This is Part 1 of the 2-Part Series on Sensory Integration
What is Sensory Integration?
Sensory integration (SI) is known under many names: sensory processing, sensory processing disorder (SPD), dysfunction in sensory integration, or occupational therapy using sensory integration (OT-SI), all of which essentially have the same meaning.
Sensory integration occurs when our body receives input from the environment and sends messages to the brain in order to control appropriate motor and behavioral responses. More specifically, the central nervous system (the brain and spinal cord), along with the peripheral nervous system (along the body’s extremities), uses the five senses to send messages through the nervous system to the brain, and the brain responds with a suitable response or action to be taken.
In a normal functioning body, this system works effectively and efficiently to keep the body away from harm and in successful interaction with the environment. For example, if you accidentally touch a hot stove, the nerves in your hand will feel the heat and send a signal to your brain through the peripheral nervous system, then the brain (central nervous system) will respond by telling the hand to pull away from the heat. But someone who struggles with sensory integration has difficulty processing the sensory input and coordinating a response. Using the same example, the messages sent between the hand and the brain would get jumbled and may result in the person not feeling the burning heat or discomfort that it causes. Therefore, he/she would not remove his/her hand from the hot stove.
A known cause has not been identified for SI, but it is assumed that both genetics and the environment play a role, and possibly birth complications or prenatal health. Research has shown that the daily activities of nearly 1 in 20 children are affected by sensory integration. Children with autism who currently receive treatment have shown great improvements in the activities of daily life when combined with OT-SI, compared to those who did not participate in OT-SI.
General Signs and Symptoms
The following senses and systems are affected by SI: sight, smell, taste, hearing, touch, vestibular (balance), and proprioceptive (body awareness). One, multiple, or all senses may play a role. Some people will over-respond to stimulation, while others may not react at all, even to pain or extreme temperatures. Often it is diagnosed during childhood, but may be misdiagnosed as ADHD or a behavioral disorder. In addition to the following, a child with SI may engage in self-soothing behaviors, usually hand flapping, rocking, nail biting, or thumb sucking. Here are some common signs and symptoms that often signal a SI difficulty:
- Stares at objects that spin, or spins one self around
- Wears sunglasses inside
- Poor eye contact
- Has a tough time locating a specific object on a shelf or in a box among other things
- Opposition to strong smells, such as perfume
- Instead of breathing through their nose, they breathe through their mouth
- Won’t use the bathroom at school
- Smells everything, including bowel movements or diapers
- Will not eat certain foods, especially those with texture
- Enjoys extreme flavors, like hot sauce or lemons
- Gags, or even vomits, when asked to eat certain foods
- Licks toys
- Sloppy or messy eater
- Does not like loud noises (lawn mower, vacuum, toilet flushing, etc.)
- Complains of noises, such as the air condition, a fly, or electricity
- Often talks very loudly or hums to self
- Does not enjoy rooms crowded with talking people, such as the cafeteria
- Withdrawal from being touched, especially light touches
- Sensitivity to clothing tags
- Dislikes getting dirty (mud, paint, glue, etc.)
- Dislikes bath time when body, face, or hair is washed
- Hyper- or hypo- sensitive to touch, pain, or extreme temperatures
- Poor sense of balance
- Hyper-sensitive or fearful of swings, ramps, slides, etc.
- Difficulty on stairs or hills
- Fearful of uneven surfaces or unstable objects
- Frequently falls
- Lack of body awareness (bumps into things, falls on face because he/she doesn’t use arms to brace the fall, etc.)
- Trouble with fine motor skills using small objects, such as buttons
- Does not like to learn new motor activities
Recently The American Academy of Pediatrics recommended that doctors avoid using the diagnosis of SI alone, as there is no scientific evidence that it is not linked to other developmental disorders. The American Psychiatric Association also excluded it from the revised diagnostic manual of Mental Disorders (DSM-5), which is the handbook used for official diagnoses. A primary care provider or psychologist can diagnose, but may include an occupational therapist (OT) as part of their multidisciplinary team. An OT trained in sensory integration will asses the following areas:
- How the child performs at home and school while doing daily activities
- Which activities or toys the child chooses or avoids during play
- A parent or caregiver questionnaire, such as a sensory profile
- Specific problems with senses or processing across multiple environments
- Clinical observations of motor skills, posture, coordination, etc.
Many children with SI become socially isolated because, unlike other kids, they struggle with typical motor skills. This can lead to low self-esteem, emotional issues, educational problems, behavioral outbursts, aggression, anxiety, or depression.
A mildly challenging activity that targets multiple senses simultaneously is a common type of treatment for SI, usually performed by an OT. The goal is to teach the brain appropriate ways to respond to sensory input, and is done through repetition of playful activities. For example, the child could be wearing a pressure vest (proprioceptive) while completing a puzzle (visual); jumping on a trampoline (proprioceptive) while counting (auditory); or swinging (vestibular) while tossing stuffed animals into a basket (visual). OT will take place one-on-one in a therapy clinic, engaging in activities that the child enjoys while incorporating a full sensory experience.
Another technique commonly used is brushing, where a soft-bristled brush is rubbed across the child’s skin with deep pressure. The entire body is brushed except for the face, chest, stomach, and genitals. It is supposed to help make one’s peripheral nervous system more aware and calm. Some clinical research shows no marked effect, while some anecdotes and case studies reveal progress; therefore, future research is needed to determine the efficacy of brushing.
Similar to a well-balanced diet of nutritious foods, a child with SI needs a well-balanced sensory diet. This includes specific routines, sensory elements, social interaction and recreation activities used to calm a child, reduce self-stimulation, increase productivity, and teach self-regulation. Sensory stimulation that the child seeks out (such as hard pressure or loud noises) is incorporated, while also teaching him/her how to appropriately engage with the senses they do not desire (such as soft touch and quiet noises). Here is a great example of a sensory diet and routine. (Please note that this is only an example; every child requires unique needs. Talk with your multidisciplinary team to create the appropriate sensory diet for your child).
What types of therapy do you provide for your child with SI? Does your child experience specific symptoms within their senses? Share with us below in the comments.
This is Part 1 of a 2-Part Series on Sensory Integration. Check out Part 2: Assessing the Senses of Sensory Integration, and Helpful Resources.