Sensory Integration: The Concept

All of the information we receive about the world comes to us through our sensory systems. Because many sensory processes take place within the nervous system at an unconscious level, we are not usually aware of them. Although we are all familiar with the senses involved in taste, smell, sight, and sound, most of us do not realize that our nervous systems also sense touch, movement, force of gravity, and body position. Just as the eyes detect visual information and relay it on to the brain for interpretation; all sensory systems have receptors that pick up information to be perceived by the brain. Cells within the skin send information about light, touch, pain, temperature, and pressure. Structures within the inner eat detect movement and changes in the position of the head. Components of muscles, joints, and tendons provide and awareness of body position.

Sensory Integrative Disorder
For most children, sensory integration develops in the course of ordinary childhood activities. Motor planning ability is a natural outcome of the process, as is the ability to respond to incoming sensation in an adaptive manner. But for some children, sensory integration is disordered, a number of problems in learning, development, or behavior may become evident.

Signs of Sensory Integrative Dysfunction

• Overly sensitive to touch, movement, sights, or sounds
• Under-reactive to sensory stimulation
• Activity level that is unusually high or low
• Coordination problems
• Delays in speech, language, motor skills, or academic achievement
• Poor organization of behavior
• Poor self concept

Evaluation: The Next Step
If you suspect that your child fits this picture, an evaluation can be conducted by a qualified occupational or physical therapist. Results of the evaluation will indicate whether or not a sensory integrative disorder is present, and will provide you with a profile of your child’s sensory processing abilities in a number of areas.

Evaluation consists of both standardized testing and structured observations of responses to sensory stimulation, posture, balance, coordination, and eye movements. The occupational or physical therapist who conducts testing may also informally observe spontaneous play, and may ask you to provide information about your child’s development and typical behavior patterns. A thorough evaluation usually requires about 1 1/2 to 3 hours. Following the evaluation, you will a report and interpretation of the scores.

How Therapy Works
In therapy, your child will be guided through activities that challenge his or her ability to respond appropriately to sensory input by making a successful, organized response. Therapy will involve activities that provide vestibular, proprioceptive, and tactile stimulation, and are designed to meet your child’s specific needs for development. The activities will also be designed to gradually increase the demands upon your child to make an organized, more mature response. Emphasis is placed on automatic sensory processes in the course of a goal-directed activity, rather than instructing or drilling the child on how to respond.

Training of specific skills is not usually the focus of this kind of therapy. One important aspect of therapy that uses a sensory integrative approach is that the motivation of the child plays a crucial role in the selection of the activities.

Why Children Like Therapy
Therapy using sensory integrative procedures in almost always fun for the child.

What to Expect from Therapy
When a sensory integrative approach to therapy is successful, the child is able to automatically process complex sensory information in a more effective manner than previously. This can have a number of important payoffs. An improvement in motor coordination may be documented by the child’s ability to perform gross and fine motor tasks with greater skill and at a higher level of complexity than would be expected with no intervention. Some children will demonstrate gains in language development, while others will improve significantly in school achievement as their nervous systems begin to function more efficiently. Very often, parents report that their child seems to be better “put together,” more self-assured, better organized and easier to live with.

If your child has been diagnosed with and Sensory Integration Disorder or has some of the signs listed above please go to our HOW TO GET STARTED PAGE to see how we can help you.

Autism Spectrum Disorders:
Autism Spectrum Disorders (ASDs) are a group of developmental disabilities that can cause significant social, communication, and behavioral challenges. According to the most recent statistics from the Centers for Disease Control (CDC), autism is four times more likely to occur in males than females and affects an average of 1 in 110 children in the United States (2009).

The Diagnostic and Statistical Manual IV (DSM IV) categorizes ASDs into three types within a continuum:

Autistic Disorder:
This is what most people think of when hearing the word “autism.” People with autistic disorder usually have significant language delays, social and communication challenges, and unusual behaviors and interests. Many people with autistic disorder also have intellectual disability.

Asperger Syndrome:
People with Asperger syndrome usually have milder symptoms of autistic disorder. They might have social challenges and unusual behaviors and interests. However, they typically do not have delays with language or intellectual disability.

