Sensory Integration Difficulties and Dysfunctions in Children with Fetal Alcohol Spectrum Disorders

264 Pages·2017·2.52 MB·English

by  Maritha Du Plooy

Sensory Integration Difficulties and
Dysfunctions in Children with Fetal
Alcohol Spectrum Disorders
by
Maritha du Plooy
B Occupational Therapy (US)

Dissertation submitted in fulfilment of the requirements in respect
of a Master’s Degree
M. Occupational Therapy
in the
DEPARTMENT:
OCCUPATIONAL THERAPY
FACULTY:
HEALTH SCIENCES
UNIVERSITY OF THE FREE STATE
JUNE 2017

Study leader: Biostatistician:
Mrs A van Jaarsveld Dr J Raubenheimer
Co-study leader:
Mrs E Janse van Rensburg
Sensory Integration Difficulties and Dysfunctions in
Children with Fetal Alcohol Spectrum Disorders (FASD).

RESEARCHERS
Student: Mrs Maritha du Plooy - 2012155566
Study Leader: Mrs Annamarie van Jaarsveld
Co-study Leader: Mrs Elize Janse van Rensburg
Biostatistician: Dr Jacques Raubenheimer

i
In the words of Eloise McGraw….
“To all children
who have ever felt different”

ii
DECLARATION

I, ………………………… ………., declare that the
Master’s Degree research dissertation entitled

Sensory Integration Difficulties and Dysfunctions in Children

with

Fetal Alcohol Spectrum Disorders
that I herewith submit for the Master’s Degree qualification
Magister in Occupational Therapy at the University of the Free State,

is my independent work,

and that I have not previously submitted it for a qualification

at another institution of higher education

…………………………………..

Maritha du Plooy

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"I continue to believe that if children are given the
necessary tools to succeed, they will succeed beyond
their wildest dreams!"
David Vitter, U.S. Senator

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ACKNOWLEDGEMENTS
I hereby acknowledge the following people for their support and assistance in the
completion of this dissertation.
• Every parent who was willing to participate in the study and allowed me to
assess their child.
• Every child who enthusiastically participated. Each of you is very special.
• Every educator for their cooperation and time.
• My supervisor, Annamarie van Jaarsveld, for guiding me with expertise and
endless patience. Thank you for your belief in this study.
• My co-supervisor, Elize Janse van Rensburg, for setting the academic bar high.
You continuously inspired me to do better.
• My statistician, Dr Jacques Raubenheimer, for making sense from the raw data
and for assuring me that I needn’t know everything!
• My friend Pieter, for your huge contribution in capturing the data.
• Heather, for being my right hand throughout the months of testing. Thank you
for motivating and encouraging me and for your kind, gentle way with each
child.
• My husband Jaco, for always allowing me to spread my professional wings.
• My children, Elri, Petrie and Adoré, for assuring me that this was possible when
I started doubting myself.
• My mother Engela, for teaching me by example what empathy looks like.
• SAISI and the University of the Free State - SAISI for their financial contribution
and the University of the Free State for a master’s scholarship, one of those
awarded since 2016 – making this study more affordable.
• My heavenly Father, for giving me a love of children and the opportunity to be
in a profession where I can make a difference in other’s lives.
• John Kench, for your superb language editing of the thesis.
• Matty, Molly, Asha, Lexie, Raph, Muffin and Jesse, for your quiet, loyal support
and presence, either by my feet or on the keyboard blocking my view!

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TABLE OF CONTENTS
Page
DEDICATED TO ii
DECLARATION iii
ACKNOWLEDGEMENTS v
TABLE OF CONTENTS vi
LIST OF TABLES x
LIST OF FIGURES xi
ACRONYMS AND ABBREVIATIONS xii
CONCEPT CLARIFICATION xiii
SUMMARY AND KEY WORDS xvi

CHAPTER 1 – INTRODUCTION AND ORIENTATION TO RESEARCH 1
1.1 INTRODUCTION 1
1.2 PROBLEM STATEMENT 5
1.3 PURPOSE OF THE STUDY 6
1.3.1 Aim 6
1.3.2 Objective 6
1.4 DELIMITATIONS 7
1.5 METHODOLOGY 7
1.6 THE IMPORTANCE AND VALUE OF THE STUDY 8
1.7 ETHICAL CONSIDERATIONS 9
1.8 OUTLINE OF CHAPTERS 9
1.9 SUMMARY 10

