Sensory integration refers to the neurological process whereby the Central Nervous System organises and uses information received through our senses so that we can respond appropriately to the different situations we find ourselves in on a daily basis. In order to function effectively, our brain needs to integrate or connect information received through sight, sound, smell, touch, taste and movement in order to create a reliable picture of the world around us. By integrating all the information we receive, we are able to assign meaning to our daily experiences and thereby learn how to respond and behave appropriately. For most people this process occurs automatically. For instance, when sitting in class we are able to listen to the teacher talking in front of the class, maintain an upright posture in the chair we are seated in, use our fingers to press down on a pencil to write on paper, use our sight to see what she has written on the black board as well as screen out all other information that we don’t need to execute the task correctly, without even being aware that our brain is doing all that.
Our brains are constantly focussing, screening, sorting and responding to sensory information not only from the external environment but from our internal environment (info from our bodies) as well. Therefore, the information we need to gather through our senses in order to function effectively are not only limited to that related to sound, smell, sight, and touch but also includes information we receive about the physical status of our bodies. Information from the vestibular system relates to that which we receive through balance and movement, and provides us with information regarding the position of our head in relation to gravity and movement. For example, when sliding down a slide, our vestibular system tells us that we are moving downwards and therefore changing our position in space. Our proprioceptive sense, or more specifically, the information we receive through the movement of our muscles and joints provides us with an internal awareness of the position of our joints and muscles in relation to space. This helps us to plan and coordinate our movements, for example, coordinating our movements to enable us to lift a spoon and place it in our mouths without spilling.
When sensory integration becomes a problem:
When the process of sensory integration is disrupted, information about the world is processed ineffectively which results in an inconsistent and therefore, unreliable picture of the world around us. Sensory information is experienced as something unreliable, inconsistent, or threatening which affects the way we respond to this information, often resulting in inappropriate or inconsistent behaviour.
Children with sensory integration difficulties respond to sensory input in different ways. Some children might be overly sensitive to sensory information, for example, being constantly aware of clothes against their skin or always covering their ears when hearing a siren. In such cases, children can become fearful of certain stimulations or situations and try to avoid certain activities and/or demonstrate distress when forced to perform certain tasks. Others might be under-responsive to sensory information and almost appear not to notice sensory input, for example, not responding when their name is called or not noticing when they have minor injuries like a cut or bruise. In addition, some children with sensory integration difficulties might also actively seek out excessive amounts of sensory stimulation, touching everything in sight or constantly craving movement and not being able to sit still. This can negatively impact their ability to focus and sustain their concentration over a period of time. It rarely occurs that a child experiences difficulty in processing information from only one sensory system and it is possible that they might be over sensitive to information from one sensory system while being under-responsive to another. These difficulties might vary from day to day as well as between different contexts.
First Signs:
- It is important to note that therapists do not randomly select children to assess.
- These children are sent for assessment and treatment because other people have noticed a problem of some kind.
- The frontline people in this regard are teachers and parents. Therefore the whole system depends on these first-responders.
- A child is usually also not diagnosed on the basis of one presenting problem, but rather a composition of observations, over time, by multiple observers who becomes increasingly aware of the presenting behaviour and problems.
- A lot of times these concerns regarding the child repeats over several years until someone gets concerned or frustrated enough to refer the child.
- There are some typical observations that leads to the diagnosis
Parent Observations
- It is important to remember that no one knows a child better than his/her parent.
- They have their nagging concerns and keeps hearing and seeing the same things in terms of the child’s behaviour.
- They are also at the end of receiving the wrap of the child’s frustrations.
- Very few parents would schedule an assessment or appointment if there is not an issue.
- However, it is not to say that the parent is also correct in what the problem is or who the appropriate service provider might be.
Teachers’ Observation
- The value of teachers in identifying the child’s difficulties is sometimes overlooked.
- They are however invaluable due to various reasons:
- They spend the most time with the child, second to the parent.
- They have contact with other children of the same age and developmental stage to from a framework of a “typical” child in this population. They can therefore identify the children who are different from the rest of the class.
