Most Sensory Integration research and practice focuses on children who have a variety of developmental and learning difficulties, including autism and other developmental disabilities, behavior and attention disorders, learning disabilities and developmental coordination disorder.
Thorough assessment is critical in ascertaining whether a sensory processing issue is a factor in the child’s development, and if so, which intervention strategies will best help the child and family.
My intervention takes place within a specially designed therapeutic environment that allows the therapist to present specific sensory and movement challenges to the child, which gradually increase in complexity over time. This type therapeutic intervention is characterized by a playful atmosphere in which the child is encouraged to generate ideas for activities, to flexibly respond to novel challenges and to develop confidence as well as competence in a variety of tasks.
Intervention includes consultation and education with parents, teachers and other caregivers, modification of environments and inclusion of appropriate sensory-based activities throughout the day.
The application of sensory integration principles within organizations takes into consideration the sensory demands in the workplace. The application for populations takes into account the sensory and practice differences and demands for a population such as with autism.
Signs of Sensory Integration Dysfunction:
Overly responds to sensations
Under responds to sensations
Poor Body Awareness
Problems maintaining a calm-alert state
Visual Perceptual problems
Auditory Processing problems
Motor planning difficulties
Gravitational insecurity
Delays in academic achievement
Poor organizational skills
Poor self-esteem
Overly responds to sensations:
Child may become overwhelmed by everyday sensory experiences
- Irritability or withdrawal when touched
- Bothered by tags or seams in clothing
- Dislikes touch sensation occurring during grooming, brushing teeth, brushing hair or having his/her face washed
- Avoids putting hands in sand, finger paint or glue
- Avoids going barefoot when walking or crawling on surfaces such as sand or grass
- Avoidance of certain textures of clothing or foods
- Fearful of ordinary movement experiences such as those typically found on a playground or when riding on an escalator or elevator
- Dislikes crowded/noisy places such as shopping malls, restaurants or birthday parties; may walk at the end of the line at school
- Dislikes swings or carnival rides
- Has an exaggerated fear of falling or heights
- Reacts to motion or change of head position with signs of distress
- Seems afraid of walking on a raised surface such as stepping off of a street curb as though it seems too high
- Avoids games that involve unpredictable movements of other children, especially those that may impact balance
- Seems bothered by bright lights
- Becomes distressed in unusual visual environments such as a bright, colorful room
- Frightened by sounds that do not usually cause distress in other children such as a vacuum cleaner or a hair dryer
- Responds negatively to loud sounds by running away with hands held over ears
- Avoids certain textures or temperatures of foods
- Gags at the thought of an unappealing food
- Shows distress at smells that other children do not notice
Under responds to sensations:
Due to a child’s inability to adequately register sensory information, child may seek more intense sensory experiences
- Seeks more intense sensory experiences such as spinning, crashing, bumping
- Excessively touches objects or others
- Cannot tell what something is by feeling the object without being able to see the object
- May not feel or notice pain as much as others
- Messy when eating
- Does not get dizzy, even after many minutes of spinning, and loves fast moving equipment
- Walks into objects as if they were not there
- Enjoys watching objects spin
- Likes to flip light switches on and off repeatedly
- Appears not to hear certain sounds
- Licks, smells or mouths non-food objects excessively
Poor Body Awareness:
Inability to know where the body is in space and how the body moves through space
- Tends to lean on objects or others
- Bumps into things or other children
- Grasps objects too hard or too soft
- Chews on toys, clothes or other objects
- Breaks things from pressing or pushing too hard on them
- Jumps a lot
- Misjudges how high or low to move body parts when sitting down or stepping over objects.
Problems maintaining a calm-alert state:
Maintaining the “just right” level of arousal according to the task demands
- Activity level that is unusually high or low with severe fluctuations between one extreme and the other throughout the day
- Slow to rise/difficulty falling asleep at bedtime
- Frequently wakes in the middle of the night
- Problems maintaining attention in the classroom or while doing homework–decreased self control, impulsivity
Visual Perceptual problems:
The ability to organize and mentally manipulate visual stimuli in the brain to be able to discriminate parts from whole, to see an object imbedded with other objects, to understand the objects position in space and to recognize objects that are partially hidden.
- Difficulty staying within the lines when coloring, drawing or writing
- Shows difficulty with puzzles or building with blocks
- Gets lost easily
- Has trouble recognizing similarities and differences in patterns or designs
- Has a hard time finding something in a drawer or picking a face out of a crowd
- Has difficulty aligning fasteners on clothing or putting shoes on the correct foot
- Attends to “parts” of a project but has trouble getting the “whole picture”
- Has difficulty with organizational skills in the classroom such as where to place completed homework, location of the pencil sharpener, copying assignments off of the blackboard, etc.