CHAPTER 2 – LITERATURE REVIEW 11
2.1 INTRODUCTION 11
2.2 OVERVIEW OF FETAL ALCOHOL SPECTRUM DISORDERS 11
2.2.1 History 11
2.2.2 Diagnosis of Fetal Alcohol Syndrome 12
2.2.3 Diagnostic process relevant to this study 17
2.2.4 Fetal Alcohol Spectrum Disorders in South Africa 20
2.2.5 The effects of alcohol on brain and behaviour 24
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2.3 AN OVERVIEW OF THE CHILD WITH FASD IN SA – SPECIFICALLY 40
IN THE CAPE WINELANDS EDUCATION DISTRICT IN THE
WESTERN CAPE
2.4 FASD AND OCCUPATIONAL THERAPY 43
2.4.1 Occupational therapy scope of practice 43
2.4.2 Sensory integration 50
2.4.3 Sensory-motor development and sensory integration 67
in children with FASD
2.4.4 The value of using a sensory integration framework to 77
evaluate children with FASD
2.5 FASD AND EDUCATION 78
2.6 FASD INTERVENTIONS 83
2.6.1 Interventions during alcohol exposure 83
2.6.2 Interventions for individuals with FASD 84
2.7 CONCLUSION 91

CHAPTER 3 – RESEARCH APPROACH AND METHODOLOGY 93
3.1 INTRODUCTION 93
3.2 RESEARCH APPROACH AND STUDY DESIGN 93
3.2.1 Quantitative approach 93
3.2.2 Observational analytical design 94
3.3 RESEARCH POPULATION 94
3.4 SAMPLING 94
3.4.1 Inclusion criteria 95
3.4.2 Exclusion criteria 96
3.4.3 Sampling 97
3.4.4 Sample size 97
3.5 RESEARCH PROCEDURE 98
3.6 PILOT STUDY 100
3.7 MEASUREMENT 101
3.7.1 The measurement instruments 102
3.7.2 Data collection process 112
3.8 DATA ANALYSIS 115
3.9 METHODOLOGICAL AND MEASUREMENT ERRORS 116
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3.9.1 Measurement errors 116
3.9.2 Confounding variables 120
3.10 ETHICAL ASPECTS 120
3.11 SUMMARY 124

CHAPTER 4 – RESULTS 125
4.1 INTRODUCTION 125
4.2 DEMOGRAPHIC INFORMATION 126
4.3 DIAGNOSTIC INFORMATION 129
4.4 SENSORY PROFILES 130
4.4.1 Sensory Profile Caregiver Questionnaire 130
4.4.2 Sensory Profile School Companion 141
4.5 SIPT 145
4.5.1 SIPT Clinical observations results by group 145
4.5.2 SIPT subtests mean scores 146
4.5.3 SIPT subtests by group 148
4.5.4 SIPT patterns of dysfunction 150
4.6 CONCLUSIONS 152

CHAPTER 5 – DISCUSSION OF RESULTS 153
5.1 INTRODUCTION 153
5.2 DEMOGRAPHIC INFORMATION 153
5.2.1 Study participants’ demographic information 154
5.2.2 Family structure 154
5.2.3 Maternal information 155
5.3 DIAGNOSTIC INFORMATION 157
5.4 SENSORY PROFILES 157
5.4.1 Sensory Profile Caregiver Questionnaire 157
5.4.2 Sensory Profile School Companion 164
5.4.3 Results summary of sensory profiles 167
5.5 SIPT 171
5.5.1 Clinical observations 171
5.5.2 SIPT subtests 173

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5.6 PATTERNS OF SENSORY INTEGRATION DYSFUNCTION 189
5.6.1 General observations 190
5.6.2 Identified patterns in this study 190
5.7 SUMMARY 192

CHAPTER 6 - CONCLUSIONS AND RECOMMENDATIONS 193
6.1 INTRODUCTION 193
6.2 LIMITATIONS OF THE STUDY 193
6.3 CONCLUSIONS 196
6.4 RECOMMENDATIONS 199
6.5 CLOSURE 200

REFERENCES 201
APPENDICES 215
APPENDIX A: Letter of approval from Ethics Committee
APPENDIX B: Study permission from Prof Seedat
APPENDIX C: Permission to conduct research in public schools in the
Western Cape
APPENDIX D: Explanatory document and letter of consent to Director
of the Cape Winelands Education District
APPENDIX E (i): Explanatory document and letter of consent to
parents/caregivers of children with FASD
APPENDIX E (ii): Explanatory document and letter of consent to
parents/caregivers of children in control group
APPENDIX F (i): Explanatory document and letter of assent of participant
APPENDIX F (ii): Explanatory document and letter of assent of participant
(Control Group)
APPENDIX G: Diagnostic guidelines for specific fetal alcohol spectrum
disorders (FASD) according to the IOM, as clarified by Hoyme
et al. (2005)
APPENDIX H: Definition of Documented Prenatal Alcohol Exposure
(as Applied to the diagnostic categories set forth in
APPENDIX I)
APPENDIX I: Updated criteria for the diagnosis of FASD
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