Sensory Integration Sensory Integration DysfunctionDysfunction

An overview of the dysfunction and its An overview of the dysfunction and its presentation in children ages two to fivepresentation in children ages two to five

By Joy Snider

Overview of Sensory Integration

A variety of processes involving the use of cognition and the sensory systems to interact with the world (Dietz, Watling, & White, 2001).

Basic types of functioning:ه Bilateral integration and sequencingه Motor planning (praxis)ه Somatosensory processingه Sensory input sensitivity

Bilateral integration and Bilateral integration and sequencingsequencing

Using the two sides of the body in separate, simultaneous movements

Performing actions in the appropriate order

Can you…Climb a ladder?Ride a bicycle?Run without tripping?

Praxis

Thinking about, planning, and carrying out motor activities

Can you…Decide to go for a walk?Plan the route you will take?Carry out your plans based only on your mental

picture of your activity?

Somatosensory processing

Gaining information about the positioning of one’s body in relation to the physical environment

Sensory information gained through the internal organs rather than the sensing organs

Developed through large movement, muscle resistance (such as swimming), and deep pressure, especially at the joints

Can you…Run or walk quickly without feeling disoriented?Jump from one stone to another without missing?Throw a ball with moderate accuracy?

Sensory input sensitivity

Comfortably experiencing and understanding input from the five senses

Can you…Understand what people say to you?Differentiate between different textures?Feel comfortable looking around a brightly-decorated

room?

ObservationsObservations

Abnormal sensory sensitivities is the least-researched area of sensory integration dysfunction

The purpose of these observations was to examine the behaviors associated with abnormal sensory sensitivity

Focus children were chosen based on knowledge of their sensory hypo- or hypersensitivity

Sensory hyper- and hyposensitivity HypersensitivityHypersensitivity—experiencing sensory input

too intensely, with a resulting inability to process the information effectively Bothered by sensory input that seems normal to

others May exhibit hyperactivity or irritability, or may

withdraw from the stimulus HyposensitivityHyposensitivity—experiencing sensory input at

a lower intensity than is needed Craves more intense sensory input May appear to have visual or hearing deficits

because of inability to process this information Both may occur at different times with the same

child

Observations were done at:

Subsidized child development center, Menifee, California

Summerhill Park, Lake Elsinore, California

Homes of two focus children in Murrieta, California and Temecula, California

CDC focus children

M, two years old, male, suspected autism, shows signs of tactile and auditory hypo- and hypersensitivities

D, three-and-a-half years old, male, suspected ADHD, shows signs of visual and tactile hypersensitivity and auditory hyposensitivity

Summerhill Park focus child

B, three-and-a-half years old, male, shows signs of tactile and gustatory hypersensitivity

Home study focus children

JA, five years old, female, shows signs of tactile hypersensitivity and auditory hypo- and hypersensitivity

J, two years old, female, shows signs of tactile and visual hypersensitivity

Each observation location also included normally-functioning children of the same ages as the focus children. Behaviors reported in this study can be assumed to have not been observed in these normally-functioning children.

Tactile sensitivity

All five focus children displayed tactile hypersensitivity.

JA was tickled on the cheek with a soft blanket, and spent the next two minutes rubbing the area firmly with her hand

B put his hand on a warm slide that other children were using comfortably, and jerked it away quickly, crying, “Hot!”

M went to teachers and sought out back rubs and light scratches

D caught a knobby rubber ball a few times, then dropped it and asked for a Band-Aid for his hands

J dipped one hand into a bowl of “ooblick” (cornstarch and water) and immediately tried to shake it off; when this didn’t work she yelled until her mother helped her wash it off

Auditory sensitivity

Three of the five children displayed auditory hyposensitivity, and two of those three also displayed auditory hypersensitivity

JA and D were both unresponsive when asked a question or given a direction; they responded when the caregiver made eye contact and spoke more slowly

M was unresponsive 3 out of 5 times when his name was called, and 4 out of 5 times when he was given instructions even with eye contact

