson Davies
so I know. Again, sensor integration, very complex. We don't have time to go over everything in this podcast, like all this, all the tests and the sift. Obviously, we're not going to do that. You have a whole nother course for all of that good stuff. But what should a good sensory integration assessment look like?
Zoe Mailloux
Well, kind of in a nutshell, the main areas of sensory perception that contribute to so for OT, we're concerned about doing, you know, being able to participate and engage in activities. That means tactile perception, proprioception, vestibular perception and visual perception, at least. So those four areas of sensory perception need to be assessed, Praxis or motor planning. Postural ocular, bilateral integration and sensory reactivity, sensory reactivity separately, or at least understood as differentiated from sensory perception. Those are the four main umbrella areas that contribute to a comprehensive sensory integration, assessment, sensory perception in those sensory systems, praxis, postural, ocular, bilateral integration and sensory reactivity.
Jayson Davies
Okay, so if you were in a school today and you got a referral, kind of, what would your How would you kind of go about through that step? I mean, obviously, I know there's a much larger, complex. But what tools would you use? What observations would you do? What would you be looking at?
Zoe Mailloux
Well as an OT who has worked in the school system, I would if I felt there was some chance that the child's difficulties might be explained by sensor integrative functions. I. Would give the sensory integration and Praxis tests, because those are the only tests we have right now that are standardized for children that mirror that measure all of those areas they don't include sensory reactivity. So I would use the sipped plus observations and standardized questionnaires to teachers and caregivers, something like the sensory processing measure. Okay, the in combination something like the sensory processing measure and the SIFT would cover all areas. And unfortunately, there has not been an alternative. It's not like we can say, well, you know, instead of the SIFT, will use such and such, there is currently no alternative that's a standardized test for children. In in most of those areas, there's some visual perception tests. Yes, that's it. Yeah, there's no there's no other test of praxis. There's no other test of tactile perception or proprioception or vestibular function.
Jayson Davies
Correct and sorry, I want to ask you real quick, because this morning, I went on my Instagram, and I just, I actually did ask for feedback for questions like, hey, sensory integration podcast, who has any questions that they want me to ask or kind of, you know, try to try to put into the podcast. And one was, one of the questions was SPM versus the sensory profile, and you mentioned the SPM, is that your preferred?
Zoe Mailloux
I personally, I prefer the SPM. I don't think there's anything wrong with the sensory profile. Both instruments rely on someone else's perception of the child. So, you know, I always have that in mind, and I recognize that what the parent sees at home might be different, and it might truly be different than what the teacher sees at school, and might be different than what I would see in a direct assessment. I you know, I think we'll probably talk about in a few minutes, but we do have a new set of tests that are under development that are meant to address some of the challenges that seem to have kept OTs from using the sip. And in that new set of tests, we will have some direct measures for sensory reactivity. I can't really, you know, the reason I use the sensory processing measure is that it's easier for me to interpret the results in relation to the sensory integration framework. But I think both of those questionnaires that are caregiver reports require a lot of additional thought, like any test does, but even more so when you realize that you are going through someone else's lens.
Jayson Davies
Yeah. And I often will get questions, either via email or Instagram or whatever, and people want to know, well, what? How do you interpret when, like, everything across the board on the SPM is way up in the definite dysfunction, and I think what you just said kind of explains it. You have to take into consideration that this isn't your trained, skilled observation that is that scaling this or that scoring this kid in the definite dysfunction this, this is the behaviors that the parent is seeing or the teacher is seeing. And does that kind of make sense?
