Motor Skills

Understanding Sensory Integrative Dysfunction
by Linda C. Stephens, OTR/L

Some children might be labeled “lazy, stubborn, shy or headstrong” when sensory integrative problems are the real culprit. Identifying the underlying causes of these behaviors can be a vital step toward helping children reach their fullest potential.

All of us depend on the integration of our senses to carry out daily tasks in work, play and self-maintenance. Sensory integration disorders can greatly influence our ability to function but also can be so subtle that they easily go unrecognized. Particularly in young children, it is easy to attribute behaviors and reactions to other causes (“He doesn’t want to do it,” or “She’s spoiled.”) or to consider it within the norms of the wide range of personality and developmental characteristics. Identifying and addressing sensory integrative dysfunction is important, however, to enable children to function at their best and to minimize disruption in family life.

What is Sensory Integration?
Sensory integration is the ability to take in information through senses (touch, movement, smell, taste, vision and hearing), to put it together with prior information, memories and knowledge stored in the brain and to make a meaningful response. Sensory integration occurs in the central nervous system and is generally thought to take place in the mid-brain and brainstem, portions of the brain responsible for such things as coordination, attention, arousal levels, autonomic functioning, emotions, memory and higher-level cognitive functions.

A. Jean Ayres, Ph.D., was an occupational therapist who first researched and described the theories and frame of reference we now call sensory integration. In her book, Sensory Integration and the Child, Ayres makes several analogies that describe sensory integration and its dysfunction. One analogy compares the brain to a large city with traffic consisting of the neural impulses. She writes: “Good sensory processing enables all the impulses to flow easily and reach their destination quickly. Sensory integrative dysfunction is a sort of `traffic jam’ in the brain. Some bits of sensory information get `tied up in traffic,’ and certain parts of the brain do not get the sensory information they need to do their jobs.”

Various characteristics of sensory integrative dysfunction include attention and regulatory problems, sensory defensiveness, specific activity patterns and troubling behaviors.

Attention and Regulatory Problems
The level of attention to a task depends on the ability to screen out, or inhibit, nonessential sensory information, background noises or visual information. Children with sensory integrative dysfunction frequently respond to or register sensory information without this screening ability. Often, they’re considered distractible, hyperactive or uninhibited. These children are always “on the alert” and constantly asking about or focusing on sensory input that others ignore (refrigerator motor, heater fan, distant airplane, etc.). Other children fail to register unique sensory input and are unresponsive. For example, children might not turn around or respond when their names are called. One parent said that her child was oblivious and unresponsive to a loud noise in the same room but immediately responded when he heard a piece of candy being unwrapped two rooms away.

Children with regulatory disorders often have difficulty establishing appropriate sleeping and eating patterns, are unable to calm or console themselves and might overreact to environmental stimuli.

Sensory Defensiveness
Sensory defensiveness is a sensory integrative disorder characterized by a “fight, flight, or fright” reaction to sensory information most individuals would consider harmless. In the 1960s, Ayres identified this as tactile defensiveness or hyper-responsiveness to touch. Since that time researchers have recognized defensiveness in other sensory areas as well. The individual who has sensory defensiveness typically has a highly aroused nervous system that prepares the body for survival but does not recognize that the input is nonthreatening.

Behaviors associated with tactile defensiveness are aggressiveness, avoidance, withdrawal and intolerance of daily routines. Combing or shampooing hair, cutting fingernails or brushing teeth can be exhausting and difficult for families of children who react defensively with acting out behaviors or tantrums. Other children cope by being rigid and demanding, insisting on certain textures of clothing, cutting all tags and labels out of clothing or displaying extremely limited choices of food because of intolerance to textures. Social skills can be limited if the child withdraws or picks fights as a result of unexpected touch.

