DURHAM
FOSTER PARENT ASSOCIATION
SENSORY INTEGRATION (SID)

When parents first find out about sensory processing disorders, their reaction usually comes as: a "flash", a "light bulb moment", the "Aha!", "So that explains it!", "Oh, so now I understand!", "Why didn't someone tell me about this years ago?"

A New Name

This is the newest term for, and is used synonymously with, Sensory Integration Disorder or Sensory Integration Dysfunction.

At this point, sensory integration is still being used to describe the theory and treatment, based on the original work of A. Jean Ayres.

Sensory Processing Disorder is used to define and describe the disorder / dysfunction symptoms - in hopes of making this a universally accepted "medical diagnosis" - thus enabling insurance reimbursement for evaluation and treatment.

We Receive And Perceive Sensory Input Through Sights, Sounds, Touch, Tastes, Smells And Movement.

Difficulty taking in or interpreting this input can lead to devastating consequences in:

  • daily functioning

  • social and family relationships

  • behavioral challenges

  • regulating emotions

  • self-esteem

  • learning
     

Ever Wonder Why Your Child Does The Things He/She Does?

 

  • Do you wonder why they are excessive risk takers - jumping and crashing into anything they can ?

  • Why they can’t do puzzles - write well - or find the coordination for riding a bike or hitting a ball?

  • Why they cry or cover their ears with every loud sound - even vacuums, toilets or hairdryers ?

  • Why they don’t like to be touched or can’t be touched enough?

  • Why they will only eat macaroni and cheese and pizza?

  • Why they will only wear certain clothes or need you to cut the tags out of their shirts?

  • Ever wonder why you can’t seem to calm them down or get them to sleep?

  • Why they won’t put their hands in anything messy or use glue, Play Doh, or play with mud?

  • Why they fear playground equipment or being tipped upside down?

  •  Why crowded stores bother them so much leading to major meltdowns in public places?

  • Take some time to explore this site for more of these “behaviors” and to find the reasons why this apparent “chaos” actually makes perfect sense.

    Through this site, you will finally begin to understand - or further understand, why your child does the things he/she does.

    Sensory Processing Disorder - also known as Sensory Integration Dysfunction - is still in the process of becoming widely accepted and treated by all professionals.

      SITE LINK: http://www.sensory-processing-disorder.com/ 

Sensory Integrative Dysfunction in Young Children

by Linda C. Stephens, MS, OTR/L. FAOTA reprinted with permission from AAHBEI News Exchange, Vol. 2, No. 1, Winter 1997

(note: this article is a reprint. The article is presented as a public service. It was not authored by school staff.  Please do not write requesting additional information. Sensory integration is not an area of expertise at the school. We can provide no additional information on this topic.)

For more information see

All of us depend on adequate sensory integrative functioning in order to carry out daily tasks in work, play and self-maintenance. Disorders in this domain can greatly influence our ability to function, but also can be so subtle that they easily go unrecognized. Particularly in the young child it is easy to attribute behaviors and reactions to other causes ("He's stubborn, lazy, or doesn't want to do it," or "She's spoiled, shy, or headstrong.") or to consider it within the norms of the wide range of personality and developmental characteristics of young children. However, it is important to identify and address sensory integrative dysfunction to enable the child to function at his or her optimum level and to minimize disruption in family life. This article will explain ways of addressing sensory integrative problems within the context of family life and the child's normal activities.

What is sensory integration?

Sensory integration, simply put, is the ability to take in information through senses (touch, movement, smell, taste, vision, and hearing), to put it together with prior information, memories, and knowledge stored in the brain, and to make a meaningful response. Sensory integration occurs in the central nervous system and is generally thought to take place in the mid-brain and brainstem levels in complex interactions of the portions of the brain responsible for such things as coordination, attention, arousal levels, autonomic functioning, emotions, memory, and higher level cognitive functions. Because of the complexity of the various areas which are dependent upon and interact with each other as well as the child's own personality and environment, it is not possible to have a single list of symptoms which identify sensory integrative dysfunction.

