What Is Sensory Integration?
Each of us has a sensory system. Put succinctly, it is how our brain and nervous system work together to interpret and act on what is going on around us. We respond to our external environment through the familiar five senses of sight, hearing, taste, smell, and touch, as well as through three lesser-known senses: movement (vestibular), body awareness (proprioception), and skin sensitivity (tactile).
Sensory integration is the process by which the brain takes incoming information, organizes it, and interprets it so that we can respond to it appropriately. For example, through the tactile sense, we learn fine motor movements such as those that enable us to button clothing and develop discrimination skills. It can also serve as a protective mechanism when we get too close to something dangerous like a heat source. The vestibular sense receives information about where a person is in space. Changes in head position, and body movement through space, are received through this sense, which coordinates the movements of the eyes, head, and body. Proprioceptive input is responsible for the muscle control in movement. It allows us to manipulate objects, jump, run, and walk. When all the senses are coordinated, they provide a foundation along with cognitive abilities for perceptual skills and motor planning. Motor planning is the ability to organize sensory information in order to plan and carry out the appropriate sequence of movement required to complete a task. For example, motor planning would be observed in a child, who acting on his desire to play with a ball, knows how to judge where the ball is in space and where to position his arms to catch it.
At times of stress, exhaustion, hunger, or illness, we all demonstrate difficulties in sensory integration, but for the most part, the nervous system is able to process and interpret meaningfully without difficulties. For some children, however, sensory integration does not develop as efficiently as it should. How and why this occurs may be linked to hereditary factors, prenatal development, or premature birth (which can be factors in both domestic and international adoptions). Lack of stimulation in early years of development, such as a limited repertoire of foods and textures in the diet or limited opportunity for movement and exploration, plays a large part in contributing to sensory integration problems. Therefore, children who have lived for a time in orphanages often display some sensory integration difficulties, which are usually transitional, if appropriate intervention is provided.
Depending on the severity of the symptoms, effects can be transitory or long term. However, since the nervous system in children is so malleable, intervention often significantly improves or ameliorates the problem. As children matures neurologically (both on their own and/or with intervention), positive changes in behavior will occur as well as achievement in the developmental milestones. Learning to accommodate to the changing environment or to a particular area of weakness is also possible as a child learns and grows.
The Right Diagnosis
The characteristics that are linked with sensory integration (SI) dysfunction can be similar to many other diagnoses like ADD or ODD or RAD. It is important to accurately assess what is going on with each child because the interventions are very different depending on the issue. The wrong intervention depletes a family's time, energy, and money, and frustrates a child who is trying.
There are some generalized behaviors typically observed for sensory integration dysfunction that are important for parents to be aware of. Catching problems with sensory integration early can prevent more complicated difficulties later. Below is a brief list of behaviors that are often indicative of a sensory integration problem.
Oversensitive to touch, movement, sights, sounds, and taste/food textures: What parents may see in the child are behaviors of irritability or withdrawing when touched on the head, shoulders, or hands, or when being lovingly kissed and hugged. These children don't seem to explore or touch things. The children may have a limited repertoire of food items and will not accept new textures of foods. Parents may notice that their child has a strong, fearful reaction to ordinary movements such as being held or avoids typical playground equipment. Some children don't seem to explore or touch things. Typical grooming routines such as bathing or hair brushing bring on tantrums that are exhausting to the parents. Being in crowds or noisy places may cause crying or withdrawal.
Underreactive to sensory stimulation: These children may seek out intense sensory experiences and may constantly trip, fall, or bump into things, seemingly oblivious to bumps and bruises they may get in the process. They may not realize they are hugging a friend too tightly and may seem aggressive because they are rough with their toys and other children. They may also crave the experience of movement on swings and jumping or running. These are children who are incredibly active -- walking or running across the playground, unaware of swings or bicycles. Sometimes they can even walk into a tree or a car without even taking note. Like the oversensitive child, these children also do not explore items, and play skills, if any, are very limited and very routine.
