Sensory Integration
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What Is Sensory Integration?
Sensory integration refers to how people use the information provided by all the sensations coming from within the body
and from the external environment. We usually think of the senses as separate channels of information, but they actually
work together to give us a reliable picture of the world and our place in it. Your senses integrate to form a complete
understanding of who you are, where you are, and what is happening around you. Because your brain uses information
about sights, sounds, textures, smells, tastes, and movement in an organized way, you assign meaning to your sensory
experiences, and you know how to respond and behave accordingly. Walking through a shopping mall, if you smell a
powerful, sweet scent, you are able to identify it as a candle or essential oil and realize that you're walking past an
aromatherapy store. You may linger a moment to enjoy it or hurry by to escape it.
For most of us, sensory integration occurs without conscious thought or effort. Let's say you're ironing and chatting with
your child. You stay focused on your conversation and hear all the fascinating details of the latest episode of Blue's Clues.
You may find that you've ironed an entire pile of shirts without even thinking. You certainly didn't have to consciously
consider how to apply the correct pressure to the iron, or figure out what to do when you came across a wrinkle or
finished a sleeve. You just ironed. That's how good you are at using your senses to function adaptively. Of course, if
something unexpected happens, say, you notice a stain, your senses would sharpen and focus on this alerting information.
Otherwise, no big deal – just another day, another pile of ironing.
For others, sensory integration happens inefficiently. People with SI dysfunction have great difficulty figuring out what is
going on inside and outside their bodies, and there's no guarantee that the sensory information they're working with is
accurate. In response, a child may avoid confusing or distressing sensations – or seek out more of the sensation to find out
more about it. For example, a child who has difficulty integrating tactile (touch) input may avoid unpleasant touch
experiences such as getting his hands messy with paint, sand, or glue, while another child may crave such touch input and
actively seek it out.
If you had SI dysfunction, ironing would be extremely taxing, even dangerous, as you'd have to think so much about what
you're doing. That same walk past the aromatherapy store might be so distressing that the smell might overwhelm you to
the point where you become nauseated and upset and have to leave the mall immediately.
For most kids, sensory integration skills develop naturally. As children learn about new sensations, they become more
confident about their skills, refine their ability to respond to sensory experiences, and are thus able to accomplish more
and more. An infant startles and cries when a fire engine whizzes past blaring a siren, but years later when that baby is a
teenager, the same noise might cause him to simply cover his ears as he watches the fire engine go down the street. As an
adult, this person may merely stop talking with a friend until the fire engine passes. As sensory processing skills mature,
vital pathways in the nervous system get refined and strengthened, and children get better at handling life's challenges.
For some children, sensory integration does not develop smoothly. Because they can't rely on their senses to give them an
accurate picture of the world, they don't know how to behave in response, and they may have trouble learning and
behaving appropriately. The essential first step toward helping your child with sensory issues is to develop empathy for
how he experiences his world.
Sensory Responsiveness: What's Normal and What Isn't
We're not big believers in the term normal. All it really means is that something falls within the norm, meaning it
is average statistically. Of course, as a parent, you want all the things you find delightful about your child to be
better than average or even extraordinary, which, of course, would fall under the definition of abnormal. So,
you might want to toss out that normal label altogether.
While it's typical to have some sensory issues, kids with SI dysfunction have much more trouble with sensory
processing. They usually show many of the following behavioral symptoms, which can interfere with daily
activities and learning:
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oversensitivity or undersensitivity to touch, sights, sounds, movement, tastes, or smells
high distractibility, with problems paying attention and staying focused on a task
an unusually high or low activity level
frequent tuning out or withdrawing
intense, out-of-proportion reactions to challenging situations and unfamiliar environments
impulsiveness, with little or no self-control
difficulty transitioning from activity to activity or situation to situation
rigidity and inflexibility at times
clumsiness and carelessness
discomfort in group situations
social or emotional difficulties
developmental and learning delays and acting silly or immature
awkwardness, insecurity, or feeling "stupid" or "weird"
trouble handling frustration, tendency to tantrum longer and more intensely than other children do, and
more difficulty returning to a calm state
problems transitioning from an alert, active state to a calm, rested state (for example, difficulty falling
asleep or waking, or doing a quiet activity after being very active or vice versa)
Lots of kids show these signs for lots of reasons. Some of these behaviors are appropriate at certain ages.