A. Jean Ayres, Ph.D., was an occupational therapist who first researched and described the theories and frame of reference which we now call sensory integration. In her book, Sensory Integration and the Child, Dr. Ayres makes several analogies which describe sensory integration and its dysfunction. She describes sensory information as food for the brain similar to the food which nourishes our physical bodies. Difficulty in processing and organizing sensory information causes dysfunction which can be compared to indigestion which occurs when the digestive tract malfunctions. Another analogy compares the brain to a large city with traffic consisting of the neural impulses. She states: "Good sensory processing enables all the impulses to flow easily and reach their destination quickly. Sensory integrative dysfunction is a sort of `traffic jam' in the brain. Some bits of sensory information get `tied up in traffic,' and certain parts of the brain do not get the sensory information they need to do their jobs." (Ayres, p. 51)

Various characteristics of sensory integrative dysfunction will be discussed under four categories: attention and regulatory problems, sensory defensiveness, activity patterns, and behavior.

Attention and Regulatory Problems

The ability to attend to a task depends on the ability to screen out, or inhibit, nonessential sensory information, background noises, or visual information. The child with sensory integrative dysfunction may frequently respond to or register sensory information without this screening ability and is considered distractible, hyperactive, or uninhibited. These children are always "on the alert" and constantly asking about or orienting to sensory input that others ignore (refrigerator motor, heater fan, distant airplane, etc.). Other children may fail to register unique sensory input and are unresponsive to stimuli. For example, the child may not turn around or respond when her name is called. One parent said that her child was oblivious and unresponsive to a loud noise in the same room but immediately responded when he heard a piece of candy being unwrapped two rooms away.

Children with regulatory disorders often have difficulty establishing appropriate sleeping and eating patterns, are unable to calm or console themselves, and may overreact to environmental stimuli. Georgia DeGangi states that "disorders of regulation appear to be based on problems associated with sensory processing, communicative intent, state control and arousal, and modulation of emotions" (DeGAngi, 1995). The infant or child who is very irritable, difficult to soothe, emotionally labile, and hypersensitive to touch or other sensory input may have regulatory problems.

Sensory Defensiveness

Sensory defensiveness is a sensory integrative disorder characterized by a "fight, flight, or fright" reaction to sensory information most individuals would consider harmless. Tactile defensiveness, or hyper responsiveness to touch, was identified by Dr. Ayers in the 1960's. Since that time researchers have recognized defensiveness in other sensory areas as well. The individual who has sensory defensiveness typically has a highly aroused nervous system which prepares the body for survival, but does not recognize that the input is nonthreatening. Behaviors which can be associated with tactile defensiveness are aggressiveness, avoidance, withdrawal, and intolerance of daily routines. Combing or shampooing hair, cutting fingernails, or brushing teeth can be exhausting and difficult for families of children who react defensively with acting out behaviors or tantrums. Other children may cope by being very rigid and demanding with insistence on certain textures of clothing, cutting all tags and labels out of clothing, or displaying extremely limited choices of food because of intolerance to textures. Social skills can be very limited if the child withdraws or picks fights as a result of unexpected touch.

Auditory defensiveness can occur with negative responses or fears related to sounds and noises. Some children are so fearful of sounds such as vacuum cleaners, lawn mowers, hair dryers, leaf blowers, or sirens that parents must arrange to use appliances when the child is out of earshot. Other children may show intolerance of sounds and noises by clapping their hands over their ears. One child I knew could not tolerate the sound of a flushing toilet, another covered his ears when his preschool class had music.

Visual defensiveness can occur with hypersensitivity to light or avoidance of gaze. Oral-motor defensiveness (tactile defensiveness within the mouth) can cause distress with brushing teeth and dentist visits as well as intolerance to textures or temperatures of food. Children with olfactory defensiveness (intolerance to odors) may gag or be distressed with certain smells which other persons don't notice or don't mind. One child I know could not tolerate going into a deli with his mother because the odors made him feel sick.

