Ms Cassandra Lane
School of Medicine and Public Health
Senses working overtime
Whether studying the neural mechanisms underlying diagnostic conditions or trialing novel clinical interventions, Professor Shelly Lane has dedicated her research career to understanding and minimising the negative impact of developmental deficits in children.
Joining the University of Newcastle in mid-2015, Shelly brings her long and productive research legacy and administrative experience to the School of Health Sciences. She continues to contribute to an understanding of sensory integration and processing, the development of praxis, and the impact of trauma on development.
Her research focuses on children who are at risk of developmental delays because of autism, attention deficit, premature birth or any number of things that create developmental risk concerns.
Informed by an in-depth knowledge of neuroscience, Shelly's expertise centres around three practical areas in this arena, the first being defining age norms related to the diagnostic criteria for children with dyspraxia.
Her second area of focus is understanding and minimising the negative impact of sensory integration and processing difficulties in children.
And the third is utilising a sensory-based approach to improve outcomes for young children who have experienced early trauma.
Shortly after graduating as an occupational therapist, Shelly became convinced that further study was needed to inform her clinical practice.
Awarded her PhD from the University of Texas Health Science Center, San Antonio, she investigated the impact of drug dependence and withdrawal on second messenger systems in the cerebellum using an animal model.
"My PhD work gave me a great foundation in neuroscience, allowing me to read the literature without being afraid of it," Shelly laughs.
A two-year post-doctoral fellowship at the UCLA Neuropsychiatric Institute followed, where she worked with Dr Edward Ornitz to examine the startle reflex in children with Attention Deficit Hyperactivity Disorder (ADHD) and autism.
"That work was about sensory processing, and how children with diagnostic conditions like ADHD and autism reacted to sound," Shelly explains.
"There are kids who seem to be over-responsive to sound or touch or movement or other sensations, and those who appear under-responsive. And, it is often context related, which can be confusing. In one environment, home for instance, a child may appear under-responsive to sound and not notice when someone calls his or her name. In another environment, the grocery store perhaps, the same child may cover their ears against the sounds of people talking, flouro lights buzzing, carts rolling…"
"Further research in this area has shown that children with difficulties processing sensation have faulty filtering mechanisms, meaning their response to sensory input results in their inability to predict or anticipate it."
THE WEIGHT OF IMPACTS
The impact of sensory processing difficulties on children cannot be underestimated, and Shelly reports that people describe over-responsivity as "painful".
"If you are over sensitive to touch, it hurts when people touch you," she observes. "Or with loud sounds, some people cover their ears because it hurts. They categorise the level of central activation as pain."
The long term impact of sensory responsiveness differences is unknown. There is some research suggesting over-responsivity may diminish with age, but much more information is needed for us to be certain.
Shelly compares the possible consequences of these impacts to those of dyspraxia, another of her focal points. With dyspraxia messages from the brain to the body may be misinterpreted, causing difficulties in knowing how to move, and in planning movement. Overall behavioural organization can be problematic.
"As a child with dyspraxia, you may have oral motor, gross motor and/or fine motor clumsiness, meaning that speech, play, and school tasks may be problematic" she imparts.
"You have a hard time socially, and you have a hard time in school from an organisational, playground and gym class perspective."
"If it stretches out longer and longer then it impacts on life choices. There are activities you avoid because they require more coordination than you feel you have, and professions that you would not even consider, because you would not be able to manage them."
Following on from UCLA, Shelly held a joint clinical/academic position at the University of Alabama, Birmingham, and as Director of Occupational Therapy at the University's Sparks Center for Developmental and Learning Disorders.
The University of Edmonton in Alberta, Canada was Shelly's next stop. Here she completed locally funded research on the developmental sequelae of preterm birth.
An appointment at State University of New York in Buffalo came next, where Shelly looked at the developmental sequalae from prenatal drug exposure in human babies.
"I worked in a clinic looking after children who had been prenatally exposed to cocktails of drugs," she says.
"We looked at the developmental outcomes of those kids."
While at Buffalo, Shelly also worked with colleagues in examining the use of assistive technology to promote the development of play in young children with delays.