Most toddlers are pretty impulsive – that's the terrific but terrible twos. But a four-year-old who acts on every
little impulse is a different story. A strong dislike of wool clothing, discomfort making eye contact with strangers,
or fear of a goat that bleats loudly and unexpectedly at the petting zoo fall within the range of so-called typical
sensory sensitivity for a child so long as these sensory experiences do not interfere with daily function. A child
with sensory problems usually has maladaptive responses to everyday situations, consistently showing
behaviors that are not age-appropriate and that can't just be dismissed.
Hypersensitivity and Hyposensitivity
A hallmark of SI dysfunction is inconsistent responses to sensory information. Your child may very well be
oversensitive (hypersensitive) to certain types of sensory input and undersensitive (hyposensitive) to other types
of input. A child with auditory sensitivity may love sounds within a certain frequency range (such as a lowfrequency lawn mower) and detest sounds at a different frequency range (such as a high-frequency ringing
telephone). Another way to think of it is that a child who is hypersensitive may avoid that sensation, while a
child who is hyposensitive may actually seek it out because it is calming and comforting. There are also
children with mixed reactivity who may be oversensitive to a sensation one day, and undersensitive to it the
next day. This can be really confusing and look like a behavioral issue more than anything else. Say, one day
your son craves splashing around in a bubble bath, but the next day, he absolutely refuses to step foot in it.
Rather than assuming he's just being difficult, it may be that yesterday his nervous system was "organized"
enough to enjoy it, but today his "disorganized" nervous system just can't tolerate it. You can't always predict
how a malfunctioning nervous system is going to react from day to day – or even hour to hour – or when a new
sensory challenge is going to crop up.
To make matters more confusing, children may accustom themselves to a "repulsive" sensation and suddenly
develop another sensitivity. A child who finally starts to tolerate having his hair brushed, washed, and cut might
suddenly find it unbearable to have clothing tags or seams touch his skin. If you previously knew nothing at all
about the nuances of sensory input, having a child with sensory problems will make you hyperaware of them!
The common denominator in these sensitivities and the resulting seeking and avoiding behaviors is that these
responses to sensory experiences are not completely voluntary. They are unusual neurological responses that
result in unusual behaviors.
So why doesn't your child just put mind over matter and tolerate the feel of the brush against his scalp and the
foam of the toothpaste in his mouth? Well, many children do attain higher tolerance as they mature. And the
older we get, the more we figure out ways to adapt to please other people, to be accepted, and to get along in the
world while meeting our own needs. Those of us with typical sensory integration skills put up with scratchy
clothing for a business meeting or eat calamari because we don't want to embarrass our hostess, but the younger
a child is, the harder it is for him to fake it.
Also, the more outside stresses a child has in his life – the demands of school, illness, lack of sleep, tension at
home, hormonal fluctuations of adolescence, changes in any medications – the harder it will be for him to "buck
up" and tolerate his sensory issues as well.
Sensory Problems Affect Every Aspect of Life
How do sensory issues impact your child from day to day? Of course, life is a multisensory experience and most
children with SI dysfunction have trouble with more than one sensory system. For the sake of simplicity,
though, let's just consider just one sense: touch.
Tactile Oversensitivity
A child who is tactile oversensitive will have difficulty in one or more of these areas:
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Sensory exploration. She might avoid making physical contact with other people and things in the
environment, leading to impoverished sensory experiences and social isolation. A child uncomfortable
with touch may not feel safe and comforted by a parent's hug. A child who avoids cold, wet textures
won't discover the delight of making a snowman.
Emotional and social. He may have trouble behaving according to social norms, may isolate himself
from others, and become aggressive or depressed. A child who dislikes having other kids brush up
against him or bump into him might avoid getting physically close and refuse to stand on line or hold
another child's hand as requested. He may also refuse to participate during group activities by pushing
other kids away or withdrawing into himself.
Motor. She may be unwilling to try new fine and gross motor activities such as cutting with scissors or
swimming, and have poor physical coordination. She may have trouble with motor planning, that is,
doing physical things in sequence (such as holding both feet together while jumping, and landing with
both feet together).