Defensiveness in the vestibular area can result in intolerance to movement or unstable surfaces with fearfulness, avoidance, or motion sickness. The child may be afraid to go down steps or to ride an escalator. One child I knew not only would not step up a few inches on my floor mat, but refused to step up a curb, even holding his mother's hand. Each time they came to a curb, the mother either had to carry him or allow him to get on his hands and knees to crawl over the curb. Another child was so sensitive to motion in the car that her family always had to take the back roads avoiding the expressways (rather difficult in an urban area!).

Activity Levels

Young children are, by nature, active. We expect the toddler to be "into things" and the preschooler to be curious, to explore and to play vigorously. We don't expect the young child to have a very long attention span. Characteristics which indicate problems in one child may be perfectly normal in a younger child. Here are some warning signals related to activity levels:

1. The child is disorganized and lacks purpose in his or her activity. This is the child who goes through the room like a tornado. Even though the child may appear to be interested in a toy or object initially, once he gets it he may throw it aside, dump it out of the container, or immediately be distracted by something else. Another characteristic is that the child lacks exploration or manipulation; he may dump objects out of a container or off a shelf without stopping to manipulate, visually examine, or play creatively with them. On the playground the child may run around a lot but does not organize his activity to climb, swing, or explore equipment.

2. The child does not move around or explore the environment. This is the "good" baby or toddler who is content to stay in one place and does not make many demands on his or her caretakers. This child may be content to watch things in his environment although he is physically able to move around and interact. The older child may use good verbal skills to engage the adult in conversation as a way of avoiding manipulating with his hands or actively engaging in activity.

3. The child lacks variety in play activities. Some children become very repetitive or stereotypic in playing with toys. Everything may be flung aside, tapped on a surface, or brought to the mouth. Another child may prefer only visual activities (TV, videos, looking at books) while avoiding visual-motor or manipulative toys (coloring, drawing, clay, construction toys.) Other children may learn one way to interact with a toy or playground equipment without adding variations, creative play, or generalizing to other similar objects. For example, the child may line up toy cars but does not pretend they are going places or experiment with rolling them down an incline.

4. The child appears clumsy, trips easily, has poor balance. The child may experience an excessive number of bumps, bruises, stitches, or broken bones. Sometimes this child seems always to be in a hurry and impulsive, does not "look where he is going." Other children may always be bumping their heads because they lack protective responses and do not "catch themselves" when they begin to fall.

5. The child has difficulty calming himself after exciting physical activity or after becoming upset. After this child "loses it" he cannot be consoled. Tantrums may last for hours, or the child may become so excited after vigorous play that he continues high activity levels long after the event. Some children regularly escalate their activity levels during the day without experiencing "down time" or being able to engage in quiet activity. Dinner time becomes chaotic and the child has extreme difficulty falling asleep at bedtime.

6. The child seeks excessive amounts of vigorous sensory input. Many children like to jump, swing, and spin; but when this is excessive, it may be problematic. The child may spin himself on playground equipment or twirl around a room for prolonged periods without experiencing dizziness. Another child may continually throw himself on the floor, deliberately hurl himself against people and things, or jump excessively.

Behaviors

Sensory integrative dysfunction can adversely affect many areas of a child's development, including emotional and social. Many children become discouraged or develop poor self-concept, especially if they become aware of differences in their function and those of their peers. If a young child has difficulty with motor skills and play activities, it may be hard for him to make friends or to be part of a group. Sensory defensiveness can cause aggressive behaviors or cause the child to be a loner.

Sometimes behavior problems are the first indications that the child may have sensory integrative dysfunction. The child may lack flexibility, be explosive, or have difficulty with transitions such as leaving one place to go to another. The child may show extreme irritability or crying which may seem unexplainable until it is discovered that he is fearful of certain sounds, overwhelmed by visual stimuli, or is intolerant to wrinkles in his socks. Sometimes children are so rigid in their behaviors that families go to extremes to accommodate them in order to maintain peace. The mother who follows the child around with a spoonful of food, begging him to eat, or the parents who allow the child to sleep in their bed because he won't go to sleep otherwise, may be taking care of the short-term problems of getting the child to eat or to sleep without addressing underlying problems.

