Lucy Jane Miller

Sensory Processing Disorder Foundation, Greenwood Village, Colorado, United States

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Publications (17)27.26 Total impact

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    Lucy Jane Miller, Darci M Nielsen, Sarah A Schoen
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    ABSTRACT: Children with attention deficit hyperactivity disorder (ADHD) are impulsive, inattentive and hyperactive, while children with sensory modulation disorder (SMD), one subtype of Sensory Processing Disorder, have difficulty responding adaptively to daily sensory experiences. ADHD and SMD are often difficult to distinguish. To differentiate these disorders in children, clinical ADHD, SMD, and dual diagnoses were assessed. All groups had significantly more sensory, attention, activity, impulsivity, and emotional difficulties than typical children, but with distinct profiles. Inattention was greater in ADHD compared to SMD. Dual diagnoses had more sensory-related behaviors than ADHD and more attentional difficulties than SMD. SMD had more sensory issues, somatic complaints, anxiety/depression, and difficulty adapting than ADHD. SMD had greater physiological/electrodermal reactivity to sensory stimuli than ADHD and typical controls. Parent-report measures identifying sensory, attentional, hyperactive, and impulsive difficulties varied in agreement with clinician's diagnoses. Evidence suggests ADHD and SMD are distinct diagnoses.
    Research in developmental disabilities 05/2012; 33(3):804-18. · 4.41 Impact Factor
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    ABSTRACT: Sensory modulation disorder (SMD) is a severe inability to regulate responses to everyday sensory stimulation to which most people easily adapt. It is estimated to affect 5% to 16% of the general population of children. Although heterogeneity is seen in the presentation clinically, previous research has not empirically investigated whether the clinical heterogeneity of SMD can be classified into subtypes. This study explores a cohort of 98 children identified with SMD at the Department of Pediatric Rehabilitation by a member of the occupational therapy team at The Children's Hospital of Denver. Two subtypes of SMD were identified through cluster analysis based on data from 4 parent-report instruments. The first subtype is characterized by sensory seeking/craving, hyperactive, impulsive, externalizing (eg, delinquent, aggressive), unsocial, inadaptive, and impaired cognitive/social behavior. The second subtype is characterized by movement sensitivity, emotionally withdrawal, and low energy/weak behavior. Findings from this study present a step toward understanding and classifying the complexities of children with SMDs.
    Comprehensive psychiatry 02/2011; 52(6):715-24. · 2.08 Impact Factor
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    ABSTRACT: The overall goal of this study was to determine if parasympathetic nervous system (PsNS) activity is a significant biomarker of sensory processing difficulties in children. Several studies have demonstrated that PsNS activity is an important regulator of reactivity in children, and thus, it is of interest to study whether PsNS activity is related to sensory reactivity in children who have a type of condition associated with sensory processing disorders termed sensory modulation dysfunction (SMD). If so, this will have important implications for understanding the mechanisms underlying sensory processing problems of children and for developing intervention strategies to address them. The primary aims of this project were: (1) to evaluate PsNS activity in children with SMD compared to typically developing (TYP) children, and (2) to determine if PsNS activity is a significant predictor of sensory behaviors and adaptive functions among children with SMD. We examine PsNS activity during the Sensory Challenge Protocol; which includes baseline, the administration of eight sequential stimuli in five sensory domains, recovery, and also evaluate response to a prolonged auditory stimulus. As a secondary aim we examined whether subgroups of children with specific physiological and behavioral sensory reactivity profiles can be identified. Results indicate that as a total group the children with severe SMD demonstrated a trend for low baseline PsNS activity, compared to TYP children, suggesting this may be a biomarker for SMD. In addition, children with SMD as a total group demonstrated significantly poorer adaptive behavior in the communication and daily living subdomains and in the overall Adaptive Behavior Composite of the Vineland than TYP children. Using latent class analysis, the subjects were grouped by severity and the severe SMD group had significantly lower PsNS activity at baseline, tones and prolonged auditory. These results provide preliminary evidence that children who demonstrate severe SMD may have physiological activity that is different from children without SMD, and that these physiological and behavioral manifestations of SMD may affect a child's ability to engage in everyday social, communication, and daily living skills.
