Training for the Senses
Occupational therapy is the treatment of choice for DSI. The goal: to help children better tolerate ordinary sensations, plan and organize their movements, and regulate their attention and activity levels. It typically takes place in a sensory-enriched gym set up with different kinds of swings for kids who need help processing information about movement, gravity, and balance. Obstacle courses are used to work on motor planning; materials like beans, rugs, and mats of different textures provide various tactile sensations.
The treatment may also involve therapeutic brushing. Using a special type of plastic brush, the OT will apply pressured strokes to a child's arms, back, and legs to help reduce an aversion to touch. This is followed by joint compression, in which the child will jump up and down or push against a wall, or in which the OT will apply gentle pressure to the joints at, say, the elbow or shoulder. "We teach parents how to do this at home," says Barbara Bassin, an OT in Bethesda, MD. The brushing, which takes about two minutes, may initially be done every two hours but quickly winds down to three times a day -- in the morning, afternoon, and evening. It can also help calm a child who is overstimulated or having a meltdown.
Indeed, much of the therapy continues at home. Parents are encouraged to set up a backyard swingset. Obstacle courses can be created with cardboard boxes, milk crates, and tunnels, one of many suggestions in Kranowitz's new book, The Out-of-Sync Child Has Fun: Activities for Kids With Sensory Integration Dysfunction. Slathering a table with shaving cream and encouraging a child to practice "writing" in the foam is great for kids who are overly sensitive to touch, since it introduces them to a new soft texture and sensation.
Laura Campbell and her parents do a lot of what looks like roughhousing. But the pillow fights, the twirling, and the crashing into cushions are intended to heighten Laura's awareness of sensations coming from her joints, muscles, tendons, and ligaments. And the difference is striking. "At the dinner table, she's usually dropping utensils, running around, or sliding under the table," says her mother. "If we do that kind of play before dinner, she can sit at the table for the whole meal."
Drug therapy is used only when the child has another diagnosis that warrants medication. Ritalin, as well as antidepressants, may be prescribed to soothe the central nervous system enough for the child to engage in OT.
But treatment does not offer a cure so much as a way to cope. Working on a problem area like motor planning will strengthen a child's skills and help her devise ways to compensate. But, cautions Dr. Silver, "early intervention is critical." The earlier children start, the more likely they are to adapt -- and the less likely they are to develop the psychological insecurities that plague kids marching to the beat of their own idiosyncratic drummer. It's even possible that early intervention effectively rewires parts of the brain involved in sensory processing, spurring new neural pathways to grow.
Of course, OT is not a proven treatment. And not every child benefits from it. But anecdotal evidence at the very least shows that it can improve the lives of not only the children but also their families. Bassin recalls a child she treated who was so withdrawn that his aunt thought he was being physically abused. The boy pulled away from hugs and hid under tables. After about three months of therapy, Bassin received a phone call from his overjoyed mother, thrilled that her son had danced with her and allowed her to kiss him.
But alternative approaches to DSI such as visual training therapy and diet interventions have little or no scientific validity. "Some of these treatments may even be harmful," warns Dr. Sandler.