What is Sensory Integration?
Our senses give us information about our body as well as the world around us. Sensory information flows into the brain at every moment, and the brain has to organise it so that we can move, learn and interact with others. This process of organisation gives meaning to what we have experienced by sifting through all the incoming information and selecting what to focus on. Adequate sensory integration forms the underlying foundation for academic learning and social behaviour – it forms the building blocks for the development of sensory motor, perceptual and cognitive development.
The brain has to locate, sort, and order sensations coming in from the world just like a traffic officer directs moving cars. When sensations flow into the brain in an integrated manner, the brain can use these sensations to guide learning, behaviour and motor skills. When the flow is disorganised…life can feel like a rush hour traffic jam. The information doesn’t get to their destination, and the brain cannot function the way it is supposed to.
There are five common senses that most people are aware of: touch, taste, hearing, vision and smell. But there are 3 hidden senses that the brain also detects. One is the body position sense, called proprioception. This is the sensation that comes from our muscles and joints that tell us where our body parts are in space, and the direction and force of our movements.
The other is the sense of movement and gravity that comes from our vestibular system and is detected by the sense organs in the inner ear. This tells the brain the body’s position in relation to gravity. It is key contributor to balance and coordination. The last sense is our perception of sensations from inside the body and includes the feeling of our heart beat, our breathing, hunger/fullness, and need to go to toilet. This is known as interoception.
The process of sensory integration ‘puts it all together’ by taking information from our eyes, nose, mouth, skin, muscles and joints to form the whole experience.
For example, when we eat an orange, our brain has to integrate information from our eyes so we can see its shape and colour. As we touch the orange, we experience the rough texture on the outside and the moistness inside from the information from our hands and fingers. By integrating the smell and information from our nose, we know that the orange has a citrus odour. All this information blends together to form the whole experience of eating an orange.
The development of sensory integration
Sensory integration starts in the womb, where the fetus begins to sense the movement and touch of their mother. After birth, the baby is able to hear, see and smell the world around them. Further sensory integration occurs as the child learns to crawl, stand and walk. Childhood play leads to more sensory integration. By interacting with many things in the world and adapting their body and brain to physical challenges, the child learns to organise the sensations from their body and gravity, along with the sights and sounds around them. That is why play is so important to children – it forms the foundations for their physical, academic, social and emotional development.
“The sensory integration that occurs when moving, talking and playing is the groundwork for more complex sensory integration that is necessary for reading, writing and good behaviour” (Ayres, 2005).
Sensory processing forms the foundations and building blocks for all other skills. If there is a problem at this lower level of sensory integration – you can expect there to be developmental gaps and weaknesses in the higher learning areas. This is why, as Occupational Therapists working with young children, we look at sensory processing first in the assessment stage – because it will have an impact on all other areas of development.
What happens when sensory information is not integrated efficiently?
No one organises sensations perfectly. Some people are better than others at integrating sensory information. People like dancers and gymnasts develop very good integration of the body and gravity sensations so that their movements are smooth and graceful. Other people just have average sensory integration. The problem comes in when poor sensory integration starts to interfere with many aspects of the child’s life. They are unable to cope with the ordinary demands and expectations placed on them at home or at school.
What causes poor sensory integration?
There is no simple answer to this question. There are many theories and correlations to what causes poor sensory integration, but no clear cause has been found.
Some possible causes are:
- Premature birth
- Birth trauma (e.g. lack of oxygen)
- Heavy metals
It is important to keep in mind that the founder of sensory integration, Jean Ayres believed that sensory integration dysfunction is not as a result of neurological damage, but rather a problem in the central processing of information within the child’s brain. The problem is in the brains ability to process sensory information – that is why sensory integration therapy can help to rewire and strengthen the signals and organisation of sensations within the child’s brain.
Sensory Processing Disorder
Children who are unable to process and use the sensory information they receive are diagnosed with sensory processing disorder. The dysfunction can occur within a specific sensory system, or within many systems. There are 2 ’types’ of sensory processing disorders: Sensory Modulation Disorders and Sensory Discrimination Disorders. Within each type, there are various other dysfunctions.
Sensory Modulation Disorder: Sensory Sensitivity
Sensory modulation is the process whereby the brain takes in information and tells us what we need to attend to, and what we can ignore. When a person is well regulated, they can organise and prioritise incoming sensory information to focus on what is relevant and what is irrelevant.