Zoe Mailloux
It does, and in the manual for the SPM, the questions are categorized by what they're actually getting at. So it's also important to look at which questions were answered in sort of the extreme ways. So you can't only look at the score. You really have to dig deeper. Absolutely, it's not enough, even if you have definite dysfunction in every area, most of the questions on the SPM or the sensory profile are about over or under sensory reactivity. That's a really important thing to know about. It's an important area, but it's only one of, as I mentioned, the core areas that need to be assessed. So what I see most often is that therapists might use a questionnaire like the sensory profile, sensory processing measure, and then maybe they use the VMI, maybe they use a little bit of the brunix, but that means they have not considered praxis. Praxis is not assessed by those instruments. They haven't considered tactile perception, proprioception or vestibular functions, and they haven't considered a lot of other aspects of some of the core si areas, like bilateral integration. I mean, OTs, we have to look broader than only sensory integration, but these are some really basic core building blocks for learning, behavior and attention. And if we're not looking at these, no one else is, yeah, you know the OTs using a VMI, that's great. But usually a psychologist, a school psychologist, is doing some kind of visual perceptual testing. Absolutely, if I had to give up any area as an OT, I would give up visual perception because. I think I could get that information from someone else on the team. If I don't test these other areas, no one else is going to look at them. So I feel like I'm really responsible for that.
Jayson Davies
Yeah, and you're absolutely right. I don't even use the VMI anymore because, I mean, I use the ravma, which is very similar to the VMI, and portions of the bot, again, similar to the VMI, but I can't use the VMI because my psychologist uses it, and we can't use the same assessment at the same time. So
Zoe Mailloux
that's right, but who's testing tactile perception? Who's looking at proprioception? You know, when the child has too much pressure on the writing, or too light of pressure, or they're, you know, bumping into their friends, who's assessing their proprioceptive functions to understand why those things are happening. Yeah, if we're not, no one else is. And then if you don't know there's a problem, it's more likely that it's thought of as a behavioral issue or something purposeful.
Jayson Davies
Absolutely, you brought up the new assessment. The Easy correct is that.
Zoe Mailloux
yes. So we have a new assessment well under development. It's called the evaluation in airs, sensory integration, the EASI, the easy named, hopefully, so that therapists will not be quite as afraid of it as they have been of the sipped. And it's going to be a free, open access test. So I believe my view, my little view of on the SIFT, is that I think it's a fantastic test. It's a fantastic set of tests that doctor has developed. They're difficult to learn, but they are not difficult to give once you know, once you're familiar with them, just like driving a car. I mean, learning to drive a car is not simple, but once you know how to drive a car, you don't give it a second thought. Yeah, pretty much. And I think that's the case with the sift. So the double edged sword with the SIFT is that it's difficult to learn and it's expensive to give because it has a high price tag on scoring. Yes, I don't think the kit itself is exorbitant. You know, test, test kits cost money, but the fact that there is an ongoing scoring cost, in my view, has made it a special occasion. Test, I think OTs are a little bit of a hoarder have a little bit of a hoarder mentality, and they like to save things that cost money. And so what I've seen a lot of therapists do is they might learn how they might learn the SIP, but then they don't give it frequently, because it costs money, and because they don't give it frequently, it never becomes easy to give, and so it always feels overwhelming for me. I give the sip. It takes me an hour, maybe an hour 15 minutes. Yeah, I get so much information that would take me hours and hours to try to put together by other tools and observations and guessing, and I know what to work on immediately. I know exactly what to work on in my therapy. I'm not playing trial and error. And the kids get a lot better. They get better their goals. And we're effective, and we can be effective. So the easy is meant to tackle some of these challenges. It's it's a grassroots effort. It will be a test standardized on children aged three to 12. Currently, we have 105 countries participating, so it will be normed around the world. That was another issue related to the SIFT is that it was only standardized on children in the US that worked for us here in the US, but there was an interest around the world. So this is meant to alleviate that problem, and we hope that with a free test, that then therapists will actually get over that hump, that it won't feel it's not going to be any easier to learn. It's going to still be it's motor planning for the therapist. A therapist has to motor plan these skills until they become automatic. Once they're automatic, we hope that no one will think it's that big of a deal. It's just an assessment. You use, you score, and you get your results, and then you know what the children need. That's what we hope.
Jayson Davies
Yeah, and if I can share real quick. I I was fortunate. My district that I used to work for sent me to all four courses of the SIP by WPS and USC. And you kind of explained exactly my whole quote, unquote fear, yeah, yeah. I went to it. I went to all four classes within a year's time frame. I completed, you know, the sipped in order to get the certification, you have to assess a kid or two, you know, a typical developing kid and and a non typical, I think it was, but I still have the little flash drive, the little purple flash drive with a few assessments left. I still have all the protocols sitting in my somewhere, and I was so. Scared to use it in a way. I mean, it's for me. I never learned it well enough for it to be, I don't want to say effective for me, but it practical. Yeah, probably wasn't practical, correct. But at the same time, how many kids did I not test that I should have tested? I probably could have helped a lot better or a lot more.