- Has poor eye-hand coordination skills such as those needed to cut along lines and gluing objects in the correct place.
Auditory Processing problems:
Our sense of hearing must be able to inform our brain with information that allows us to process and understand spoken words and where sounds are coming from within our immediate environment. We must also be able to filter sounds that are unnecessary such as the low hum of fluorescent lights in a classroom or the sound of cars going by outside our window. Without the ability to filter this sensory input, we would be unable to focus our attention without being constantly distracted.
- Responds inconsistently when spoken to
- Seems to misunderstand what is said
- Misunderstands similar sounding words such as box and socks
- Cannot repeat back what is said
- Difficult to understand
- Cannot hear well when in a noisy environment
- Has difficulty looking and listening at the same time
- Tunes out or seems disinterested during group activities
- Holds head at an angle to be better able to hear
- Speaks in a monotone or exceptionally loud voice
- Highly sensitive to noise or hears things that other people do not hear
Motor planning difficulties:
Motor planning or Praxis is an outcome of good sensory integration. It is the integration of sensations from our skin, muscles and joints and inner ear that provides us with a “map” of our bodies, which allows us to move without having to think about our movements. Motor planning, also called Praxis, is the ability to plan, initiate, grade and execute movements efficiently to accomplish an activity.
- Has trouble getting started on or ending activities
- Difficulty learning new tasks
- May not use a preferred hand consistently
- Difficulty manipulating tools or toys
- Difficulty using utensils for eating and writing
- Problems coordinating the two sides of the body which impacts ball skills and the ability to do well in sports
- Inability to imitate someone else’s body movements such as during a game of Simon Says, waving bye-bye, and blowing kisses
- Problems with eating or speech/language development
- Difficulty building a structure with blocks or legos from a picture or a structure that someone else has built
- Seems to do things in inefficient ways and has difficulty following directions
- Avoidance of unfamiliar tasks tends to play the same games over and over
Gravitational insecurity:
Gravitational insecurity is an unusual fear response to movements and/or height that is not typically threatening to other children of the same age
- Becomes anxious when feet are off of the ground
- Has an exaggerated fear of falling
- Reacts negatively to changes in head position, particularly when the head is inverted forward or backwards
- Does not enjoy playgrounds or riding toys as much as other children
- Avoids stepping or jumping down from a higher surface to a lower surface
- Afraid of losing his or her balance
- Avoids climbing activities
- Avoids games that involve unpredictable movements such as tag, soccer and dodgeball
- Feels insecure in wide open spaces
Delays in academic achievement:
In young preschool aged children, these can be seen in combination with other sensory signs such as over or under responsivity to touch or movement. In older, school aged children, there may be academic difficulties despite normal to high intelligence.
- Difficulties transitioning
- Fidgets or appears lethargic and uninterested when sitting and listening
- Difficulty following classmates in a line
- Poor organization of classroom materials
- Unable to follow classroom routines
- Gets lost in the school hallways
- Difficulty carrying lunch tray/spills items during meals
- Difficulty copying from the board
- Presses to hard/light with pencil and handwriting is messy
- Problems with being able to read across a page or line up numbers during math
Poor organizational skills:
The inability to plan, gather materials, sequence multiple steps and execute a task to completing efficiently
- Difficulty sitting still
- Impulsive and does not appear to have a plan of action to accomplish a task
- Difficulty with multiple step directions and sequencing the steps of a task
- Difficulty adjusting to new situations or environments
- Easily frustrated
- Distractible and has difficulty maintaining attention
- Decreased frustration tolerance
- Difficulty with transitions
- Controlling or inflexible
Poor self-esteem:
A sense of individual success
- Feels badly about himself but doesn’t know why
- Appears lazy, bored or unmotivated
- May look for ways to avoid tasks that are difficult or embarrassing such as homework
- May be considered troublesome or stubborn
If a child has sensory integration dysfunction, it is not likely that he or she will “grow out of it”. The child may learn “splinter skills” that compensates for poor sensory processing however, this only covers up the problem and requires much more effort and energy, leaving less energy left to deal with other things. Sensory integration dysfunction can be considered a hidden problem because it is not as noticeable as physical impairments or speech delays (PTN, 2004). When a problem is difficult to see or understand, parents and children may begin to blame themselves which can result in family tension, poor self-esteem and a general feeling of hopelessness.
Sensory integration (SI) was originally developed by A. Jean Ayres PhD, OTR, who was both an occupational therapist and an educational psychologist. A former member of the USC occupational therapy faculty, she developed a theoretical framework, and a clinical approach for identification and remediation of SI problems in children. Her publications on sensory integration span a 30-year period from the 1960’s through the 1980’s, and include psychometric studies as well as clinical trials and single case studies.
