Sensory Integration / Sensory Processing Disorder
Sensory integration disorder or dysfunction (SID) / Sensory Processing disorder (SPD) is a neurological
disorder that results from the brain's inability to integrate, process, and respond to 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).  Sensory integration provides a crucial foundation for later, more complex
learning and behavior.

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
sensory integration occurs automatically and without effort for most, for some the process is inefficient.
Extensive effort and attention are required in these individuals for sensory integration to occur, without a
guarantee of it being accomplished. When this happens, goals are not easily completed, resulting in
sensory
integration disorder (SID) / sensory processing disorder (SPD)
.

The normal process of
sensory integration begins before birth and continues throughout life, with the
majority of sensory development occurring before the early teenage years.  For most children sensory
integration develops in the course of ordinary childhood activities.  But for some children, sensory
integration does not develop as efficiently as it should.  This is known as
dysfunction in sensory
integration (D.S.I.)
.  When the process is disordered, a number of problems in learning, motor skills and
behavior may be evident.  The ability for sensory integration to become more refined and effective coincides
with the development process as it determines how well motor and speech skills, and emotional stability
develop.  

The concept and theory of
sensory integration disorder / sensory processing disorder comes from a
body of work developed by A.  Jean Ayres, PhD, OTR, and an occupational therapist that was based in
California, U.S.A.  As an occupational therapist, Dr. Ayres was interested in the way in which sensory
processing and motor planning disorders interfere with activities of daily living and learning.  The beginnings
of the sensory integration theory by Ayres instigated research that looks at the foundation it provides for
complex learning and behavior throughout life.

Causes and Symptoms

The presence of a sensory integration disorder is typically detected in young children. While most children
develop sensory integration during the course of ordinary childhood activities, which helps establish such
things as the ability  for motor planning and adapting to incoming sensations, others' sensory integration
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
sensory integration disorder / sensory processing disorder
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 /
sensory processing disorder:

•        Over sensitivity to touch, movement, sights, or sounds
•        Under reactivity to touch, movement, sights, or sounds
•        Specific learning difficulties /delays in academic achievement  
•        Difficulty in making transitions from one situation to another
•        Tendency to be easily distracted / Limited attention control
•        Activity level that is unusually high or unusually low
•        Social and/or emotional problems
•        Difficulty learning new movements
•        Delays in speech, language, or motor skills
•         Physical clumsiness or apparent carelessness
•        Impulsive, lacking in self-control      
•        Inability to unwind or calm self
•        Poor self concept / body awareness

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.
Sensory integration / sensory processing disorder transfers through all age
groups, as well as intellectual levels and socioeconomic groups. Factors that contribute to
sensory
integration / sensory processing disorder
include: premature birth; autism and other developmental
disorders; learning disabilities; delinquency and substance abuse due to learning disabilities; stress-related
disorders; and brain injury.              

Research has identified
autism and attention-deficit hyperactivity disorder (ADHD) as two of the
biggest contributing conditions as well as learning disorders (i.e. Specific learning difficulties),
developmental disabilities and fragile X syndrome.

Diagnosis

In order to determine the presence of sensory integration or sensory processing disorder, 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.

Sensory processing disorder is usually recognized in early childhood or adolescence but may be seen
throughout the lifespan. These children do not “outgrow” the problem. Difficulties continue into adulthood,
although sometimes severity of symptoms may become less apparent as the child learns managing
techniques.

Children with sensory processing disorder have difficulty with:
•        Managing anxiety
•        Handling high stress situations
•        Dealing with frustration
•        Staying on tasks to finishing point
•        Effectively using fine and gross motor skills

When comparing children’s sensory processing problems with coping abilities, the sensory
processing problems were mostly related to the child’s difficulty with their ability to
:

•        Handle new situations
•        Change plans / transition
•        Appropriately learn new situations
•        Understand independence and dependence
•        Use self-defense successfully
•        Have an proper activity level
•        Control impulses

Sensory processing disorder is often associated with other diagnoses such as:

•        Pervasive developmental disorder/ autism spectrum
•        Learning disabilities/ attention deficit disorder
•        Language disorders
•        Behavioral disorders
•        Anxiety disorder/ depression

Children with sensory processing disorder may display the following behaviors:

•        May not like messy things or getting dirty
•        May not like to be touched, hugged or cuddled
•        Likes to touch objects and people to the point of becoming annoying
•        May frequently put things in his/her mouth
•        Refuses to brushing teeth
•        May gag during tooth brushing

Sensory seeking children appear to desire touch because they need sensation that is intense, frequent and/or
of long interval.  Touch systems around the head and face may contribute to over-sensitive to touch, leading
to poor tolerance of anything around the mouth.