Zoe Mailloux
I mean, what we you know, I've probably taught 1000s of people by now over all these decades, and what I see is that a very small percentage move ahead and get over that hump. The therapist who get over the hump and who know the SIP routinely tell me they can't imagine practicing without using it once, once you get over that hump and you use it, and you see how much information you get and how facilitated your treatment is, and how you probably missed so many problems and other kids you can't imagine not using it. But the problem is that the percentage of people who get over that hump and you yeah is small, yeah, so we felt like we needed an alternative to that, and we're just hopeful that by making a test that's more accessible and feasible, we're also hoping that we can use something called Computer adapted testing that would be in real time as you're testing, that you would get some guidance. You know, if you're entering scores as you go, that you might be able to get messages that say, Okay, this with this child, you can jump ahead to this item. With this child, you can stop now, so that rather than having just predetermined basal and ceilings, they could be more in real time related to how that child's doing, to tell you what items you absolutely have to give. So we're hoping that's a way that we can shorten the testing. But honestly, I think in OT we have to somehow, across the board, get away from this obsession with having the shortest possible assessment. When I worked in the schools, sometimes school psychologists would test children for 13 hours days. And I just always thought, how did this happen? That OTs are told they get 1520 minutes, and they say, okay, the school psychologist would never think that was okay, because they need that much time to understand the child. Yeah, so I've never been an advocate for Well, we have to find a test that takes, you know, that's a screener that takes 15 minutes. I think if we're going to take a child's time and someone's money to apply our professional skills, that it's our ethical responsibility to know what we're doing, and the only way we can know what we're doing is to first start with a comprehensive assessment.
Jayson Davies
Yeah, I think you're right. It's true, though, and I think some of us don't want to see it. I think some of us don't want to realize it, and we get comfortable.
Zoe Mailloux
I and I understand the pressure. I mean, therapists in schools have heavy case loads. Yes, I have them too. I don't know, I had 60 some children on my caseload, but, you know, it doesn't really make our jobs easier to not know what we're doing absolutely. You know, we're spinning our wheels, and these are precious children's time we're taking, and especially if we, you know, whatever we do in OT it's fun, you know, the kids are having fun. We make it playful, which is what it should be. So the negative side of that is that it's a little bit easy to skate, you know, it we can make it all look like everything's okay. The children are happy to come to us. They're not complaining. We probably hit and miss somehow, make some changes, but I know where. I know we are missing important functions we could make a lot better if we understood them.
Jayson Davies
Yeah, and I'm gonna throw it out there right now. We're lucky to have both you, and then we actually have Kelly coming on for a part two, kind of to the sensory integration, which you're very familiar with. So we're not I know I would love, and I'm sure everyone else listening would love for us to dive into the treatment aspect, but we're going to kind of take it back to the evaluation aspect. We'll get into treatment a little later. So the easy I'm currently enrolled in, I believe it's Module One of the CLASI, the CL asi.org, website, the module one, course. So is that kind of the new, the new modules of courses to go through, to learn kind of about, still the SIFT as well as the easy.
