communication

Sensory Integration

Most of us unconsciously learn to combine our senses (sight, sound, smell, touch, taste, balance, body in space) in order to make sense of our environment. Children with autism have trouble learning to do this. Consequently, their play schemes are limited to the few habitual manners they use when interacting with the world.

Occupational therapists use sensory integration therapy to help a child with autism play like other children. Sensory integration therapy involves placing a child in a room specifically designed to stimulate and challenge all of the senses. During the session, the therapist works closely with the child to encourage movement within the room. Sensory integration therapy is driven by four key principles:

the child must be able to successfully meet the challenges that are presented through playful activities (Just Right Challenge)

the child adapts his/her behaviour with new and useful strategies in response to the challenges presented (Adaptive Response)

the child will want to participate because the activities are fun (Active Engagement)

the child's preferences are used to initiate therapeutic experiences within the session (Child Directed)

Sensory integration therapy is based on the assumption that the child is either over- or understimulated by the environment. Therefore, the aim of sensory integration therapy is to improve the ability of the brain to process sensory information so the child will function more adaptively in his/her daily activities.

A sensory integration room is designed to make the child want to run into it and play. During sensory integration therapy, the child interacts one-on-one with the occupational therapist and performs an activity that combines sensory input with motion. Examples of such activities include:

swinging in a hammock (movement through space)

dancing to music (sound)

playing in boxes filled with beans (touch)

crawling through tunnels (touch and movement through space)

hitting swinging balls (eye-hand coordination)

balancing on a beam (balance)

The child is guided through all of these activities in a way that is stimulating and challenging, so the focus is on integration of movement with the different senses.

A parent can integrate sensory integration into the home by providing many different opportunities for a child to move in different ways and feel different things. For example, a swing set can be a form of sensory integration therapy, as can a ball pit or a lambskin rug.

On a daily basis, most people experience events that stimulate more than one sense simultaneously. We use our multiple senses to take in this varied information, and combine it to give us a clear understanding of the world around us. We learn how to do this during childhood. Thus, through childhood experiences we gain the ability to use all of our senses together to plan a response to anything we notice in our environment. Children with autism are less capable of this kind of synthesis and therefore have trouble reacting to different stimuli and formulating more appropriate responses.

Children with autism have a difficult time listening when they are preoccupied with something. This is an example of their difficulty in receiving information via more than one sense simultaneously. Physicians who treat children with autism believe these difficulties are the result of a difference between the brains of children with autism and others.

The underlying concepts of sensory integration therapy are based on research in the areas of neuroscience, developmental psychology, occupational therapy, and education. Research suggests sensory information received from the environment is critical; interactions between the child and the environment shape the brain and influence learning. Furthermore, research suggests the brain can change in response to environmental input, and rich sensory experiences can stimulate change in the brain.

The effectiveness of sensory integration therapy is controversial and there are very few well-designed studies upon which to base a clear assessment of whether or not it works. Approximately half of the reports in scientific literature show some type of effectiveness with sensory integration therapy, and half show no benefits at all. Some researchers suggest that sensory integration therapy would be more useful for younger children than for older children. Some experts suggest that sensory integration therapy be discontinued if effects are not apparent during a specified time frame or if the child has a negative reaction.

Successful sensory integration therapy decreases sensitivities to touch and other stimuli. The result is that the children are better able to play, learn, and interact with people and surroundings.

While sensory integration therapy is not harmful, some forms of sensory therapy may be uncomfortable for the child. Children with autism can be especially sensitive to certain types of sensory stimulation; the therapist should respond appropriately to each child. Children should be closely monitored for any negative reactions or self-soothing behaviour.

True sensory integration therapy, however, should be child-directed, playful, and pleasant for the child.

References

Schaaf, R.C., and L.J. Miller. 2005. "Occupational therapy using a sensory integrative approach for children with developmental disabilities." Ment.Retard.Dev.Disabil.Res.Rev. 11(2):143-148.

Dempsey, I., and P. Foreman. 2001. "A Review of Educational Approaches for Individuals with Autism." International Journal of Disability, Development and Education v48 n1 p103-16 Mar 2001.

Baranek, G.T. 2002. "Efficacy of Sensory and Motor Interventions for Children with Autism." Journal of Autism and Developmental Disorders v32 n5 p397-422 Oct 2002.

Iarocci, G., and J. McDonald. 2006. "Sensory integration and the perceptual experience of persons with autism." J Autism Dev.Disord. 36(1):77-90.

Wallace, M.T., and B.E. Stein. 2006. "Early Experience Determines How the Senses Will Interact." J Neurophysiol.

Minshew, N.J., et al. 2004. "Underdevelopment of the postural control system in autism." Neurology. 63(11):2056-2061.

Waterhouse, L., et al. 1996. "Neurofunctional mechanisms in autism." Psychol.Rev. 103(3):457-489.

Boddaert, N., et al. 2004. "Superior temporal sulcus anatomical abnormalities in childhood autism: a voxel-based morphometry MRI study." Neuroimage. 23(1):364-369.

Dawson, G., and R. Watling. 2000. "Interventions to facilitate auditory, visual, and motor integration in autism: a review of the evidence." J Autism Dev.Disord. 30(5):415-421.

Ayres, A.J., and L.S. Tickle. 1980. "Hyper-responsivity to touch and vestibular stimuli as a predictor of positive response to sensory integration procedures by autistic children." Am.J Occup.Ther. 34(6):375-381.

Case-Smith, J., and H. Miller. 1999. "Occupational therapy with children with pervasive developmental disorders." Am.J Occup.Ther. 53(5):506-513.

By Lara Pullen, PhD. The information from this page was reprinted with permission from Healing Thresholds. "Copyright (c) 2007, Healing Thresholds, Inc. All rights reserved"