Cognitive. Because he is distracted by his need to avoid tactile input, he may show attention and
learning deficits. An infant may avoid learning to hold his bottle because he is distressed by how it feels
in his hand. A teenager may be so distracted by the possibility that a rowdy classmate will bother him
that he can't follow what the teacher is saying.
Speech-language. If she avoids interaction with others, she may have poor communication skills. If she
has tactile issues inside her mouth she may have trouble speaking and making her ideas, needs, and
wants known.
Eating. If he avoids certain food textures, he may become malnourished – often in subtle ways, as we
shall see later on. If he hates the feel of eating with utensils, he may refuse to eat at all unless he can
eat with his fingers. He may avoid social situations where he feels pressured to eat foods he finds
repulsive, or even act out or have a meltdown when faced with this possibility.
Grooming and dressing. She may refuse to brush her teeth or hair, use shampoo, or shower. She might
insist on wearing clothing that is comfortable and familiar even if it is very dirty or inappropriate for the
occasion or weather.
Tactile Undersensitivity
Children can also be undersensitive, needing more intense touch input to obtain the tactile information they
need. A child who is undersensitive to touch may have these difficulties:
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Sensory exploration. He makes excessive physical contact with people and objects, perhaps even
licking them, touching other children too forcefully or inappropriately (such as biting or hitting), fingering
all the objects in a store, perhaps to the point of injuring others and breaking things.
Emotional and social. She may crave touch to the extent that friends, family, and even strangers
become annoyed and upset, scolding her and making her feel unwanted or weird. She might be the
baby who constantly needs to be held, or the toddler who hangs on to her mother's leg, craving
continual physical contact.
Motor. The child who is undersensitive doesn't adequately register tactile input. To get more tactile
sensory information, he may need to use more of his skin surface to feel he's made contact with an
object. He may use his whole fist to really feel that marker in his hands, or sprawl on the floor to really
know that it's beneath him. Because his ability to sense tactile input is impaired, he may have limited
skills needed for precise motor tasks such as writing and catching a ball.
Cognitive. Because she is distracted by her need to obtain tactile input, she may show attention and
learning deficits. For example, if she is too absorbed in checking out how the pencil, paper, desk, and
chair feel, she will be unable to concentrate on learning to form letters proficiently, or to put her
thoughts together well on paper.
Speech-language. If he doesn't process tactile sensations inside his mouth well, he may have trouble
mastering the precise movements of the lip and tongue needed to produce articulate speech.
Eating. If the skin in and around her mouth is undersensitive, she may drool, and food may pool inside
her cheeks or remain in her mouth or on her lips. She might stuff her mouth with too much food to feel
that there's something in there, to the point where it poses a choking hazard.
Grooming and dressing. He may choose clothing that is, to you, unacceptably tight or loose. He may
brush his teeth so hard that he injures his gums; a girl may wear braids so tight and keep them in for so
long that it damages her hair. A child may insist on wearing her favorite sneakers even though they're
way too small and cause blisters.
All of these examples may ring true for your tactile sensitive child – or not. Your child may not have tactile
issues at all and may be struggling instead with her other senses. Whatever the case, if your child is having
difficulties handling certain kinds of sensory input, you need to be aware that he may be experiencing problems
in many areas of daily life that you may not have imagined.
Sensory Integration Disorder
By Beth Kapes
Definition
Sensory integration disorder or dysfunction (SID) is a neurological disorder that results from the brain's inability
to integrate certain information received from the body's five basic sensory systems. These sensory systems
are responsible for detecting sights, sounds, smell, tastes, temperatures, pain, and the position and
movements of the body. The brain then forms a combined picture of this information in order for the body to
make sense of its surroundings and react to them appropriately. The ongoing relationship between behavior
and brain functioning is called sensory integration (SI), a theory that was first pioneered by A. Jean Ayres,
Ph.D., OTR in the 1960s.
Description
Sensory experiences include touch, movement, body awareness, sight, sound, smell, taste and the pull of
gravity. Distinguishing between these is the process of sensory integration (SI). While the process of SI occurs
automatically and without effort for most, for some the process is inefficient. Extensive effort and attention are
required in these individuals for SI to occur, without a guarantee of it being accomplished. When this happens,
goals are not easily completed, resulting in sensory integration disorder (SID).