Zoe Mailloux
Well, actually, fortunately, there's a big international effort. I'll just say briefly that in 2014 a group of occupation mostly occupational therapists and physical therapists who were meeting internationally recognized that in the year 2020 Dr Ayers would have been 100 years old. So we launched an initiative called the airs sensory integration 2020 vision that that will culminate next year in July. By 2020, what would have been Dr Ayers 100th birthday? That initiative involved three goals. We got together. We said, What would Dr Ayers want for her 100th birthday? And we set three goals to meet. One of them was to develop a comprehensive set of tasks that would be accessible and feasible. That was the easy another goal was to recognize scholarship in this field and the evolution of sensory integration theory. So for any listeners who want access to more current literature, the goal number one is on the ASI 2020 vision website. It's ASI 2020, vision.org and we have been having people around the world review articles, research papers related to sensory integration, and then once we decide if the paper does or does not contribute, it's posted. We're a little behind in posting the papers, but I think we have about 40. Our goal is to have 100 and we've reviewed quite a few, but we only have 40 of them posted so far. So it's a good resource. Yeah. And then the third goal was to establish standards for training. So there's an international a new international organization that's called the International Council for Education in ASI, it's ice ASI, and that organization has established a definition of what is required in training related to air sensor integration. What are the standards? What are the components that must be included? Organizations around the world that meet those criteria will get kind of a stamp from this international organization, ice ASI, so in the United States, CLASI, which is a non profit organization, the collaborative for leadership in ASI, has applied for and has been granted, you Know, approval that that that program meets those standards, occupational therapists or therapists around the world will be able to look for that stamp to know if a program that they are if they want to learn about air sensor integration, they'll want to go to a program that has that stamp. So it doesn't mean that it's the only training in the you know, available related to sensory functions, but it will be the standard for learning about Ayers sensory integration. And so, I mean, that was a long way around to answer your question, but the collaborative for leadership in Ayers sensory integration has a certificate program in Ayers si that has six modules. The first module is on theory. This. There's a strong emphasis on assessment, and right now, the assessment is both the SIFT and an introduction to the easy those that happens in modules two and three, the we're still training on the SIFT, because we can score the sift. We have children who are coming next week who need help, and we can't wait a few years until we know what the scores on the easy will mean. So that program includes both the SIFT as the tool to use today, and information about the easy so that you know people are aware of it. The easy is as similar to the SIP as as is feasible when making a new test. So we do believe that anyone who knows the sip and has practiced the SIP will have a much smoother transition to the easy, and we don't think it's a waste of anyone's time to learn the SIP now and use it now. It will provide a strong foundation for any new test in the future. Awesome.
Jayson Davies
So then classes one is theory. Two and Three is the assessment. Four, five and six are treatment.
Zoe Mailloux
Two is online training in in the details of assessment. And three is an on site practice course where once you've been on your own trying to learn the assessments, you come together and get some feedback and mentorship. Four is the interpretation of the scores online. Five is the is an introduction to intervention and learning about something called the heirs si fidelity measure. One of the important developments in sensory integration over the last 10 years has been the development of a fidelity measure. Fidelity measures are common in intervention work, and they verify that an approach you think you're using is actually that approach. So in research, it's really not possible now to do intervention research, if there's not a fidelity measure that kind of proves that you're actually providing the intervention you're studying. And we are encouraging OTs to use this fidelity measure in their own practices. If you think you're doing or using air sensor integration as a framework, then check it. By using this tool to see if you really are and then module six is a hands on application of the interpretation and intervention principles.
Jayson Davies
So where can people find that tool? Is that a tool on sale? Or is it published in a no.
Zoe Mailloux
It's not. We don't sell anything. We try to give everything. We don't want anybody to be held up by funds. Now the Arizona fidelity measure, we have three articles in a ot going back to 2007 on this tool, it's available during the CLASI module five. You know, the publications that are out in the journals would be the place to get information about it.
Jayson Davies
and we'll be sure to we always have a show notes page, and we'll be sure to link to those different articles. It's going to be at ot schoolhouse.com, forward slash episode 25 so we'll be sure to link to all those articles at the show notes.
Zoe Mailloux
Just one other thing we do use an approach called data driven decision making in Ayers si that was developed mostly by Dr Roseanne Shaw as part of her intervention studies. And it you know, sensor integration is very complex. It's not a protocol, it's not a recipe approach, but data driven decision making is a step wise approach that encompasses the complexity of sensory integration to help therapists be methodical and systematic. And one of the things that we use in this approach is to make your decisions based on data, just like it's called rather than, hmm, I think today we'll try this and we'll see what happens. And so we in our programs, we try to link, you know, step one, step two, step three. Start with theory. What are your ideas? But then do an assessment, take that assessment data and specifically plan your intervention based on your assessment data. It seems like a lot of times in OT, in all aspects of OT, we kind of jump into treatment. We might even do an assessment, but then we jump into treatment, and we're not often carefully going back to the assessment data to make our day by day, moment by moment decisions in in our treatment sessions.