All three children have had their hearing tested and have no problems in that regard

JA found herself near the CD player while dancing with some friends; her body stiffened and she covered her ears; she relaxed only after moving as far from the CD player as the room allowed

Children in M’s classroom were yelling and laughing loudly; he covered his ears, cried, and shook his head back and forth until a teacher put ear muffs on him

Visual sensitivityManifests itself both in discomfort to the

child, and in misbehavior

A small disco ball was brought into D’s classroom and his hyperactivity was substantially increased until the ball was turned off

J’s mother reported that the lights in the house are kept dim because J misbehaves more when they are on full power

D was shown a very colorful painting by one of his classmates; he winced and ran away from her

J’s brother handed her a multi-colored pinwheel; she held it at arm’s length and looked at it only out of the corner of her eye

Gustatory sensitivity

Displayed only by B

Given pudding for a snack; spit out his first spoonful and asked for a cracker instead; dipped his cracker in water before eating it

Parents report that he is difficult to feed at home as well because his tastes vary; he is not being picky, but truly cannot stand the taste of certain foods; the one constant is that he cannot stand any type of spice in his food

Unexpected findingsUnexpected findings

The purpose of the study was merely to observe the behaviors of children with abnormal sensory sensitivity

However, each of the children also displayed signs of somatosensory dysfunction

Somatosensory dysfunctionSomatosensory dysfunction

Deep massage can help to develop somatosensory

functioning Water provides resistance that stimulates deep muscle tissue

Sleeping times:ه JA lay down on her right side, with her left arm

straight up in the air; her mother reported that this is her usual behavior when going to sleep, relaxing, or bored

ه B’s parents reported that he cannot get to sleep without having his bottom patted firmly; without this treatment he will toss and turn for hours, but with it he falls asleep within minutes

JA and B are displaying somatosensory dysfunction in their need for grounding. Resting and times of boredom are two times in which a child with this area of SI dysfunction might feel the most physically detached from the world, and pressure through firm patting or holding a limb in the air helps to reaffirm one’s position in space

Dealing with disappointment and pain:ه M was headed towards a toy car when

another child took it; M fell to the floor screaming; a teacher picked him up and squeezed him tightly, and he soon stopped screaming; the teacher explained that M is prone to “meltdowns” and that squeezing is the best way of calming him

ه JA’s sister hit her with a toy, and JA ran to her mother for comfort; her mother took her hands, and LA locked her elbows and leaned in, putting a great amount of pressure on the joints; her mother explained that this is often how JA seeks comfort

M and JA are displaying somatosensory dysfunction in their need for help in regulating their emotional and physical reactions. When a child with somatosensory dysfunction gets upset he or she may feel more detached from the environment, and this disorientation results in a more pronounced emotional response. Deep pressure helps the child to regain control.

Discipline:ه J and D display nearly identical

behaviors Both children are told to do something theyھ

do not want to do, and begin to cry and attempt to hit their respective caregivers; both caregivers wrapped their child tightly—D’s teacher wrapped him in her arms and legs, and J’s mother wrapped her in several blankets—and then methodically squeezed their joints; both children screamed at the caregiver to let them go, but within one minute both children had stopped screaming and their bodies were relaxing

ه J’s mother and D’s teacher both reported that such incidents happen daily and that the wrap-and-squeeze technique always works

J and D are displaying somatosensory integration in the same way that JA and M displayed it when upset or in pain. Their anger at being disciplined leads them to lash out, and this reaction makes them feel even more detached. The tight pressure and squeezing of the joints helps to ground them and enables them to regulate their behavior and their emotions.

ConclusionsConclusions

No previous studies are available linking abnormal sensory sensitivity with any other area of SI dysfunction

This study cannot claim to have established a definite connection, but further research is in order, to investigate such a possibility

All pictures are borrowed from the internet; no photos were taken of the actual children in the study.

No child was included in the study, either as a focus child or as a normally-functioning child to use as contrast, without parental consent.