The normal process of SI begins before birth and continues throughout life, with the majority of SI development
occurring before the early teenage years. The ability for SI to become more refined and effective coincides with
the aging process as it determines how well motor and speech skills, and emotional stability develops. The
beginnings of the SI theory by Ayres instigated ongoing research that looks at the crucial foundation it provides
for complex learning and behavior throughout life.
Causes & symptoms
The presence of a sensory integration disorder is typically detected in young children. While most children
develop SI during the course of ordinary childhood activities, which helps establish such things as the ability for
motor planning and adapting to incoming sensations, others SI ability does not develop as efficiently. When
their process is disordered, a variety of problems in learning, development, or behavior become obvious.
Those who have sensory integration dysfunction may be unable to respond to certain sensory information by
planning and organizing what needs to be done in an appropriate and automatic manner. This may cause a
primitive survival technique called "fright, flight, and fight," or withdrawal response, which originates from the
"primitive" brain. This response often appears extreme and inappropriate for the particular situation.
The neurological disorganization resulting in SID occurs in three different ways: the brain does not receive
messages due to a disconnection in the neuron cells; sensory messages are received inconsistently; or
sensory messages are received consistently, but do not connect properly with other sensory messages. When
the brain poorly processes sensory messages, inefficient motor, language, or emotional output is the result.
According to Sensory Integration International (SII), a non-profit corporation concerned with the impact of
sensory integrative problems on people's lives, the following are some signs of sensory integration disorder
(SID):
• oversensitivity to touch, movement, sights, or sounds
• underreactivity to touch, movement, sights, or sounds
• tendency to be easily distracted
• social and/or emotional problems
• activity level that is unusually high or unusually low
• physical clumsiness or apparent carelessness
• impulsive, lacking in self-control
• difficulty in making transitions from one situation to another
• inability to unwind or calm self
• poor self concept
• delays in speech, language, or motor skills
• delays in academic achievement
While research indicates that sensory integrative problems are found in up to 70% of children who are
considered learning disabled by schools, the problems of sensory integration are not confined to children with
learning disabilities. SID transfers through all age groups, as well as intellectual levels and socioeconomic
groups. Factors that contribute to SID include: premature birth; autism and other developmental disorders;
learning disabilities; delinquency and substance abuse due to learning disabilities; stress-related disorders;
and brain injury. Two of the biggest contributing conditions are autism and attention deficit hyperactivity
disorder (ADHD).
Diagnosis
In order to determine the presence of SID, an evaluation may be conducted by a qualified occupational or
physical therapist. An evaluation normally consists of both standardized testing and structured observations of
responses to sensory stimulation, posture, balance, coordination, and eye movements. These test results and
assessment data, along with information from other professionals and parents, are carefully analyzed by the
therapist who then makes recommendations about appropriate treatment.
Treatment
Sensory integration disorder (SID) is treatable with occupational therapy, but some alternative methods are
emerging to complement the conventional methods used for SID.
Therapeutic body brushing is often used on children (not infants) who overreact to tactile stimulation. A specific
non-scratching surgical brush is used to make firm, brisk movements over most of the body, especially the
arms, legs, hands, back and soles of the feet. A technique of deep joint compression follows the brushing.
Usually begun by an occupational therapist, the technique is taught to parents who need to complete the
process for three to five minutes, six to eight times a day. The time needed for brushing is reduced as the child
begins to respond more normally to touch. In order for this therapy to be effective, the correct brush and
technique must be used.
A report in 1998 indicates the use of cerebral electrical stimulation (CES) as being helpful to children with
conditions such as moderate to severe autistic spectrum disorders, learning disabilities, and sensory
integration dysfunction. CES is a modification of Transcutaneous Electrical Nerve Stimulation (TENS)
technology that has been used to treat adults with various pain problems, including arthritis and carpal tunnel
syndrome . TENS therapy uses a low voltage signal applied to the body through the skin with the goal of
replacing painful impressions with a massage-like sensation. A much lower signal is used for CES than that
used for traditional TENS, and the electrodes are placed on the scalp or ears. Occupational therapists who
have studied the use of CES suggest that CES for children with SID can result in improved brain activity. The
device is worn by children at home for 10 minutes at a time, twice per day.
Music therapy helps promote active listening. Hypnosis and biofeedback are sometimes used, along with
psychotherapy, to help those with SID, particularly older patients.