Jayson Davies
Yeah, so I wanted to jump back just slightly. I am part of the ASI 2020, Vision goal for the academia to look at some of those papers.
Zoe Mailloux
And great. Thank you. Thank you for reviewing papers definitely.
Jayson Davies
And, so I did look at as a recent one. I have it right here. It was the efficacy of sensory integration on school participation of children with sensory disorders. And one of the things that that it points out is how different sensory strategies are from sensory integration. And I think, I think you kind of referenced it a little bit earlier, is that sensory is just everywhere now, like the word sensory is, teachers are using it. Every item in a classroom that's not an academic item is a sensory item. And so how do you explain to people when someone might be referencing to sensory as though it's sensory integration, but it's not really sensory integration?
Zoe Mailloux
Well, I mean, I usually with that conversation. You know this the just to recognize that air sensory integration is a specific theory and intervention framework that includes components that must be there to actually meet the definition of air sensor integration, and that there might be other approaches that, in one way or another, use a sensation, use a sensory component that by itself, in no way means it's the same thing. And so in evaluating whether or not an approach, an intervention, you know, a tool, is going to be effective or not, we need to know what we're talking about. And I can feel very confident about using air sensor integration, because I understand all the steps that are needed. I know that there's strong evidence for this approach. We have good, strong evidence that this approach is effective, and I don't know that about a lot of the protocols or strategies that are out there. I'm not even to me. I'm not even really sure why they got names and why we started using them. I mean, we use a lot of therapeutic activities. Yes, we don't name every one of them, you know? We don't put a name on them and a protocol. So I don't know. I think for OTs, we have caused a lot of our own problems by jumping in and using techniques without really understanding why we're using them, by trying to treat children without a full assessment, we've probably caused a lot of the criticism that has occurred, and it's our responsibility to be more professional and. Scholarly about our work.
Jayson Davies
Yeah, and I think that's why evidence based practice is obviously so important. So keep researching and keep looking up articles. Yeah, okay, so I think I have one more question for you before I let you go. And this is a popular one, and it may also be a little loaded.
Zoe Mailloux
Okay, I'm Sicilian. I can take it right.
Jayson Davies
When assessing, how do you determine what behaviors may be due to sensory factors versus what behaviors may be due to more strictly behavioral factors?
Zoe Mailloux
Okay, well, that's actually a great question, and I don't really think it's out loaded. It's just a perfect question. I mean, really when we assess, I mean, when you're assessing with a child I have, I can't even tell you how many countless children I've assessed who were labeled as having an attention problem or labeled as having a behavior problem. When I am giving them an assessment, I get data, and I can tell if they're I rarely have children who cannot attend to these kinds of tests, and so when I know that they have been paying attention and they have been doing their best and they still have a low score, then I have data that tells me Now occasionally there is a child who is not able to take tests. But what I find is that OTs seem to think many more children are not testable than those children who are when you understand what you're assessing and you're fluent at the at the you know, administration, many, many children can take these assessments, and some of them don't even require that much cooperation. Like one of the tests we give is a post rotary nystagmus test. We're measuring a reflex. It's easy to give that test. Many, most children enjoy the test, and there's no behavior or attention involved. We give that test, we see the reflex. There's no question about, did the child try? Try or not try? They don't have that. And there's a lot of the test scores are like that. So when we have that data, and especially, you know, you mentioned strengths, when we give a comprehensive set of assessments, we can see which tests the child does better on and which ones are having more trouble with. Now, if they're if it was just purely attention, they would have trouble on everything, you know, they would just not be able to score. So I think it comes back to the same answer. You know, a good, strong assessment will will go a long way to telling us if there's a true attention problem, if there's a true behavior problem, but most of the time, you're going to get information that really helps to differentiate and most children, I mean, you know, I just think most children want to participate when they Can't. There's a reason for it, and when no one has recognized why they're having trouble, it must be so frustrating they have every reason in the world to be angry or to withdraw. Sometimes withdrawing is adaptive. You know, if something's really difficult, it's adaptive to get yourself out of that situation, yeah? So, I mean, we're the professionals, we're the adults. It's our job to try to understand and by, you know, just skimming over things, quick checklist, a little observation, that's not doing our job.
