Sensory Integration, or sensory processing, is the ability to take in information through our senses (touch, movement, smell, taste, vision and hearing), put it together with prior information, memories, and knowledge stored in the brain, and respond without over or under reacting. The process of sensory integration begins in utero and occurs throughout the lifespan. Our brain is continuously taking in sensory information from the environment and our body, deciding what to do with the information, and then sending messages to our body to respond. An example of sensory integration would be when reading a book when there is a lawn being mowed nearby, our brain recognizes what the sound is and therefore, that the lawnmower is not a threat. We are able to “tune out” the sound and continue reading. If the mower hits a rock, making a sound that we are unfamiliar with, we immediately respond by checking to make sure there is no danger. If a person has a problem with the process of sensory integration they may be unable to tune out the sound of the lawnmower in order to read their book. They might overreact to the unfamiliar sound of the lawnmower hitting a rock or may not hear it at all. Thus, the brain has difficulty sorting out and making sense of sensory input coming in from the environment, therefore affecting the ability to respond appropriately.
At nine weeks in utero the fetus is already sensing touch and movement. By birth the brain and nervous system are developed enough so that all the senses are working and sensory integration is constantly occurring. Sensory information about sights, sounds, smells, taste, touch, and movement is continuously entering the body through the eyes, ears, nose, tongue, skin, and joints. This information is then sent to the brain, where the brain tries to make sense of it by comparing it to past experiences. If the brain recognizes the sensory input it automatically knows how to tell the body to respond. If the sensory information is new, the brain typically needs more information to know how to respond and so seeks out the source, such as a sound or a texture, until the brain has figured out how to tell the body to react. In infancy we begin learning to interpret the information received through our senses so that over time we are able to perform an increasing number of skills automatically.
Throughout the lifespan there are things that help us relax, concentrate, or just feel good. For example, parents use swaddling and rocking to help calm a fussy infant and babies learn to suck their thumb or a pacifier to self-soothe. As we grow and our bodies mature, we learn which things help us feel more calm or improve concentration in various situations and often do them without even thinking about it, such as chewing gum, working out, drinking coffee, doodling, taking a warm bath, listening to music, etc.
The typical child has an inner motivation to seek out sensory activities and to conquer challenges. This drive encourages the child to participate actively in experiences that enhance sensory integration. With every experience the brain is building a store of information so that it knows how to tell the body to respond to the environment automatically in a variety of situations. Over time, we also learn, without being told, what information is important to pay attention to and what can be ignored. In the normally developing child, sensory integration occurs when the child participates in everyday activities comfortably. For this to occur, the child must also have a good sense of where their body is in relation to the environment in order to feel safe moving or being touched.
There are many children who are unable to sort out and cope with the information they receive from their senses, touch and movement as well as the eyes, ears, mouth and nose. The information is disorganized and the child’s performance is then affected. As Jean Ayres, the founder of the theory of sensory integration, states, “disorganization of processing is like a rush hour traffic jam.”
The term Sensory Processing Disorder is becoming more widely used to refer to problems occurring during the sensory integration process. It refers to difficulty with sensory processing as it relates to the ability to move the body, maintain attention, as well as react and behave appropriately in all situations. There may be weaknesses in one or more sensory systems, such as touch, movement, or body awareness, impacting the ability to accurately interpret the sensory information coming into the body and brain and then perform motor tasks in response. A child may also have difficulty screening out input from their body and/or the environment, impacting their ability to adequately focus and pay attention, resulting in problems with behavior and internal organization.
Children with a sensory processing disorder can have either a hyper (over-reactive) or hypo (under-reactive) response to sensory input, or can demonstrate a combination of both depending on the situation. The following are common behavioral characteristics of children with a hyper responsiveness or a hypo responsiveness to sensory stimulation.
The hypo responsive child may also not feel touch adequately and may:
The hypo responsive child may not get enough movement and demonstrate:
The hypo responsive child may seek out visual stimulation:
The hypo responsive child may also seek out noise:
The hypo responsive child may seek out a lot of oral stimulation:
As part of the sensory integration process, it is necessary to be able to know, without being told, what information in the environment or our bodies is important to pay attention to and what can be ignored and screened out. This is referred to as sensory regulation. Sensory regulation is the ability of the nervous system to take in sensory information and organize it, allowing us to screen out unimportant information and help us to focus on that which is important
What is a well modulated system? A well modulated nervous system adapts to changes in the environment, allows us to remain focused on a task, block out unimportant information, pay attention to relevant stimulation, and doesn’t over or under react to a situation. For example, if our brain and body are proficient at sensory regulation we are able to ignore the background sound of a lawnmower in order to read a book without feeling confused or agitated.
Poor sensory regulation occurs when the brain has a problem letting in or screening out the necessary information from the body and the environment. This usually causes a response to sensory input that is over-reactive if the brain is letting in too much information or under-reactive if the brain isn’t letting in enough information. Good sensory regulation requires us to be at an appropriate level of arousal, or attention and focus, so that we can respond to sensory stimulation with appropriate behavior responses without over or under-reacting. Children who demonstrate poor sensory regulation are also often operating at a level of arousal that is too high or too low and thus tend to have problems with behavior and attention.
Praxis / Dyspraxia
A dyspraxic child may also demonstrate:
A child’s difficulty with motor skills, or dyspraxia, may also impact their behavior, causing them to compensate with either becoming silly, overactive, or avoiding motor activities.
Sensory Integration and Praxis Test (SIPT)
Other assessments of sensory processing disorder include the Sensory Profile, the Sensory Processing Measure, and clinical observations. It is important to obtain an understanding of the child in his home and academic environments as not all children exhibit the same behavior in both. Therefore, as part of the evaluation process, parents and teachers may be asked to fill out a questionnaire on the child’s behavior in order to get the full “picture” of the child’s specific sensory processing strengths and weaknesses.
The treatment approach for children with sensory processing and/or motor disorders (dyspraxia) is to use fun, everyday activities and games which are motivating for the child. The activities focus on the use of motor activities while at the same time giving input to the senses of touch, movement and proprioception (stimulation to joints, tendons, and muscles that lets us know where our body is in relation to objects in the environment).
The treatment approach and activities used are based on testing results and an awareness of the child’s strengths and weaknesses. Through an evaluation process and parent feedback, the therapist identifies the child’s processing abilities, arousal level, sensitivities to sensory input and/or seeking of sensory input, behavior, attention and organization. Once the child’s sensory processing strengths and weaknesses have been identified and areas of behavior/attention concerns have been determined a treatment approach is developed and implemented. The treatment approach will include exploring various strategies of adding or removing sensory input along with using specific organizational strategies to find out what works best for the child. A “sensory diet” is often developed, specific to each child’s needs. This may involve “waking up” their system at certain times of the day, or “calming down” their system in order to bring them to an appropriate arousal level for better sensory processing.
A treatment session typically begins with motor activities which use the whole body and allow children to challenge themselves as they develop more confidence and awareness of their body during activities. This may involve swinging, jumping, climbing, creeping, sliding, crashing into mattresses, etc. The therapist continually observes the child’s reactions to the activities and their ability to do them, often modifying the activity as necessary in order to keep the child motivated and having fun as well as to avoid frustration and anxiety. The games become more interactive as the child begins to challenge himself, working toward higher levels of motor development and functional skills.
Following the use of large motor activities, as described above, the therapist and child work on more refined motor performance and organization skills. This may include handwriting programs, fine motor skills, such as puzzles, cutting, or buttoning, and organizational skills, social skills and improved behavioral responses.