Allopathic treatment
Occupational therapists play a key role in the conventional treatment of SID. By providing sensory integration
therapy, occupational therapists are able to supply the vital sensory input and experiences that children with
SID need to grow and learn. Also referred to as a "sensory diet," this type of therapy involves a planned and
scheduled activity program implemented by an occupational therapist, with each "diet" being designed and
developed to meet the needs of the child's nervous system. A sensory diet stimulates the "near" senses
(tactile, vestibular, and proprioceptive) with a combination of alerting, organizing, and calming techniques.
Motor skills training methods that normally consist of adaptive physical education, movement education, and
gymnastics are often used by occupational and physical therapists. While these are important skills to work on,
the sensory integrative approach is vital to treating SID.
The sensory integrative approach is guided by one important aspect--the child's motivation in selection of the
activities. By allowing them to be actively involved, and explore activities that provide sensory experiences
most beneficial to them, children become more mature and efficient at organizing sensory information.
Expected results
By combining alternative and conventional treatments and providing these therapies at an early age, sensory
integration disorder may be managed successfully. The ultimate goal of both types of treatment is for the
individual to be better able to interact with his or her environment in a more successful and adaptive way.
Key Terms
Axon
A process of a neuron that conducts impulses away from the cell body. Axons are usually long and
straight.
Cortical
Regarding the cortex, or the outer layer of the brain, as distinguished from the inner portion.
Neurotransmission
When a neurotransmitter, or chemical agent released by a particular brain cell, travels across the
synapse to act on the target cell to either inhibit or excite it.
Proprioceptive
Pertaining to proprioception, or the awareness of posture, movement, and changes in equilibrium
and the knowledge of position, weight, and resistance of objects as they relate to the body.
Tactile
The perception of touch.
Vestibular
Pertaining to the vestibule; regarding the vestibular nerve of the ear which is linked to the ability to
hear sounds.
Further Reading
For Your Information
Periodicals
• "Body Brushing Therapy for Tactile Defensiveness." Latitudes (April 30, 1997).
• "Brain Stimulation for Autism?" Latitudes (October 31, 1998).
• "Sensory Integration Therapy." Latitudes (December 31, 1994).
• Morgan, Nancy. "Strategies for Colic." Birth Gazette (September 30, 1996).
Organizations
• Sensory Integration International/The Ayres Clinic, 1514 Cabrillo Avenue, Torrance, CA 90501-2817.
http://www.sensoryint.com.
Other
• "Sensory Integration Dysfunction." http://home.ptd.net/blnelson/SIDEWEBPAGE2.htm.
• Sensory Integration Network. http://www.sinetwork.org.
• Southpaw Enterprises, Inc. http://www.southpawenterprises.com.
Gale Encyclopedia of Alternative Medicine. Gale Group, 2001.
Sensory Integration
Cindy Hatch-Rasmussen, M.A., OTR/L
Therapy Northwest, P.C.
Beaverton, OR 97005
Children and adults with autism, as well as those with other developmental disabilities, may have a
dysfunctional sensory system. Sometimes one or more senses are either over- or under-reactive to stimulation.
Such sensory problems may be the underlying reason for such behaviors as rocking, spinning, and handflapping. Although the receptors for the senses are located in the peripheral nervous system (which includes
everything but the brain and spinal cord), it is believed that the problem stems from neurological dysfunction in
the central nervous system--the brain. As described by individuals with autism, sensory integration techniques,
such as pressure-touch can facilitate attention and awareness, and reduce overall arousal. Temple Grandin, in
her descriptive book, Emergence: Labeled Autistic, relates the distress and relief of her sensory experiences.
Sensory integration is an innate neurobiological process and refers to the integration and interpretation of
sensory stimulation from the environment by the brain. In contrast, sensory integrative dysfunction is a disorder
in which sensory input is not integrated or organized appropriately in the brain and may produce varying
degrees of problems in development, information processing, and behavior. A general theory of sensory
integration and treatment has been developed by Dr. A. Jean Ayres from studies in the neurosciences and those
pertaining to physical development and neuromuscular function. This theory is presented in this paper.