    Frontiers in Integrative Neuroscience 01/2010; 4:4.
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    ABSTRACT: This study examined the relation between restricted, repetitive, and stereotyped behaviors and interests (RBs) and sensory responses in a group of 70 children and adolescents diagnosed with an autism spectrum disorder (ASD). Caregivers completed the Repetitive Behavior Scale-Revised (RBS-R) and the Sensory Profile. Controlling for IQ and age, total RBS-R and Sensory Profile scores revealed significant correlations both prior to and after removing overlapping items. Examination of the co-occurrence of RBs and atypical sensory responses in this population suggests a subgroup has consistently high rates of problems in both RBs and sensory processing. In addition, this subgroup has high rates of prescribed psychoactive medications and co-morbid psychiatric diagnoses. The IQ and age of this subgroup did not differ significantly from the rest of the participants. Results are consistent with previous research describing the co-occurrence of RBs and sensory response abnormalities in the ASD population. Further investigation of the subset of individuals with ASD who have high rates of RBs and abnormal sensory responses may lead to a more comprehensive understanding of their clinical picture and improve interventions. Additionally, research with this subgroup may have significance for identifying a specific phenotype in ASD.
    Research in Autism Spectrum Disorders. 01/2008;
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    ABSTRACT: This study (1) explored the feasibility of using electrodermal activity (EDA) to characterize the arousal and sensory reactivity of children with high functioning autism (HFA) and Asperger's Syndrome (AS), (2) determined the reliability of electrodermal measures and (3) described the variability of EDA in this sample. Forty children with HFA and AS participated. All participants received a diagnostic psychological assessment and a physiological evaluation. Fourteen participated in the retest study on the physiological measures. Results indicated psychophysiologic testing was feasible with this sample. Seventy-three percent of the variables had reliability coefficients greater than .33, with a median variable reliability of .45. No significant differences were detected between HFA and AS groups. Visual inspection of skin conductance level (SCL) suggested two patterns: (1) high SCL (high arousal), with higher EDA magnitudes, faster latencies and slower habituation and (2) low SCL (low arousal), with lower EDA magnitudes, slower latencies and faster habituation. The presence of two EDA patterns applied equally when medications were eliminated. The previous inconsistency in studies of EDA in children with HFA and AS may be due to the presence of a high arousal groups and a low arousal group. Hence, this population should not be assumed to be homogeneous.
    Research in Autism Spectrum Disorders. 01/2008;
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    Roseann C Schaaf, Lucy Jane Miller
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    ABSTRACT: This article provides an introduction and overview of sensory integration theory as it is used in occupational therapy practice for children with developmental disabilities. This review of the theoretical tenets of the theory, its historical foundations, and early research provides the reader with a basis for exploring current uses and applications. The key principles of the sensory integrative approach, including concepts such as "the just right challenge" and "the adaptive response" as conceptualized by A. Jean Ayres, the theory's founder, are presented to familiarize the reader with the approach. The state of research in this area is presented, including studies underway to further delineate the subtypes of sensory integrative dysfunction, the neurobiological mechanisms of poor sensory processing, advances in theory development, and the development of a fidelity measure for use in intervention studies. Finally, this article reviews the current state of the evidence to support this approach and suggests that consensual knowledge and empirical research are needed to further elucidate the theory and its utility for a variety of children with developmental disabilities. This is especially critical given the public pressure by parents of children with autism and other developmental disabilities to obtain services and who have anecdotally noted the utility of sensory integration therapy for helping their children function more independently. Key limiting factors to research include lack of funding, paucity of doctorate trained clinicians and researchers in occupational therapy, and the inherent heterogeneity of the population of children affected by sensory integrative dysfunction. A call to action for occupational therapy researchers, funding agencies, and other professions is made to support ongoing efforts and to develop initiatives that will lead to better diagnoses and effective intervention for sensory integrative dysfunction, which will improve the lives of children and their families.