Sensory Under-Sensitivity

Children with under sensitivity do not respond to and may seem uninterested or unresponsive to
sensory experiences. These children may exhibit the following traits:

•        The child seems weak, slumps, and leans on people or furniture.
•        The child has low energy and has a hard time waking up.
•        The child gets tired easily, lies around and appears to have little motivation to walk around.
•        The child does things very slowly.
•        The child seems depressed or neutral.

Sensory Over-Sensitivity

Children with over sensitivity respond to sensations from just one sensory system faster, with more intensity
or for a longer period than typical peers.

•        The child responds negatively or emotionally to loud people or places.
•        The child has trouble concentrating in noisy environments
•        The child frequently hums or makes other strange noises.

Some children who are overwhelmed by their environment over-react to sounds or even ‘shut them out’ so
that it seems like they are not hearing, while other kids make sounds to block the noises in their
environment. These children are sensory seeking and seem to have a craving for strong levels of sensation.
Children with over-sensitivity may become uncomfortable with changes to new situations.

Sensory Modulation Disorder

This sensory processing disorder causes problems with modifying responses to sensory inputs resulting in
withdrawal or strong negative responses to sensations that do not usually bother typical peers. Problems are
often seen in irregular emotions that are made worse by stress, and vary with the situation.

Signs of Sensory Modulation Disorder

•        Easily distracted by sounds
•        Extremely sensitive to sounds
•        Difficulty with falling or staying asleep
•        Reacts defensively to being touched lightly or unexpectedly
•        Easily distracted by visual stimuli
•        Overly active
•        Outbursts of anger

Sensory Discrimination Disorder

Children with sensory discrimination disorder have trouble in recognizing and interpreting differences or
similarities in the nature of stimuli. It is commonly seen with problems in processing sensations from touch,
muscles, joints and head movements (vestibular or inner ear sensations).

Signs of Sensory Discrimination Disorder

•        The child hits or pushes other people
•        The child grips objects too tightly or uses too much strength
•        The child frequently drops things or knocks things over
•        The child mouths, licks, chews, or sucks on non-food items
•        The child craves movement, such as spinning or jumping around
•        The child is afraid of heights/ swings or slides
•        The child has poor balance

Postural-Ocular Disorder

Postural-Ocular Disorder is a problem with control of posture or quality of movements seen in low muscle
tone or joint instability and/or poor functional use of vision. These children have difficulty stabilizing the
body while resting/moving and trouble with using both sides of the body together. This disorder is often
seen with vestibular (the inner ear) problems.

Sings of Postural-Ocular Disorder

•        The child seems weaker than other children
•        The child wears out easily
•        The child often moves around repeatedly
•        The child slumps while sitting
•        The child has difficulty making eye contact/ following with the eyes, such as reading
•        The child seems clumsy he/she may fall and tumble frequently
•        The child may seek movements of swinging or spinning

Dyspraxia

Children with dyspraxia have trouble with planning, sequencing & executing unfamiliar actions resulting in
awkward & poorly coordinated motor skills typically seen with a sensory processing deficit. It is usually
seen with difficulty doing new activities or those that are done infrequently. Children with dyspraxia may be
slow at learning a new sequence of movement. Children who have dyspraxia have difficulty figuring out
what movement they need to make, planning how to move and accomplishing a plan. They need to be given
more time between transitions.

Signs of Dyspraxia

•        Difficulty following multi-step directions
•        Strong desire for sameness or routines
•        Has an awkward pencil grasp
•        Has poor handwriting
•        Dislikes or hesitant to participate in sports
•        Easily frustrated
•        Problems with daily life skills like dressing or using utensils
•        Trouble figuring out how to get on swings or slides, play with new toys, get dressed or make certain
speech     sounds
•        Frequently trips, falls, bumps into things and drops toys
•        Difficulty imitating simple movements with his hands, arms, legs or mouth
•        Difficulty with changes in his routine or schedule
•        May show separation anxiety / difficulty separating from caretaker

Sensory Integration Treatment

Occupational therapists play a key role in the conventional treatment. By providing sensory integration
therapy, occupational therapists are able to supply the vital sensory input and experiences that children with
sensory processing disorder 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 sensory processing.

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.

Alternative treatment

Sensory integration disorder (SID) / Sensory Processing disorder (SPD)
is treatable with occupational
therapy, but some alternative methods are emerging to complement the conventional methods used for
sensory integration.

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.

Remember - An important step in promoting sensory integration in children is to recognize that it
exists and that it plays a vital role in their development.
Remember - An important step in promoting sensory integration in children is to
recognize that it exists and that it plays a vital role in their development.
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