"For children with significant physical disabilities, like Cerebral Palsy or Spina Bifida, therapists tend to make the primary caregiver, mother or father, into the “home” therapist," Shelly conveys.
"From then on, every single moment with the caregiver focuses on sitting, balance and reach and grasp - completely losing sight of play."
"We decided to approach this project from a play perspective."
CHANGING THE FOCUS OF THERAPY
With funding from the US Department of Education, Shelly and her Let's Play! Project team put together a library of toys and assistive technology tools for families to borrow. A suite of resources created for caregivers and therapists is still being accessed today.
"We incorporated therapy into activities that were enjoyable, and used assistive technology to make play easier," Shelly says.
"We received great feedback from caregivers who were able to simply play with, and enjoy being with their child again."
Moving on to Virginia Commonwealth University, Shelly held the position of Chair of Occupational Therapy, and Assistant Dean of Research before concentrating on her research.
Overseeing the set up at the state-of-the-art Sensory Processing and Stress Evaluation (SPASE) Laboratory, she and her team completed several studies on sensory processing disorders.
"We were able to find a million dollar endowment for the lab so it was hard to leave behind," Shelly reveals. During her work at Virginia, Shelly worked on a project utilising a sensory-based approach for preschoolers who had experienced early trauma. Working side-by-side with both a counsellor and a teacher, this team implemented an approach that capitalised on a sensory-based foundation, child and parent counselling, and strengths-based teaching.
THE PRAXIS PUZZLE PIECE
Linked with the SPASE lab, Shelly also worked with colleagues on establishing age norms for the development of ideational and ideomotor praxis in young children.
This work has synergies with Shelly's colleague, Associate Professor Alison Lane. Alison has identified specific sensory subtypes in children with Autism Spectrum Disorder (ASD). "Alison and I share an interest in sensory processing," Shelly affirms.
"We'll work together to look at early identification and use her sensory subtyping model, but also add that praxis piece in."
Shelly is also collaborating with others at UON. She has joined a team of researchers headed up by Dr Jennifer St. George, studying Father-Child Play, and is working with A/Prof Alison Lane and her team investigating self-regulation strategies in children with autism.
"I'm looking forward to working with some new faces on new perspectives."
Find out more
- Priority Research Centre for Brain and Mental Health (CBMHR)
- Priority Research Centre for Physical Activity and Nutrition (PAC-PAN)
- Information about completing a PhD or MPhil in Occupational Therapy
Making sense of autism
Occupational Therapist Associate Professor Alison Lane has identified specific sensory subtypes in children with Autism Spectrum Disorder that relate to distinct neural profiles and patterns of challenging behaviour.
Alison's work is focused on investigating the sensory motor basis of Autism Spectrum Disorder (ASD), specifically in children, and anchored on three simple but essential questions regarding how they react to sensory input.
Are sensory behaviours the same in all children with ASD?
If not, what causes differences?
And how might understanding differences affect the targeting of therapies?
Years of clinical occupational therapist practice in non-government, community and hospital settings informed Alison's understanding of the barriers to participation children with ASD face.
"As occupational therapists we use clinical instincts and input from parents to design interventions in an attempt to grow the capacity of children with ASD to manage their behaviours and emotions in normal daily situations," Alison says.
"However, the research to back up our approaches has been lagging. My research is a contribution toward understanding the nature of these sensory behaviours."
"With better understanding we can choose better targeted therapies, and hopefully, we'll see better outcomes."
Unlocking the secrets of sensory features could vastly improve the lives of many people with ASD, and their families. Alison notes that not all children with ASD have difficulty with sensory input, and not all children with sensory issues have ASD.
"We think around 60% of children with ASD have these difficulties," Alison states.
"So although not every child with ASD has them, it is the majority, and there can be significant issues."
Alison explains by citing a school fire drill as an unexpected stimulus that may unsettle any child. Most children could, she says, follow instructions and ultimately cope.
Comparatively, the same disruption could have a major negative impact on a child with ASD, for whom responding appropriately could be extremely difficult.
"Another sensory stimuli is touch," Alison explains.