Jayson Davies
Yeah, I kind of agree with that. But when you're talking right there. Sorry, I want to share one more story. You kind of well, just the story came up, and I remember this was a student right after I just taken the sift all four courses. And I was, I actually did use the sipped with this student. I can't remember if this was right before or right after I did the SIP, but this student, she was doing, she was writing, and all of a sudden, she just pushed all her paper off the table, through her pencil, so frustrated because she was having a tough time, and then within like, two seconds, was like, I'm so sorry. I'm so sorry. Picked it all up, and you could just see the frustration on her, just it was so difficult for her to write. And I truly believed, I mean, through my assessment, that, yeah, there was some sensory stuff going on that was making that difficult. And no matter how much we continue to work with this student to learn how to write her name, unless we work on some of those underlining factors, some of that vestibular integration and stuff like that, it just wasn't going to come together for her and so.
Zoe Mailloux
Exactly. And you know, I mean, and it's not to say that there aren't other elements. I mean, we are OTs, we have to consider the whole person. There could be emotional, psycho, emotional things going on, psychosocial things going on. There could be medical issues. I mean, I had, when I worked in this one school where I was the only ot for a while, and I had a full caseload. So. So there was one child that the teacher suddenly said this, this kid has to come see you. And we happened to be at a school where there was a little Therapy Clinic at the school, and she wanted this child to come and see me every single day. And this child was really unhappy. He was crying. He was uncomfortable. I said, there is more going on here. This is not just an OT issue. This is not a sensory integration issue. Well, this little guy had abscessed cavities in his mouth, and he had autism, and he'd been kind of written off that it was just the autism, and it wasn't just the autism. He had a raging infection in his mouth, so we can't just assume that everything can be explained, you know, by and we have to keep our our wide brimmed ot hat on that considers all the possibilities. But that That being said, at least if we do our job and consider the areas that no one else is considering, yeah, we can really be an important member of the team to illuminate. And I found in the schools that when I came with data, and I could show test scores and I could explain the relationship of these functions to what was happening in the classroom, I didn't have any pushback. I had psychologists and principals explaining sensory integration to parents. You know, my job got a lot easier. I didn't feel like this was a struggle. It was. We were all working together to understand the children and to help them and more of the time, it was a relief to the team that somebody at the table had information that was making sense. So I think we'll do better as a profession if we step up.
Jayson Davies
Yeah, got to do those good assessments. So all right. Well, I want to say thank you so much for coming on. It was a pleasure having you. Yeah, I've seen you speak a few times, and I was just like, when this podcast first got started, you were like, one of the first names that popped up into my mind. I was like, I want to have Zoe on this podcast.
Zoe Mailloux
And so happy to be here, and I hope that the listeners stop guessing and start assessing.
Jayson Davies
There you go, real quick before I let you go. Is there anywhere other than the CL, asi.org website where people can learn more about you or?
Zoe Mailloux
I have a website, I do have a website that's just my name, Zoe Mailloux.
Jayson Davies
I can put a link to that, of course.
Zoe Mailloux
.com, and I mean, one of the things on my website that I do have are some free information pages for parents that explain things like tactile perception and proprioception in everyday language, and they're translated into four or five languages, so those are available. Might be helpful to the therapist and might also be helpful to their consumers.
Jayson Davies
Perfect. Well, thank you so much, and I'll let you enjoy the rest of your President's Day. Have a great day.
Zoe Mailloux
Thanks. Thanks for doing this podcast. Yeah, great. Thank you.
Jayson Davies
Bye. Bye, all right. Well, that concludes today's episode with Zoe Mayu, and I just want to give out a very special thank you once again to Zoe for coming onto the podcast. I couldn't have asked for any better way to really celebrate one year of the OT school house podcast. So really do appreciate that to all of you out there listening. Thank you for listening again, whether this is your first episode of the 25th episode you're listening to just a big thank you to everyone, and we'll see you in episode number 26 when we start year number two. Take care. Bye, bye.
Amazing Narrator
Thank you for listening to the OT school house podcast for more ways to help you and your students succeed right now, head on over to otsoolhouse.com Until next time class is dismissed.
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