Sensory integration focuses primarily on three basic senses--tactile, vestibular, and proprioceptive. Their
interconnections start forming before birth and continue to develop as the person matures and interacts with
his/her environment. The three senses are not only interconnected but are also connected with other systems in
the brain. Although these three sensory systems are less familiar than vision and audition, they are critical to our
basic survival. The inter-relationship among these three senses is complex. Basically, they allow us to
experience, interpret, and respond to different stimuli in our environment. The three sensory systems will be
discussed below.
Tactile System: The tactile system includes nerves under the skin's surface that send information to the brain.
This information includes light touch, pain, temperature, and pressure. These play an important role in
perceiving the environment as well as protective reactions for survival.
Dysfunction in the tactile system can be seen in withdrawing when being touched, refusing to eat certain
'textured' foods and/or to wear certain types of clothing, complaining about having one's hair or face washed,
avoiding getting one's hands dirty (i.e., glue, sand, mud, finger-paint), and using one's finger tips rather than
whole hands to manipulate objects. A dysfunctional tactile system may lead to a misperception of touch and/or
pain (hyper- or hyposensitive) and may lead to self-imposed isolation, general irritability, distractibility, and
hyperactivity.
Tactile defensiveness is a condition in which an individual is extremely sensitive to light touch. Theoretically,
when the tactile system is immature and working improperly, abnormal neural signals are sent to the cortex in
the brain which can interfere with other brain processes. This, in turn, causes the brain to be overly stimulated
and may lead to excessive brain activity, which can neither be turned off nor organized. This type of overstimulation in the brain can make it difficult for an individual to organize one's behavior and concentrate and
may lead to a negative emotional response to touch sensations.
Vestibular System: The vestibular system refers to structures within the inner ear (the semi-circular canals) that
detect movement and changes in the position of the head. For example, the vestibular system tells you when
your head is upright or tilted (even with your eyes closed). Dysfunction within this system may manifest itself
in two different ways. Some children may be hypersensitive to vestibular stimulation and have fearful reactions
to ordinary movement activities (e.g., swings, slides, ramps, inclines). They may also have trouble learning to
climb or descend stairs or hills; and they may be apprehensive walking or crawling on uneven or unstable
surfaces. As a result, they seem fearful in space. In general, these children appear clumsy. On the other extreme,
the child may actively seek very intense sensory experiences such as excessive body whirling, jumping, and/or
spinning. This type of child demonstrates signs of a hypo-reactive vestibular system; that is, they are trying
continuously to sti mulate their vestibular systems.
Proprioceptive System: The proprioceptive system refers to components of muscles, joints, and tendons that
provide a person with a subconscious awareness of body position. When proprioception is functioning
efficiently, an individual's body position is automatically adjusted in different situations; for example, the
proprioceptive system is responsible for providing the body with the necessary signals to allow us to sit
properly in a chair and to step off a curb smoothly. It also allows us to manipulate objects using fine motor
movements, such as writing with a pencil, using a spoon to drink soup, and buttoning one's shirt. Some common
signs of proprioceptive dysfunction are clumsiness, a tendency to fall, a lack of awareness of body position in
space, odd body posturing, minimal crawling when young, difficulty manipulating small objects (buttons,
snaps), eating in a sloppy manner, and resistance to new motor movement activities.
Another dimension of proprioception is praxis or motor planning. This is the ability to plan and execute
different motor tasks. In order for this system to work properly, it must rely on obtaining accurate information
from the sensory systems and then organizing and interpreting this information efficiently and effectively.
Implications: In general, dysfunction within these three systems manifests itself in many ways. A child may be
over- or under-responsive to sensory input; activity level may be either unusually high or unusually low; a child
may be in constant motion or fatigue easily. In addition, some children may fluctuate between these extremes.
Gross and/or fine motor coordination problems are also common when these three systems are dysfunctional
and may result in speech/language delays and in academic under-achievement. Behaviorally, the child may
become impulsive, easily distractible, and show a general lack of planning. Some children may also have
difficulty adjusting to new situations and may react with frustration, aggression, or withdrawal.
Evaluation and treatment of basic sensory integrative processes is performed by occupational therapists and/or
physical therapists. The therapist's general goals are: (1) to provide the child with sensory information which
helps organize the central nervous system, (2) to assist the child in inhibiting and/or modulating sensory
information, and (3) to assist the child in processing a more organized response to sensory stimuli.
For further information, contact: Sensory Integration International, P.O. Box 9013, Torrance, CA 90508, USA