OVERVIEW OF SENSORY INTEGRATION

PREFACE

When I attended a workshop on sensory integration therapy years ago and the presenter started describing the symptoms, I had to ask her how what she was describing was different from Attention Deficit Hyperactivity Disorder (ADHD), because some of the core symptoms for sensory integration dysfunction being describing included impulsivity, hyperactivity, distractibility, and fine motor problems.

ADHD and sensory SPD are not identical, even though there's a lot of similarity or overlap, she replied. Children with SPD might be unusually sensitive or over-responsive to touch or certain kinds of sensory experiences, and they might be extremely uncomfortable with certain types of fabrics, she explained. Well, my son had those problems, too -- I used to have to cut all the tags out of the back of his shirts, he still is uncomfortable stand wearing shirts with button holes, and we totally gave up on him wearing socks for over five years because he had to keep pulling them up and the seams drove him crazy. And my husband still has sensory issues about clothing and won't wear certain fabrics because he "can't stand" how they feel against his skin. But I thought that was part of their Tourette's Syndrome and Obsessive-Compulsive Disorder (OCD). Now I was beginning to wonder whether what a lot of us had attributed to OCD might be this "other thing" -- sensory processing dysfunction.

By the end of the workshop, it still seemed that there was tremendous overlap between what the presenter was calling SPD and my son's and husband's ADHD-TS-OCD.

As I started reading more on the topic of sensory integration years ago, I learned that sensory issues seemed to be discussed a lot in certain parent groups: parents of children with ADHD, parents of autistic children, parents of children with Tourette's Syndrome and/or OCD, and parents of children with Fragile X Syndrome, to name but some. Some of the research looking at SPD in different disorders is mentioned on my web other web site, which has an expanded version of this article.

OVERVIEW

Dr. A. Jean Ayres is generally credited with developing both a theory of sensory integration dysfunction and therapeutic interventions for children suffering from it. Although sensory integration involves all of our senses, because teachers are more familiar with vision, hearing, smell, and taste, we will focus on the aspects of sensory integration that may not be as familiar: vestibular and proprioceptive. We will also focus on tactile because so many children seem to have tactile defensiveness:

The tactile (touch) system provides information on light touch, pain, temperature, and pressure. If a child suffers from dysfunction in the tactile system, he may experience light touch or a gentle hug as intense or aversive, he may find certain kinds of fabrics or clothing irritating, may refuse to eat foods of a particular texture, and may avoid touching or handling certain kinds of objects. We say that a child is "tactile defensive" when he or she is extremely sensitive to light touch. When touched, it is as if the brain is flooded with an overload of sensory input that it cannot process, and the child's response may be disorganized and emotional. How often do we attempt to gently refocus a distracted child with a light touch on the shoulder?  How often have we seen a child who seems to be having an exaggerated pain response to something that we know was "just minor?" Perhaps we think that the child is just a "drama queen" or attempting to get our attention, but if the child is tactile defensive, it may be that they are really perceiving the sensory input differently than we do.

The vestibular system involves structures within the inner ear (the semi-circular canals) that detect movement and changes in the position of your head. If you were to close your eyes for a moment and tilt your head, you would know that your head is tilted even without having the visual input because your vestibular system provides that information. If a child's vestibular system doesn't develop or integrate normally, she may be hypersensitive to vestibular stimulation and have fearful reactions to ordinary childhood activities such as swinging on swings, going down slides, etc. She may also experience difficulty walking on or negotiating nonlevel surfaces such as hills or stairs. Children with this kind of hypersensitive vestibular system often appear clumsy. But not all children with vestibular dysfunction are hypersensitive. Some are under- or hyposensitive. Children with hyposensitive vestibular systems often engage in what appears to be sensation-seeking behaviors. They may whirl around like a dervish, jump, and/or spin.

The proprioceptive system provides feedback from your muscles, joints, and tendons and enables you to know your body's position in space. If there is a disturbance in the proprioceptive system, the child may be clumsy, fall, seem to maintain abnormal body postures, have difficulty manipulating small objects, and and may resist trying different movements.  If you've ever watched a student's grip on a writing instrument and noticed how abnormally tight the grip was, you may have been seeing an indication of this kind of problem.

When we talk about sensory integration dysfunction, we are talking about some disturbance in the child's ability to process sensory input. It could be a disturbance in just one of the sensory systems, or it could involve two or more systems.

SIGNS OF SENSORY INTEGRATION DYSFUNCTION

Signs of sensory itegration dysfunction in children may include:

• Overly sensitive to touch, movement, sights
• Inability to habituate to sounds and fear with unexpected noises
• Easily distracted
• Holding hands over ears in complex environment
• Avoids tastes, smells, or textures normally tolerated by children that age
• Activity level that is unusually high or unusually low
• Impulsive, lacking in self-control
• Inability to unwind or calm self
• Poor self-concept
• Social and/or emotional problems
• Physical clumsiness or apparent carelessness
• Hesitation going up or down stairs
• Difficulty making transitions from one situation to another
• Holding on to walls, furniture, people, or objects, even in familiar settings
• Delays in speech, language, or motor skills
• Delays in academic achievement
• Seeks out movement activities, but poor endurance and tires quickly

COMMENTS

While this brief overview has focused on three systems (tactile, vestibular, and proprioceptive), teachers should keep in mind that the child can have sensory defensiveness in any of the sensory systems. Thus, for example, some children will find certain sounds intolerable (such as the bell signalling change of periods, or noises in the hallway), while other children may find particular smells or tastes intolerable. Any kind of sensory defensiveness can make it difficult for the child to function normally in a school setting or to engage in normal social activities with peers.

If a student appears significantly impaired by sensory-related issues, the school-based occupational therapist should be asked to assess the student. Interventions designed to promote normalization of sensory integration appear to be most effective when provided early in life or in the elementary school-age years.

Other programs, such as Astronaut Training (for vestibular, auditory, and visual systems), and the "How Does Your Engine Run?" program are based on sensory processing and arousal. Another approach that may be used as part of programming is a sensory diet -- a planned and individualized set of activities throughout the day to control the sensory input the child receives. Many parents are already familiar with sensory accommodations such as the use of fidgets that allow children to decrease stress and channel excess energy into socially acceptable behaviors. Allowing the child to chew gum or something crunchy may be part of a sensory diet, depending on the student's needs. It is important to note, however, that there is little controlled research to demonstrate their effectiveness by typical scientific and clinical standards. In terms of research investigating specific classroom interventions, there has been very little controlled research, and teachers may be surprised to learn that a review of studies on weighted vests found only equivocal evidence for their usefulness. Other interventions, such as having the student sit on a therapy ball instead of at a traditional desk has some preliminary support, but none of the studies have used large samples or replications. As always, any intervention or possible accommodation needs to be assessed by collecting objective data before, during, and after interventions.