    Mental Retardation and Developmental Disabilities Research Reviews 02/2005; 11(2):143-8. · 3.80 Impact Factor
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    Lucy Jane Miller, Joseph R Coll, Sarah A Schoen
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    ABSTRACT: A pilot randomized controlled trial (RCT) of the effectiveness of occupational therapy using a sensory integration approach (OT-SI) was conducted with children who had sensory modulation disorders (SMDs). This study evaluated the effectiveness of three treatment groups. In addition, sample size estimates for a large scale, multisite RCT were calculated. Twenty-four children with SMD were randomly assigned to one of three treatment conditions; OT-SI, Activity Protocol, and No Treatment. Pretest and posttest measures of behavior, sensory and adaptive functioning, and physiology were administered. The OT-SI group, compared to the other two groups, made significant gains on goal attainment scaling and on the Attention subtest and the Cognitive/Social composite of the Leiter International Performance Scale-Revised. Compared to the control groups, OT-SI improvement trends on the Short Sensory Profile, Child Behavior Checklist, and electrodermal reactivity were in the hypothesized direction. Findings suggest that OT-SI may be effective in ameliorating difficulties of children with SMD.
    The American journal of occupational therapy.: official publication of the American Occupational Therapy Association 61(2):228-38. · 1.70 Impact Factor
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    ABSTRACT: This study was a preliminary investigation of parasympathetic nervous system (PNS) functioning in children with disturbances in sensory processing. The specific aims of this study were to (1) provide preliminary data about group differences in parasympathetic functions, as measured by the vagal tone index, between children with disturbances in sensory processing and those without; (2) determine effect size and power needed for future studies; and (3) to lay the foundation for further examination of the relations of parasympathetic functioning and functional behavior in children with disturbances in sensory processing. Participants were 15 children, nine with disturbances in sensory processing and six typically developing children. Heart period data were continuously collected for a 2-minute baseline and during administration of the 15-minute Sensory Challenge Protocol, a unique laboratory protocol designed to measure sensory reactivity (Miller, Reisman, McIntosh, & Simon, 2001). Groups were compared on vagal tone index, heart period, and heart rate using two-tailed, independent sample t tests. Children with disturbances in sensory processing had significantly lower vagal tone than the typically developing sample (t(13) = 2.4, p = .05). Statistical power analysis indicated that, for future studies, a sample size of 20 in each group would yield adequate statistical power. Although the number of subjects in this pilot study is small, the results from this study support further investigations of parasympathetic functions and functional behavior in children with disturbances in sensory processing.
    The American journal of occupational therapy.: official publication of the American Occupational Therapy Association 57(4):442-9. · 1.70 Impact Factor
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    ABSTRACT: The purpose of this study was to examine the ability of the Miller Assessment for Preschoolers (MAP) to predict academic performance of Israeli preschoolers after a period of 5 to 7 years. Thirty children who were classified according to the MAP as preschoolers at risk (n= 15) and not at risk (n= 15) for pre-academic problems were tracked after 5 to 7 years. Follow-up evaluations were done on motor, visual-motor integrative, and cognitive performance components; reading and handwriting academic performance areas; and a variety of measures taken to establish overall school functional status. Results indicate that children classified by the MAP as preschoolers at risk performed significantly worse 5 to 7 years later on visual-motor, cognitive, and reading and handwriting tests than those preschoolers classified not at risk and demonstrated reduced overall school functional status. The findings indicate that the MAP can predict academic performance even over a 5-year to 7-year interval. Furthermore, by linking academic performance data to performance components of children in different cultures, our investigation contributes to the overall understanding of children's functioning.