Auditory defensiveness can occur with negative responses or fears related to sounds and noises. Some children are so fearful of sounds such as vacuum cleaners, lawn mowers, hair dryers, leaf blowers or sirens that parents must arrange to use appliances when the child is out of earshot. Other children might show an intolerance of sounds and noises by cupping their hands over their ears. One child I knew could not tolerate the sound of a flushing toilet, while another covered his ears when his preschool class had music.

Visual defensiveness can occur with hypersensitivity to light or avoidance of eye contact. Oral-motor defensiveness (tactile defensiveness within the mouth) can cause distress with brushing teeth and dentist visits as well as intolerance to textures or temperatures of food. Children with olfactory defensiveness (intolerance to odors) might gag or be distressed with certain smells that other people don’t notice or don’t mind. One child I know could not tolerate going into a deli with his mother because the odors made him feel sick.

Vestibular defensiveness can result in intolerance to movement or unstable surfaces with fearfulness, avoidance or motion sickness. The child might be afraid to go down steps or to ride an escalator.

Activity Levels
Children are, by nature, active. We expect the toddler to be “into things” and the preschooler to be curious, to explore and to play vigorously. We don’t expect the young child to have a long attention span. Characteristics that indicate problems in one child might be perfectly normal in a younger child. Here are some warning signals related to activity levels:

1. The child is disorganized and lacks purpose in his or her activity. Even though the child might appear to be interested in a toy or object initially, once he gets it he might throw it aside, dump it out of the container or immediately be distracted by something else. On the playground the child might run around a lot but does not organize his activity to climb, swing or explore equipment.

2. The child does not move around or explore the environment. This is the “good” baby or toddler who is content to stay in one place and does not make many demands on his caretakers. The older child might use good verbal skills to engage the adult in conversation as a way of avoiding manipulating with his hands or actively engaging in activity.

3. The child lacks variety in play activities. Some children become repetitive or stereotypic in playing with toys. For example, children might line up toy cars but do not pretend they are going places or experiment with rolling them down an incline.

4. The child appears clumsy, trips easily or has poor balance.

5. The child has difficulty calming himself after exciting physical activity or after becoming upset.

6. The child seeks excessive amounts of vigorous sensory input. Many children like to jump, swing and spin. When the activity is excessive, however, it could indicate a problem.

Troubling Behaviors
Sensory integrative dysfunction can adversely affect many areas of a child’s development, including emotional and social. Many children become discouraged or develop a poor self-concept, especially if they become aware of differences between their function and those of their peers. If a young child has difficulty with motor skills and play activities, it could be hard for him to make friends or to be part of a group. Sensory defensiveness can cause aggressive behaviors or cause the child to be a loner.

Sometimes behavior problems are the first indications that the child might have sensory integrative dysfunction. The child might lack flexibility, be explosive or have difficulty with transitions such as leaving one place to go to another. The child might show extreme irritability or crying that seems unexplainable until it is discovered that he is fearful of certain sounds, overwhelmed by visual stimuli or is intolerant to wrinkles in his socks. Sometimes children are so rigid in their behaviors that families go to extremes to accommodate them in order to maintain peace. The mother who follows the child around with a spoonful of food, begging him to eat, or the parents who allow children to sleep with them in their bed because they won’t go to sleep otherwise might be taking care of the short-term problems without addressing underlying issues.

Sensory integrative problems manifest themselves in a number of ways. Any particular child might show only a few of the characteristics described, and some characteristics could be caused by something other than sensory integrative dysfunction. Parents and professionals should look at the pattern of behaviors and the “big picture” of how the problems interfere with the child’s play, physical and emotional development and ability to develop independence. Any child who is suspected of having a sensory integrative disorder should be evaluated by a professional, usually an occupational or a physical therapist, who has had additional training in sensory integration evaluation and treatment.

Linda C. Stephens, OTR/L, is an occupational therapist and the owner of Atlanta Children’s Therapy in Dunwoody. She can be reached at 770-451-7220 or through her Web site at www.brimer.net/act.