- If the report cards of the child would be placed in consecutive order, a pattern of the same comments over the years might be picked up. Usually this pattern reaffirms that the difficulty lies with the particular child, rather than the child/teacher match.
Common pitfalls
- No child wakes up in the morning and decides “today I am going to give all the adults in my life grief.”
- The common pitfalls are all red flags for misinterpreting the child’s behaviours.
- Here is some of the common pitfalls:
- The child is lazy – Laziness is not listed as a possible diagnosis. It might be however that the child gives up the efforts to succeed due to multiple failures.
- The child does not care – Disorganisation is a key component of ADHD and executive dysfunction.
- The child only does what he/she is interested in – It is general knowledge that any person does better in the aspects that he/she is interested in. The question rather asked must be “why does this child struggle to do a task unless he is totally interested?”
- The child will do better if he/she is just more interested – It is probably the other way around. A child who is a poor reader would rather avoid reading than perceiving herself as getting worse at it.
- The child is inconsistent. I have seen him being able to complete the task or engage in the appropriate behaviour – Just because the child was able to succeed occasionally does not mean it can be held against him forever!
- The child is just a social butterfly – It is a general phenomenon for boys to be labelled as “hyper” and girls to be labelled as “” Inattentive ADHD (especially with girls) is harder to identify than ADHD with hyperactivity-impulsivity.
- There is no problem with the child, but rather with the teacher/parent
How to help your child to cope with sensory integration difficulties:
- The standard treatment for sensory integration difficulties is Occupational Therapy, with a specific focus on providing the child with different sensory experiences and helping them to get use to those experiences. Therapy is most effective when skills taught are practised and reinforced at home.
- Interventions such as the Tomatis and Interactive Metronome can promote sensory integration
- Do not force your child to participate in activities when they show distress. Remember that their reaction is based on what their brain is telling them and that it is not under their control.
- When demonstrating signs of distress, stop the activity immediately and find something calming for your child, for example wrapping them in a blanket or slowly rocking a rocking chair or swing.
- Keep to specific routines and schedules, especially for more challenging times, for instance getting ready for school. Discuss anticipated changes or transitions beforehand with your child and try to avoid surprises or disruptions to the routine as much as possible.
- Try to eliminate or limit possible distractions in your child’s work space. Provide your child with sufficient space and guidance to complete tasks at their own pace.
- When your child demonstrates inappropriate or challenging behaviour, refrain from reacting emotionally as this might only increase sensory overload and worsen the situation. Rather find a quite space for a time-out where they can calm themselves and regain self-control. Discipline provides structure and establishes limits that make your child feel safe. Tell your child why you are disciplining him or her and what the consequences are, and remain consistent in your methods and reasons.
- Teach your child to become aware of the their body’s physiological response to certain sensations or situations as well as the appropriate way to deal with it before it becomes overwhelming, such as doing a breathing exercise when they start feeling anxious or moving around for a short while when craving movement interferes with their ability to concentrate.
- Allow your child to take sensory breaks in between tasks such as rocking a chair, jumping on a mini trampoline or sucking on candy to provide with the stimulation they might crave.
- Stimulation seeking children might benefit from chewing on gum or sitting on a inflated seat cushion or pillow while working
Sensory Integration difficulties can impact all aspects of our daily functioning, including development, learning and academic achievement, social interactions as well as behavioural and emotional responses. The Tomatis Method improves social interaction through reorganising the way that the ear responds to auditory information, clarifying sound, creating multisensory pathways and improving communication. The method consists of a 13 day listening program which is completed at home. Preceding the program, a pre listening test is conducted to establish baseline results. Following one month after the completion of the program, a post listening test is done in order to establish the improvements made.
Interactive Metronome training encourages synchronous communication between the different sensory networks in the brain, encouraging and reinforcing the integration of information from the different senses. At the ADD Lab, clients have the option of either coming in to the practice for IM sessions or clients can purchase a home device which enables the client to perform exercises at home at their own convenience. We would be happy to assist in answering any questions regarding these interventions as well as in making a booking.