    The American journal of occupational therapy.: official publication of the American Occupational Therapy Association 56(5):547-55. · 1.70 Impact Factor
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    The American journal of occupational therapy.: official publication of the American Occupational Therapy Association 61(2):135-40. · 1.70 Impact Factor
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    ABSTRACT: The purpose of this pilot study was to prepare for a randomized controlled study of the effectiveness of occupational therapy using a sensory integration approach (OT-SI) with children who have sensory processing disorders (SPD). A one-group pretest, posttest design with 30 children was completed with a subset of children with SPD, those with sensory modulation disorder. Lessons learned relate to (a) identifying a homogeneous sample with quantifiable inclusion criteria, (b) developing an intervention manual for study replication and a fidelity to treatment measure, (c) determining which outcomes are sensitive to change and relate to parents' priorities, and (d) clarifying rigorous methodologies (e.g., blinded examiners, randomization, power). A comprehensive program of research is needed, including multiple pilot studies to develop enough knowledge that high-quality effectiveness research in occupational therapy can be completed. Previous effectiveness studies in OT-SI have been single projects not based on a unified long-term program of research.
    The American journal of occupational therapy.: official publication of the American Occupational Therapy Association 61(2):161-9. · 1.70 Impact Factor
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    ABSTRACT: We sought to assess validity of sensory integration outcomes research in relation to fidelity (faithfulness of intervention to underlying therapeutic principles). We identified core sensory integration intervention elements through expert review and nominal group process. Elements were classified into structural (e.g., equipment used, therapist training) and therapeutic process categories. We analyzed 34 sensory integration intervention studies for consistency of intervention descriptions with these elements. Most studies described structural elements related to therapeutic equipment and interveners' profession. Of the 10 process elements, only 1 (presentation of sensory opportunities) was addressed in all studies. Most studies described fewer than half of the process elements. Intervention descriptions in 35% of the studies were inconsistent with one process element, therapist-child collaboration. Validity of sensory integration outcomes studies is threatened by weak fidelity in regard to therapeutic process. Inferences regarding sensory integration effectiveness cannot be drawn with confidence until fidelity is adequately addressed in outcomes research.
    The American journal of occupational therapy.: official publication of the American Occupational Therapy Association 61(2):216-27. · 1.70 Impact Factor
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    Sarah A Schoen, Lucy Jane Miller, Kathy E Green
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    ABSTRACT: This article describes 3 stages of construction of the Sensory Over-Responsivity (SensOR) Scales: instrument development, reliability and validity analyses, and cross-validation on a new sample. The SensOR Scales include the SensOR Assessment, an examiner-administered performance evaluation, and the SensOR Inventory, a caregiver self-rating scale. Both scales measure sensory overresponsivity in 7 sensory domains. Data were collected from 2 samples consisting of participants who were typically developing (ns = 60 and 44, respectively) and participants with sensory overresponsivity (ns = 65 and 48, respectively), ages 3 to 55. In developing the research edition, items on the pilot version were reviewed for their internal consistency reliability, discriminant validity, and construct validity. Data from both samples on the research edition revealed high internal consistency reliability for domains and the total test and significant discrimination between the overresponsive and the typically responsive groups (p < .05). The preliminary psychometric integrity of the scales, along with continued research efforts, is an important contribution to evidence-based practice.
    The American journal of occupational therapy.: official publication of the American Occupational Therapy Association 62(4):393-406. · 1.70 Impact Factor
  • Roseann C. Schaaf, Lucy Jane Miller
    [Show abstract] [Hide abstract]
    ABSTRACT: This article provides an introduction and overview of sensory integration theory as it is used in occupational therapy practice for children with develop- mental disabilities. This review of the theoretical tenets of the theory, its histor- ical foundations, and early research provides the reader with a basis for explor- ing current uses and applications. The key principles of the sensory integrative approach, including concepts such as "the just right challenge" and "the adaptive response" as conceptualized by A. Jean Ayres, the theory's founder, are presented to familiarize the reader with the approach. The state of research in this area is presented, including studies underway to further delineate the subtypes of sensory integrative dysfunction, the neurobiological mechanisms of poor sensory processing, advances in theory development, and the devel- opment of a fidelity measure for use in intervention studies. Finally, this article reviews the current state of the evidence to support this approach and suggests that consensual knowledge and empirical research are needed to further elu- cidate the theory and its utility for a variety of children with developmental disabilities. This is especially critical given the public pressure by parents of children with autism and other developmental disabilities to obtain services and who have anecdotally noted the utility of sensory integration therapy for help- ing their children function more independently. Key limiting factors to research include lack of funding, paucity of doctorate trained clinicians and researchers in occupational therapy, and the inherent heterogeneity of the population of children affected by sensory integrative dysfunction. A call to action for occu- pational therapy researchers, funding agencies, and other professions is made to support ongoing efforts and to develop initiatives that will lead to better diagnoses and effective intervention for sensory integrative dysfunction, which will improve the lives of children and their families with ASD.