Conclusion

This article has been an overview of some of the ways sensory integrative problems manifest themselves. Any particular child may show only a few of the characteristics described and some characteristics could be caused by something other than sensory integrative dysfunction. Parents and professionals are advised to look at the pattern of behaviors and the "big picture" of how the problems interfere with the child's function in his or her play, physical and emotional development, and ability to develop independence. Any child who is suspected of having a sensory integrative disorder should be evaluated by a professional (usually an occupational or a physical therapist) who has had additional training in sensory integration evaluation and treatment. Sensory integration "certification" means that the individual has had more than one hundred continuing education hours in theory, test mechanics, and interpretation of test results from the Sensory Integration and Praxis Tests (SIPT). Although such certification assures additional training in this specialty area, there are many licensed professionals who are very competent in the specialty who are not certified.

Resources

Ayers, a. Jean. Sensory Integration and the Child. Los Angeles: Western Psychological Services. 1994.

DeGangi, Georgia A. et al. Infant/Toddler Symptom Checklist: A Screening Tool for Parents. Tucson, AR: Therapy Skill Builders, 1995. (1-800-0763-2306)

Trott, Maryann Colby et al. SenseAbilities: Understanding Sensory Integration. Tucson, AR: Therapy Skill Builders, 1993.

Linda Stephens is an occupational therapist in private practice in Atlanta, Georgia. She specializes in sensory integration and has worked with children for thirty years. Her private practice, Atlanta Children's Therapy, Inc., is located in Atlanta, Georgia.


For more information see Sensory Integration Network
(note: this article is a reprint. The article is presented as a public service. It was not authored by school staff.  Please do not write requesting additional information. Sensory integration is not an area of expertise at the school. We can provide no additional information on this topic.)

Return to Archive THE INFORMATION WE HAVE PROVIDED YOU WITH ON THIS PAGE COMES FROM THIS LINK: http://www.tsbvi.edu/seehear/archive/index.htm     M


        

Sensory Integration

Sensory Integration is how the human brain organizes and interprets stimuli from the environment such as touch, smell, sight, sound and movement. Many people with autism have sensory problems, such as hypersensitivity or hyposensitivity to these stimuli. They may also have difficulty being able to integrate senses. This is called Sensory Integration Dysfunction (SID).

These problems can be mild or severe and may result in repetitive motion symptoms such as rocking, spinning, jumping and flapping as well as over or under sensitivity to one or more senses. Sensory integration therapies are usually provided by a trained occupational or physical therapist and are frequently integrated into other autism programs.

Sensory integration uses exercises which focus on the vestibular sense (e.g., ear problems can cause problems with balance and motion), the tactile sense (e.g., sensitivities to touch such as the feel of clothing; sensitivity or insensitivity to temperature or pain), and on proprioception (e.g. joints, ligaments). Techniques usually focus on stimulating these senses in order to make them less or more sensitive and to help a child to recognize and integrate sensory information.

Sensory integration therapy is usually given by specially trained occupational, physical or speech therapists who observe the child carefully to gain a clear understanding of her/his particular sensitivities. The goal is partly to improve attention and reduce impulsive behaviours that get in the way of concentration and learning. Some people have found that when the sensory needs of autism are met, learning is more focused, progress is better and people are better able to cope with day to day situations. Addressing sensory issues may be a very long process.  

Other sensory-based methods:

  • Berard Auditory Integration Training (called Berard AIT or AIT) involves listening to high and low frequencies in processed music for a total of 10 hours (two half-hour sessions per day, over a period of 10 to 12 days). AIT is believed to improve auditory processing, decrease or eliminate sound sensitivity and reduce behavioural problems in some autistic children.
  • The Tomatis program uses vocal exercises to help children with autism make and hear their own sounds in order to develop self-listening which improves communication and sense of self.
  • Computer-based auditory interventions include Earobics and Fast ForWord. These programs may be helpful for children who have delays in language and have difficulty discriminating speech sounds.
  • Irlen Lenses: wearing ambient (prism) lenses. People who benefit from these lenses are often hypersensitive to certain types of lighting, such as fluorescent lights and bright sunlight; hypersensitive to certain colours or colour contrasts; and/or have difficulty reading printed text. Irlen lenses may reduce sensitivity to these lighting and colour problems as well as improve reading skills and increase attention span.
  • Oculomotor exercises: performing eye movement exercises to reorganize and normalize the visual system.
  •  Swinging a child on a swing to help normalize the vestibular sense. TO READ MORE PLEASE VISIT THIS LINK: http://www.autismsocietycanada.ca/approaches_to_treatment/sensory_integration_therapies/index_e.html

Vestibular Disorders 

Sensory Input

The ability to maintain balance depends on information that the brain receives from three different sources: the eyes, the muscles and joints, and the vestibular organs in the inner ears. All three of these sources send information in the form of nerve impulses from sensory receptors, special nerve endings, to your brain. 

Integration of Sensory Input

All of the sensory input concerning balance—from the eyes, from the muscles and joints, and from the two sides of the vestibular system—is sent to the brain stem, where it is sorted out and integrated with contributions from other parts of the brain. 

Cognitive Disturbances


The vestibular system is closely linked to parts of the brain involved with absorbing and interpreting information, including mental functions such as planning, sequencing, attention, and concentration. It is also responsible for controlling eye movements and maintaining a steady gaze. Because of these connections, people with vestibular disorders commonly experience cognitive disturbances such as:  The Vestibular Disorders Association 

Types of SI Problems

Problems of sensory integration were first thought to fall into three categories. The person either was thought to be
under-processing
over-processing
processing with interference / “white noise"

This being the case, an accurate investigation had to be made to find out which applied to the client, because treatment strategies would differ.

Signs of SI problems

The following is a description of some of the commonly seen behaviors in children who exhibit sensory integrative difficulties.

  • An acute awareness of background noises
  • Fascination with lights, fans, water
  • Hand flapping/repetitive movements
  • Spinning items, taking things apart
  • Walking on tip-toe
  • Little awareness of pain or temperature
  • Coordination problems
  • Unusually high or low activity level
  • Difficulty with transitions (doesn't "go with the flow")
  • Self-Injury or aggression
  • Extremes of activity level (either hyperactive or under active).
  • Fearful in space (on the swings, seesaw or heights).
  • Striking out at someone who accidentally brushes by them.
  • Avoidance of physical contact with people and with certain "textures," such as sand, paste and finger paints.
  • The child may react strongly to stimuli on face, hands and feet.
  • A child may have a very short attention span and become easily distracted.
  • A strong dislike of certain grooming activities, such as brushing the teeth, washing the face, having the hair brushed or cut.
  • An unusual sensitivity to sounds and smells.
  • A child may refuse to wear certain clothes or insist on wearing long sleeves/pants so that the skin is not exposed.
  •  Frequently adjusts clothing, pushing up sleeves and/or pant legs.

http://www.incrediblehorizons.com/sensory-integration.htm 

 


Auditory
  • Responds negatively to unexpected or loud noises
  • Holds hands over ears
  • Cannot walk with background noise
  • Seems oblivious within an active environment
Visual
  • Prefers to be in the dark
  • Hesitates going up and down steps
  • Avoids bright lights
  • Stares intensely at people or objects
  • Avoids eye contact
Taste/Smell
  • Avoids certain tastes/smells that are typically part of children's diets
  • Routinely smells nonfood objects
  • Seeks out certain tastes or smells
  • Does not seem to smell strong odors
Body Position
  • Continually seeks out all kinds of movement activities
  • Hangs on other people, furniture, objects, even in familiar situations
  • Seems to have weak muscles, tires easily, has poor endurance
  • Walks on toes
Movement

Becomes anxious or distressed when feet leave the ground

Avoids climbing or jumping

Avoids playground equipment

Seeks all kinds of movement and this interferes with daily life

Takes excessive risks while playing, has no safety awareness

Touch

Avoids getting messy in glue, sand, finger paint, tape

Is sensitive to certain fabrics (clothing, bedding)

Touches people and objects at an irritating level

Avoids going barefoot, especially in grass or sand

Has decreased awareness of pain or temperature

Attention, Behavior

And Social

Jumps from one activity to another frequently and it interferes with play

Has difficulty paying attention

Is overly affectionate with others

Seems anxious

Is accident prone

Has difficulty making friends, does not express emotions 

This disorder is often confused with ADHD. Carol Kranowitz is dedicated to the distinguishment of the two.