Pervasive Developmental Disorder–Not Otherwise Specified (PPD-NOS)
People who meet some of the criteria for autistic disorder or Asperger syndrome, but not all, may be diagnosed with PDD-NOS. People with PDD-NOS usually have fewer and milder symptoms than those with autistic disorder. For example, they may have only a social impairment.

Recently, the phrase autism spectrum disorder has been used in the literature to refer collectively to people with one of these diagnoses.

Signs of an Autistic Spectrum Disorder include:

• Lack of or delay in spoken language
• Repetitive use of language and/or motor mannerisms (e.g., hand-flapping, twirling objects)
• Little or no eye contact
• Lack of interest in peer relationships
• Lack of spontaneous or make-believe play
• Persistent fixation on parts of objects

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The CDC recommends that all children be screened specifically for ASDs during well-child check-ups at 18 and 24 months and even more carefully if the child is considered high risk for developmental disabilities. The American Academy of Pediatrics also endorses early and continuous surveillance and screening for ASDs. (CDC, 2010)

Occupational therapy practitioners can be instrumental in helping to identify the early signs suggestive of an ASD. Young children on the autism spectrum often have difficulty participating in appropriate play, meeting developmental milestones, communicating effectively with others, making and keeping friends and conforming to expected behavioral norms. School-age children frequently need special education supports and services to benefit from their educational program.

For more information www.autismspeaks.org

ADHD/ADD is a serious problem that should not go untreated.

About 3% of all school-aged children are estimated to have attention deficit hyperactivity disorder (ADHD), a disorder in which children are unable to pay attention, control their activity, and restrain impulsive behavior. These problems may interfere with a child’s ability to hear or read instructions, complete school assignments, participate in games, and perform tasks at home. A diagnosis of ADHD is determined by a health professional
based on observation of the child’s behavior by parents, educators, and health professionals.

Children with ADHD may have difficulty learning and participating successfully at school. With the help of occupational therapy, a child can learn to master day-to-day skills and be engaged at school and at home. In the school system, occupational therapy is a related service under the Individuals With Disabilities Education Act (IDEA), and is designed to help a student with a disability benefit from special education. A child must be eligible for
special education under IDEA before being considered for occupational therapy in the schools.

Signs of ADHD/ADD:

Inattention

• Has difficulty concentrating
• Has unrelated thoughts
• Has problems focusing and sustaining attention
• Appears to not be listening
• Performance depends on task
• May have better attention to enjoyed activities
• Has difficulty planning, organizing, and completing tasks on time
• Has problems learning new things
• Demonstrates poor self-regulation of behavior, that is, he or she has difficulty monitoring and modifying behavior to fit different situations and settings

Hyperactivity (not in ADD)

• Seems unable to sit still (e.g., squirming in his/her seat, roaming around the room, tapping pencil, wiggling feet, and touching everything)
• Appears restless and fidgety
• May bounce from one activity to the next
• Often tries to do more than one thing at once

Impulsivity

Difficulty thinking before acting (e.g., hitting a classmate when he/she is upset or frustrated)

Problems waiting his/her turn, such as when playing a game

What can an occupational therapist and speech therapist do?

■ Evaluate a child at home and at school to determine how ADHD is affecting the child’s ability to perform assignments and participate at home.
■ Recommend a program that addresses the physical, behavioral, and emotional effects of ADHD and identifies goals to help the child succeed.
■ Use the intervention of sensory integration to modify the environment to decrease noise and distractions caused by visual, auditory, and tactile stimulation.
What can parents of children with ADHD do?
■ Learn about ADHD and how it affects a child’s ability to manage daily life.
■ Seek professional help in providing the resources a child needs to learn to manage his or her own behavior.
■ Join a support group for families with children with ADHD.
■ Use charts and checklists as a guide for children to complete daily tasks.
■ Break school assignments and home chores into a two-step process: listening to and understanding instructions, and accomplishing the task.
■ Offer minimal, low-key feedback for success and failure to reduce anxiety, frustration, and perfectionism.
■ Be consistent. Establish rules for the child and maintain them throughout his or her schooling.
■ Provide the child with activities outside the school environment. Consider noncompetitive physical
activity, such as martial arts, swimming, and horseback riding.
■ Focus on the child’s strengths and abilities. Do not overpraise or overcriticize.

If your child has been diagnosed with and ADHD/ADD or has some of the signs listed above please go to our HOW TO GET STARTED page to see how we can help you.