Sensory Integration Dysfunction (SID, also called sensory processing disorder) is often described by Occupational Therapists as a neurological disorder causing difficulties with processing information from the five senses (vision, auditory, touch, olfaction, and taste), the sense of movement (vestibular system), and/or the positional sense (proprioception). For those with SID, sensory information is sensed, but perceived abnormally. Unlike blindness or deafness, sensory information is received by people with SID; the difference is that information is processed by the brain in an unusual way that may cause distress or confusion.
SID is not a diagnosis, but it can be linked to conditions, including autism spectrum disorders, attention deficit disorder, dyslexia, Developmental Dyspraxia, Tourette syndrome, multiple sclerosis, and speech delays, among many others. It is considered a ‘soft sign’ of neurological dysfunction that does not require treatment.
Unfortunately, diagnosis is increasing by developmental pediatricians, pediatric neurologists, and child psychologists. There are no plans to include it in future editions of the American Psychiatric Association’s Diagnostic and Statistical Manual as a discrete diagnosis, Regulatory-Sensory Processing Disorder is an accepted diagnosis in Stanley Greenspan’s Diagnostic Manual for Infancy and Early Childhood and the Zero to Three’s Diagnostic Classification.
There are now three types of Sensory Processing Dysfunction, as classified by Stanley I. Greenspan as supported by the research of Lucy J. Miller, Ph.D., OTR. These new terms are meant to increase understanding between Occupational Therapists and other professionals who frequently encounter SID and physicians and other health professionals who approach sensory integration dysfunction from a more neurobiological vantage.
This understanding is critical as physicians are responsible for diagnosing SPD, which is a necessary step in accessing reimbursement (eventually from insurance companies) for professional services to treat SPD.
Sensory Processing Dysfunction is being used as a global umbrella term that includes all forms of this disorder, including three primary diagnostic groups:
- Type I – Sensory Modulation Disorder
- Type II – Sensory Based Motor Disorder
- Type III – Sensory Discrimination Disorder
Type I – Sensory Modulation Disorder (SMD). Over, or under responding to sensory stimuli or seeking sensory stimulation. This group may include a fearful and/or anxious pattern, negative and/or stubborn behaviors, self-absorbed behaviors that are difficult to engage or creative or actively seeking sensation.
Type II – Sensory Based Motor Disorder (SBMD). Shows motor output that is disorganized as a result of incorrect processing of sensory information.
Type III – Sensory Discrimination Disorder (SDD). Sensory discrimination or postural control challenges and/or dyspraxia seen in inattentiveness, disorganization, poor school performance.
This information is adapted from research and publications by: Lucy, J. Miller, Ph.D., OTR, Marie Anzalone, Sc.D., OTR, Sharon A. Cermak, Ed.D., OTR/L, Shelly J. ,Lane, Ph.D, OTR, Beth Osten, M.S,m OTR/L, Serena Wieder, Ph.D., Stanley I. Greenspan, M.D..
All different types of SPD are diagnosed by a questionnaire.
Sensory modulation refers to a complex central nervous system process by which neural messages that convey information about the intensity, frequency, duration, complexity, and novelty of sensory stimuli are adjusted.
Behaviorally, this is manifested in the tendency to generate responses that are appropriately graded in relation to incoming sensations, neither underreacting nor overreacting to them.
 Sensory Modulation Problems
- Sensory registration problems – This refers to the process by which the central nervous system attends to stimuli. This usually involves an orienting response. Sensory registration problems are characterized by failure to notice stimuli that ordinarily are salient to most people.
- Sensory defensiveness – A condition characterized by over-responsivity in one or more systems.
- Gravitational insecurity – A sensory modulation condition in which there is a tendency to react negatively and fearfully to movement experiences, particularly those involving a change in head position and movement backward or upward through space.
Hyposensitivities and hypersensitivities
Sensory integration disorders vary between individuals in their characteristics and intensity. Some people are so mildly afflicted, the disorder is barely noticeable, while others are so impaired they have trouble with daily functioning.
Children can be born hypersensitive or hyposensitive to varying degrees and may have trouble in one sensory modality, a few, or all of them. Hypersensitivity is also known as sensory defensiveness. Examples of hypersensitivity include feeling pain from clothing rubbing against skin, an inability to tolerate normal lighting in a room, a dislike of being touched (especially light touch) and discomfort when one looks directly into the eyes of another person.
Hyposensitivity is characterized by an unusually high tolerance for environmental stimuli. A child with hyposensitivity might appear restless and seek sensory stimulation.
In treating sensory dysfunctions, a “just right” challenge is used: giving the child just the right amount of challenge to motivate him and stimulate changes in the way the system processes sensory information but not so much as to make him shut down or go into sensory overload.
The “just right” challenge is absent if the activity and the child’s perception of activity do not match. In addition, deep pressure is often calming for children who have sensory dysfunctions. It is recommended that therapists use a variety of tactile materials, a quiet, subdued voice, and slow, linear movements, tailoring the approach to the child’s unique sensory needs.