SI Dysfunction vs. Attention Deficit Disorder:

A brief comparison of two "look-alike" disabilities

By Carol S. Kranowitz, M.A.

Posted on www.sinetwork.org 5/00

In my book, The Out-of-Sync Child, I define Sensory Integration Dysfunction (DSI) as the "inefficient neurological processing of information received through the senses, causing problems with learning, development, and behavior." Picture a child who has trouble processing and interpreting sensory messages about how things feel and what it feels like to be touched. Touch stimulation overwhelms this oversensitive child.

How does his problem play out? He is bothered by the label in his tee-shirt, the approach of a classmate, the lumps in his mashed potatoes, the stickiness of the playdough. Fidgeting and squirming, he pays a lot of attention to avoiding these ordinary sensations. Meanwhile, he is unable to pay much attention at all to the teacher's words or to playground rules.

Say a child with another form of SI dysfunction has trouble processing movement and balance sensations. Say this under-responsive child needs to move around -- much more than her peers -- in order to rev up and get going. What is the fallout of her problem? This impulsive "bumper and crasher" craves intense, vigorous movement. She often rocks, sways, twirls, jumps, climbs, leaps, gyrates and gets into upside-down positions. She pays a lot of attention to satisfying her need for movement, and not much attention to her mother's instructions or to where she left her shoes.

Inattention . . . impulsivity….fidgety movement . . . these are definitely symptoms of SI Dysfunction.

Now consider my definition for Attention Deficit Disorder (ADD): "a neurological syndrome characterized by serious and persistent inattention and impulsivity. When constant, fidgety movement (hyperactivity) is an additional characteristic, the syndrome is called Attention Deficit Disorder with Hyperactivity (ADHD)."

Inattention . . . impulsivity . . . fidgety movement . . . these are definitely symptoms of ADD/ADHD -- and of many other difficulties, as well.

In my book, I discuss other "look-alike" conditions which share symptoms with sensory integration dysfunction (pp. 17-20). SI Dysfunction may look like ADHD, and some symptoms may overlap. However, optimum treatment for the two problems is different. Before jumping to conclusions and leaping to drug therapy, parents and professionals need to look at the whole child. Then, we can thoughtfully determine what will help the most.

If the child is frequently -- but not always -- inattentive, it is useful to ask some questions: Where, when, and how often does this inattention occur? What is the stimulus? What does the child do as self-therapy? What is happening -- or not happening -- when the child concentrates well? What does the child need, and what helps?

An overloaded child needs less stimulation. So, dim the lights and turn down the radio. Comfort him with "deep pressure" bear hugs. Help him fix up a retreat, with pillows and blankets, under the dining room table.

An under-responsive child needs more sensory stimulation. So, take her to the playground each day, jog together around the block, engage her in gentle roughhousing, and provide her with a chinning bar, a punching bag, and a trampoline.

SI Dysfunction is a neurological problem, which affects behavior and learning. Medicine doesn't fix it.One needs a therapeutic sensory program that addresses the child's underlying difficulties processing sensations rather than just the symptoms of inattention, not psycho stimulants. A therapeutic sensory program may be a major component in treating the child with an attention problem. Taking a conservative approach can't hurt and often helps the inattentive child whose problem is not ADD, but developmentally delayed sensory processing.

An overview of processing deficits LINK  Processing Deficits Learning Disabilities OnLine: LD In-Depth: Understanding

 
For more information on sensory integration disorders, I highly recommend reading the book by Carol Stock Kranowitz, called The Out of Sync Child. 

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