Sensory processing, occupational performance and leisure

In Part II of the blog post on occupational performance, ASI-trained therapist Tharina Annandale looks at how sensory preferences affect leisure choice, which also has a close link to mental health.

Occupational performance can be defined as different aspects of a person’s daily living, like work, social participation, play and leisure, and sleep (Strong, S. and Rebeiro Gruhl, K.,2011 pp. 31-33).

We can consider leisure to be an occupational performance area.  An activity is regarded as leisure when it is experienced as rewarding or enjoyment is experienced during the activity.  Different people pursue different leisure activities, depending on their personal “needs” or idea of enjoyment.

In the previous article on “sensory processing and occupational performance at work” the different sensory profiles (Dunn, 1999) were considered.  Each individual has their own, unique sensory profile and there is always an unconscious experience of the sensory environment and sensory information during an activity.  In the pursuit of enjoyment and meaning, an individual will always do whatever addresses their unconscious sensory need.  Thus, all of us will have different interests in leisure activities.  Some people will prefer leisure activities like bungee jumping and free-falling.  Other people will prefer sedentary leisure activities, like building a puzzle or reading a book.

Some people are sensitive in their tactile (touch) systems and others are sensitive in their vestibular (balance and movement) system.  Of course you get so many sensory profiles that it will be impossible for me to give an example of each one, but I will attempt to explain it with the following case study.

Let’s consider the following child: A fourteen year old boy that prefers playing violin and singing in the choir.  He has never liked team sports or any form of contact sports at school.  He prefers being alone during break time and is regarded as socially awkward.  He has visited almost eight psychiatrists in his lifetime and one psychiatrist had diagnosed him with depression.  Most of the other psychiatrists have told the family that “they need to stop fighting” at home, then everything will improve.  Some have considered a diagnosis on the Autistic spectrum, but have not diagnosed him formally with Autism.  During the boy’s baby years he did not like to be put in his pram and he preferred to sit and play.  He got severe car sickness and had to sit in the front seat of the car at all times, otherwise he would even get car sick on the way to the local grocer.  His parents have thought it good to enrol him in gymnastics and the boy has been doing trampolining since he was eight.  However, the mother noted that in spite of the fact that a teacher recommended trampoline as a sport that the boy could participate in, because “a trampoline is good for children”, the boy is really irritated after he jumped on the trampoline, until seven in the evening.  When the boy is finished at his “trampoline session” he goes out of his way to irritate his younger brother, his father and his mother.  His mother explains that “he is in her space” and she only wants to “slow down” for the day.

Know, dear people, this is a typical example of two sensory profiles in conflict with each other and explains why the psychiatrists keep on saying “that the family needs to stop fighting”.  Rightfully so, the family need to stop fighting, but what is behind the conflict?  When we considered the fact that the boy started crying when he was put in his pram and that he gets car sick, the indication of a sensitive vestibular system is a possibility.  The sensory profile indicated a severely sensitive vestibular system and this lead me to one question: “Was doing the trampoline the best leisure activity for this boy?”

Let’s have a look at trampoline as a sport- the following systems are involved when doing trampoline as a sport:  Vestibular, proprioception, tactile and the visual system.  At a closer look, it was established that the gymnast will have to make 180 degree and 360 degree (which is a full circle) turns during this sport.  The position of the head is mostly upside down and the speed increases with each rotation.  Was this the ideal leisure activity for this boy?  The boy did not mind going, because “at least his parents will think that he is cool in something”.

However, the root of the conflict was analysed and an adjustment was made in terms of leisure activity and today this boy copes at school and at home.  He does not experience any “sensory overload” anymore and changed his leisure activity to squash.  Squash has less of a vestibular component, it is not a team sport and the proprioception that he gets from hitting the ball inhibits his tendency to experience vestibular information at a more intense level than other individuals.  The mother reports that she has put the boy in a school with smaller classrooms and he has adjusted his daily program and his leisure activities to accommodate his sensory profile.  The boy’s anti-depressants were stopped and he is socializing less awkwardlyJ.  This is a very good example of someone with a Sensory Processing Disorder that could have been diagnosed with Autism and on chronic medication for “aggressive outbursts” “irritating others” and “fighting” at home.  At this stage I would just like to make it clear that I am not saying that there should not be a diagnosis of Autism, but sometimes a very serious diagnosis is made that could have been different if sensory issues were sorted out.

Let’s have a look at other leisure activities and possible sensory profiles that might match the activities.

In the above examples you can see that there is literally a leisure activity that suits every sensory profile (Dunn, 1999).  Leisure activities can either enhance occupational performance or can have a negative impact on occupational performance.  Therefore, it is of utmost importance to allow children perform the leisure activities of their choice and to make sure that the leisure activity that they choose to do is not to impress a parent or any teacher.  If a person does a leisure activity that they don’t enjoy, it can have a spiral effect on interpersonal relationships, work, self-care and even sleep.

It is important to be sensory sensible when choosing your leisure activity.