While occupational therapy sessions focus on increasing a child’s ability to tolerate a variety of sensory experiences, both the activities and environment should be assessed for a “just right” fit with the child. Overwhelming environmental stimuli such as flickering fluorescent lighting and bothersome clothing tags should be eliminated whenever possible to increase the child’s comfort and ability to engage productively. Meanwhile, the occupational therapist and parents should jointly create a “sensory diet,” a term coined by occupational therapist Anna Jean Ayres.
The sensory diet is a schedule of daily activities that gives the child the sensory fuel his body needs to get into an organized state and stay there. According to SI theory, rather than just relying on individual treatment sessions, ensuring that a carefully designed program of sensory input throughout the day is implemented at home and at school can create profound, lasting changes in the child’s nervous system.
Parents can help their child by realizing that play is an important part of their child’s development. Therapy involves working with an occupational therapist and the child will engage in activities that provide vestibular, proprioceptive and tactile stimulation. Therapy is individualized to meet the child’s specific needs for development. Emphasis is put on automatic sensory processes in the course of a goal-directed activity. The children are engaged in therapy as play which may include activities such as: finger painting, using Play-Doh type modeling clay, swinging, playing in bins of rice or water, climbing, etc.
Relation to other disorders
Autism spectrum disorders
Unusual responses to sensory stimuli are more common and prominent in autistic children, though there is no good evidence that sensory symptoms differentiate autism from other developmental disorders.Differences are greater for under-responsivity (for example, walking into things) than for over-responsivity (for example, distress from loud noises) or for seeking (for example, rhythmic movements). The responses may be more common in children: a pair of studies found that autistic children had impaired tactile perception while autistic adults did not.
Some argue that sensory related disorders may be misdiagnosed as Attention-Deficit/Hyperactivity Disorder (ADHD) but they can coexist, as well as emotional problems, aggressiveness and speech-related disorders such as apraxia. Sensory processing, they argue, is foundational, like the roots of a tree, and gives rise to a myriad of behaviors and symptoms such as hyperactivity and speech delay.
For example, a child with an under-responsive vestibular system may need extra input to his “motion sensor” in order to achieve a state of quiet alertness; to get this input, the child might fidget or run around, appearing ostensibly to be hyperactive, when in fact, he suffers from a sensory related disorder
Researchers have described a treatable inherited sensory overstimulation disorder that meets diagnostic criteria for both attention deficit disorder and sensory integration dysfunction
Sensory integration therapy
Several therapies have been developed to treat SID.Some of these treatments (for example, sensorimotor handling) have a questionable rationale and no empirical evidence. Other treatments (for example, prism lenses, physical exercise, and auditory integration training) have had studies with small positive outcomes, but few conclusions can be made about them due to methodological problems with the studies. Although replicable treatments have been described and valid outcome measures are known, gaps exist in knowledge related to sensory integration dysfunction and therapy. Empirical support is limited, therefore systematic evaluation is needed if these interventions are used.
The main form of sensory integration therapy is a type of occupational therapy that places 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 provide a level of sensory stimulation that the child can cope with, and encourage movement within the room. Sensory integration therapy is driven by four main principles:
- Just Right Challenge (the child must be able to successfully meet the challenges that are presented through playful activities)
- Adaptive Response (the child adapts his behavior with new and useful strategies in response to the challenges presented)
- Active Engagement (the child will want to participate because the activities are fun)
- Child Directed (the child’s preferences are used to initiate therapeutic experiences within the session).
Children with lower sensitivity (hyposensitivity) may be exposed to strong sensations such as stroking with a brush, vibrations or rubbing. Play may involve a range of materials to stimulate the senses such as play dough or finger painting.
Children with heightened sensitivity (hypersensitivity) may be exposed to peaceful activities including quiet music and gentle rocking in a softly lit room. Treats and rewards may be used to encourage children to tolerate activities they would normally avoid.
While occupational therapists using a sensory integration frame of reference work on increasing a child’s ability to tolerate and integrate sensory input, other OTs may focus on environmental accommodations that parents and school staff can use to enhance the child’s function at home, school, and in the community (Biel and Peske, 2005). These may include selecting soft, tag-free clothing, avoiding fluorescent lighting, and providing ear plugs for “emergency” use (such as for fire drills).Some occupational therapists also treat adults with this condition.
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- Rogers SJ, Ozonoff S (2005). “Annotation: what do we know about sensory dysfunction in autism? A critical review of the empirical evidence”. J Child Psychol Psychiatry 46 (12): 1255–68. doi:10.1111/j.1469-7610.2005.01431.x. PMID 16313426.
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- Ben-Sasson A, Hen L, Fluss R, Cermak SA, Engel-Yeger B, Gal E (2008). “A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders”. J Autism Dev Disord. doi:10.1007/s10803-008-0593-3. PMID 18512135.
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