Activity level that is unusually high: Children with SI problems may demonstrate hyperactivity or appear in constant movement. They are usually impulsive in behaviors. These children are often known to break their toys while trying to manipulate them. Their attention span is quite short, often going from one subject to another in short time spans. Hyperactivity combined with distractibility is one of the reasons many children with SI difficulties are sometimes misdiagnosed as having ADHD.
Coordination problems: These children appear clumsy with some having difficulty learning new motor tasks. They may regularly bump into things, seem to have trouble orienting themselves in space, or show difficulty with writing or catching a ball. These children need more practice time to learn typical activities such as bike riding or skating.
Delays in speech, language, or academic achievement: Children with SI issues often exhibit delays in language acquisition or academic achievement. This is because they are distracted by the sensory input they are experiencing, or have such a difficult time organizing it in a meaningful way, that they can't focus on learning the skills. These children most often have average or above average intelligence, but have problems learning because of interference from the sensory system.
Poor organization of behavior: Some children may appear interested in a toy but then throw it aside or be immediately distracted by something else. They run around a lot but do not organize their activity to climb or explore equipment in the playground, or play creatively with toys. Some may have difficulty choosing a toy to play with out of a large assortment or seem resistant to putting toys back in the playbox.
Difficulties with transitions: They may seem stubborn and uncooperative when it is time to change an activity, i.e., from watching television to having dinner, or if there is a sudden change in the daily schedule (for example playtime is delayed another hour). Children with difficulties in transitions need a more structured and predictable environment than other children.
Poor self-concept: Ongoing negative feedback for their behavior when they actually want to please others usually lowers self-esteem. They often experience frustration at not being able to succeed at tasks and are usually not able to understand why they didn't succeed when they are trying so hard.
Problems with socialization/peer relationships: Children with SI difficulties may stand closer than is comfortable to other children, hug or hold hands too tightly, be too rough when playing with others, be uncomfortable with touch or common activities such as going on the slide or swing at the park. These behaviors, rooted in SI dysfunction, can cause difficulties with peer social relationships.
Evaluating Sensory Integration Dysfunction
Adopted children who are transitioning to a new environment may temporarily demonstrate some of the behaviors listed above. However, if you are concerned that your child might have sensory integration dysfunction, consider the following questions.
- What is the frequency of the concerning behaviors? Are the behaviors seen frequently throughout the day, several times a day/week or once in a while? If the behaviors are seen only once in awhile, then it is not sensory integration dysfunction.
- What is the duration of these behaviors? If irritability or impulsiveness is seen first thing in the morning, does it escalate as the day progresses? Do the behaviors last more than an hour?
- Finally, what is the intensity of these behaviors? Are the responses of the child appropriate to the situation? Or does the child "blow things out of proportion"? The first haircut can be upsetting, but do the following haircuts still bring on the same intense behaviors? Does the child really play with toys, or does he or she move things around without active engagement? Does the child demonstrate delays in gross motor skills, fine motor skills, or language/oral motor development?
If the answers to these questions confirm suspicions that your child might have sensory integration dysfunction, an evaluation can be done by a qualified occupational therapist. The occupational therapist should have experience with evaluating and treating children with sensory integration dysfunction. The term SIPT certified or SI certified means that the therapist has undergone the 100 hours of training to administer and interpret the Sensory Integration and Praxis Test (SIPT) with some discussion of the theory. A. Jean Ayres, the founder of the sensory integration development theory, designed this test to identify children between 4 and 8 year of age for sensory integration dysfunction. There are also many occupational therapists without this particular training who may be just as qualified to evaluate and treat because they have attended many courses discussing the theory and treatment of sensory integration. If your child does not meet the age range for the SIPT, there are other appropriate tests and assessment methods.
To find out more about, or to locate a qualified SI therapist in your area, please contact Linda Duval, SPARK education specialist, at 212-360-0231 or firstname.lastname@example.org.
Eva Rodriguez, MA, OTR/L, is a pediatric occupational therapist and Clinical Assistant Professor in the Occupational Therapy Program at SUNY, Stony Brook.