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    Anita C Bundy, Sue Shia, Long Qi, Lucy Jane Miller
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    ABSTRACT: This study investigated sensory processing dysfunction (SPD) and playfulness and the effect of intervention on playfulness. Twenty children with SPD and 20 children who were typically developing took the Short Sensory Profile (SSP) and Test of Playfulness (ToP). Children with SPD took the praxis tests from the Sensory Integration and Praxis Tests (SIPT) and received 20 intervention sessions. Correlations among measures and differences between mean scores of groups and pre-intervention and post-intervention were examined. Group ToP scores differed significantly; ToP did not increase post-intervention. Correlations among ToP and SSP ranged from .36 to .72; ToP and SIPT, from -0.1 to -0.46. Modulation affects playfulness. Although intervention was not effective, both groups had high scores initially, making the finding difficult to interpret.
    The American journal of occupational therapy.: official publication of the American Occupational Therapy Association 61(2):201-8. · 1.70 Impact Factor
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    ABSTRACT: Goal attainment scaling (GAS) is a methodology that shows promise for application to intervention effectiveness research and program evaluation in occupational therapy (Dreiling & Bundy, 2003; King et al., 1999; Lannin, 2003; Mitchell & Cusick, 1998). This article identifies the recent and current applications of GAS to occupational therapy for children with sensory integration dysfunction, as well as the process, usefulness, and problems of application of the GAS methodology to this population. The advantages and disadvantages of using GAS in single-site and multisite research with this population is explored, as well as the potential solutions and future programs that will strengthen the use of GAS as a measure of treatment effectiveness, both in current clinical practice and in much-needed larger, multisite research studies.
    The American journal of occupational therapy.: official publication of the American Occupational Therapy Association 61(2):254-9. · 1.70 Impact Factor
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    ABSTRACT: This study is the first to systematically examine estimated rates of sensory processing disorders using survey data. Parents of incoming kindergartners from one suburban U.S. public school district were surveyed using the Short Sensory Profile, a parent-report screening tool that evaluates parents' perceptions of functional correlates of sensory processing disorders (McIntosh, Miller, Shyu, & Dunn, 1999a). A total of 703 completed surveys were returned, which represents 39% of the kindergarten enrollment (n = 1,796) in the district for the 1999-2000 school year. Of the 703 children represented by the surveys, 96 children (13.7% of 703) met criteria for sensory processing disorders based upon parental perceptions. A more conservative prevalence estimate of children having sensory processing disorders based on parental perceptions was calculated by assuming that all non-respondents failed to meet screening criteria. This cautious estimate suggests that based on parents' perceptions, 5.3% (96 of 1796) of the kindergarten enrollment met screening criteria for sensory processing disorders. These percentages are consistent with hypothesized estimates published in the literature. Findings suggest a need for rigorous epidemiological studies of sensory processing disorders.
    The American journal of occupational therapy.: official publication of the American Occupational Therapy Association 58(3):287-93. · 1.70 Impact Factor

Publication Stats

382 Citations
27.26 Total Impact Points

Institutions

  • 2008–2012
    • Sensory Processing Disorder Foundation
      Greenwood Village, Colorado, United States
  • 2005–2012
    • University of Colorado
      • • Department of Physical Medicine and Rehabilitation
      • • Department of Family Medicine
      Denver, CO, United States
  • 2005–2010
    • Thomas Jefferson University
      • Department of Occupational Therapy
      Philadelphia, PA, United States