"Somebody might touch a child to redirect them, but the child may misinterpret the type of touch and perceive that quite aggressively, as a hostile touch."
"Their general ability to function in their environment is compromised because they experience these various sensory inputs very differently and then that affects their general behaviour."
Alison's major piece of work to date has been the definition of four distinct sensory subtypes in children with ASD.
This discovery has been replicated in three independent studies.
An algorithm based on a simple questionnaire for parents assigns children to a particular subtype.
There are two factors determining the appropriate subtype. The first is a child's sensory reactivity, or as Alison explains, "the intensity of their response to sensory input."
The second factor is multi-sensory integration, the ability to integrate and combine multiple sensory inputs that are coming at the same time.
"We have one group that has problems with sensory reactivity, one has problems just with multi-sensory integration, one has problems with both, and one has no problem with either," Alison reveals.
"And there is a severity dimension."
"So the group who has the problems with both have the most sensory symptoms. The ones that don't have issues have the fewest. And the other two are in the middle."
Classifying children into subtypes means therapy can be specifically targeted for maximum benefit.
Next, Alison is keen to investigate whether the replication within subtype groups is isolated to sensory features so therapy can be further customised.
"We are trying to establish whether children in a common sensory subtype tend to also have common difficulties or strengths in other areas, like IQ, general behavioural issues and communication abilities," she discloses.
Working with a multi-disciplinary team of University of Newcastle experts, including Professor Ulli Schall, Dr Juanita Todd and Dr Bill Budd, Alison is looking at event related potentials.
Using neuroimaging to measure the electrical activity of the brain, preliminary data suggests that the sensory subtypes do have different brain profiles.
"Parent reported distinctions in behaviour are matching with some basic distinctions in sensory processing in the brain," Alison reports.
"There is a lot of interest in investigating whether subtypes relate to physiological differences, and even further back, at a cellular and genetic level, are there patterns there?"
Understanding the links between behavior and biology may reveal new methods of treatment.
Alison's work has already begun to inform treatment, and has the potential to change the anticipated trajectory of children with ASD through early diagnosis. She is also looking for sensory-related patterns in intervention outcome data in partnership with early intervention providers, such as the AEIOU Foundation for children with autism.
It is the first year of life, however, that Alison believes may hold the key to early diagnosis, and therefore offer parents a greater window for intervention.
"Sensory and motor systems are necessarily intertwined in the first year," Alison explains.
"The motor system is developing, and we know that motor skills are highly dependent on the accurate interpretation of touch, movement and body sense information."
Using video data of babies with known outcomes involved in longitudinal studies, Alison is recording response to sound and touch in an attempt to try to code early sensory motor features.
To further our understanding of early sensory motor development in non-autism groups, Alison is now working with the asthma team at the Hunter Medical Research Institute on a large scale study to track sensory motor outcomes in babies born to mothers with asthma. By carefully following large cohorts of young babies with risk factors for medical and developmental difficulties, Alison hopes to pinpoint the sensory motor features in the first year in life that are related to autism risk in later childhood.
"If we study sensory motor development in a very rigorous way in children who have risk factors for ASD, then follow them through to see which of those children go on to get ASD, we hope to identify early developmental delay."
"Working with babies, we have the potential to change their brain wiring, modifying their responses so they find sensory stimuli less distressing. Both as babies and later in life"
Over 20 years of experience in paediatric occupational therapy practice, health service management, research and teaching are useful background to a major role in the genesis of a new collaborative of researchers interested in neurodevelopment at the University of Newcastle.
Reflecting on her career, Alison admits that it wasn't just her compassion for children with ASD that drew her sole focus.
"Early in my career a fellow academic and parent of a child with ASD, put together an Autism research group," Alison recalls.
"She saw me in a meeting one day, and said 'I need an OT for my research group and I pick you.' This area literally chose me."
Discovering how few people internationally were investigating ASD related sensory difficulties, Alison resolved to research this area in depth.
"I think we have made some really good inroads to be honest," Alison says.
"This area still has so much potential which is exciting."
"And we can already be a bit more discriminatory with therapies. With so many to chose from, I think that is really helpful."