Imagine if we were aware of all the sensory information coming in from the world at every moment of our day – we wouldn’t be able to allocate attention and maintain an optimal level of arousal. Life would be very overwhelming! If a child has a very small or limited tolerance to sensory input, we say that they have a low threshold for sensory input. Their brain needs much less sensory input than the average child in order to stay calm, regulated and attentive to the world around them. This is known as SENSORY SENSITIVITY. If you think of a glass of water, this child needs very little ‘water’ before they are full and have had enough.
In a busy, noisy and unpredictable environment, these children go into fight-flight mode. Sounds, smells, bright lights or the feeling of clothing on their body seem to bother them and cause them distress. They have frequent meltdowns because their nervous system is on high alert and they are often stressed. They also really struggle to pay attention and focus at school.
Other signs and behaviours to help identify children with sensory sensitivities:
- Easily distracted by visual stimulation
- Seems overly sensitive to sounds, or is easily distracted by lots of noise or background noise
- Avoids getting hands messy at the art tables or on the playground
- Is distressed when having to wear specific clothing items (jersey, socks/shoes, jeans)
- Seems more sensitive to pain than others
- Cannot manage transitions to different environments
- Fearful of heights on the playground equipment (on the swing, slide or bicycles) or avoids the playground area
- Extremely fussy eater with regards to textures
- Easily overwhelmed and anxious in busy group tasks such as birthday parties, concerts or shopping centres
- Often labelled as the ‘fussy’ child
Sensory Modulation Disorder: Sensory Seeking
Children at the other end of the spectrum of sensory modulation disorders are SENSORY SEEKERS. They have a high threshold for sensory information and need more stimulation in order to register, stay alert and maintain an optimal level of arousal. If you consider the analogy of the glass of water, these children need a lot of ‘water’ in their glass before they are full and their thirst is quenched. These are the children that move around a lot, fidget, hum to themselves, seek touch, and ‘crash and bash’.
Other signs and behaviours to help identify children who are sensory seeking:
- Often seems overly active, fidgety and restless when sitting or standing in one position
- Moves in and out of the chair while working
- Frequently puts fingers, clothing or objects in mouth
- Hum to themselves
- Seek touch and cannot keep their hands to themselves
- Hyperactive and easily distracted
Sensory Discrimination Disorder
Sensory discrimination disorder is quite different to sensory modulation disorder, but just as important for development and sensory integration. Sensory discrimination is the ability to interpret and differentiate between spatial and temporal qualities of sensory information. The brain tells us specific and refined information about the sensory input we receive. For example, when searching for car keys in a handbag, the tactile system sends specific information to the brain about what the hands and fingers are feeling. Once the brain recognises and identifies the exact shape and details of the car keys, it will alert the person that they have found their keys.
The importance of accurate sensory discrimination is that it combines all the information from your auditory, visual, tactile, movement and proprioceptive system to form the development of body awareness in space, motor planning, coordination, and visual perception. This also has to be done incredibly quickly and efficiently so that we can adjust our body to the world around us. Isn’t the brain just amazing!
Signs and behaviours to help identify children with sensory discrimination disorder:
- Delayed motor milestones: crawling, standing and walking
- Clumsy and accident prone (often bumps into objects and furniture)
- Trouble learning new motor skills such as cutting with scissors, riding a bicycle or tying shoe laces
- Weak in physical activities, sports and ball games
- Struggles to climb, balance and navigate their bodies on the playground equipment
- Does not play as skilfully as others and often breaks toys
- Slow to process what they hear in order to following instructions
- Often asks, “what is that sound?” because they cannot discriminate different noises that sound similar
- Difficulty with fine motor tasks such as colouring, cutting, writing and drawing
How can we help?
Early Identification and Intervention
If you are concerned that your child may have a sensory processing disorder, it is best to speak to an Occupational Therapist trained in sensory integration. Early identification and referral to occupational therapy for assessment and intervention is key to helping these children.
Sensory Integration Therapy
Once the child has been evaluated by an Occupational Therapist trained in sensory integration, treatment takes place in a fully equipped sensory gym. Sensory integration therapy gives the child opportunities for sensory-rich experiences and adaptive responses that help organise the child’s brain. It rewires and strengthens the communication between the brain and body. The therapist exposes the child to sensory input through repetitive activities in the sensory gym. They gradually make activities more challenging and complex to build the child’s self-confidence and skills. The idea is that through repetition, the child’s nervous system will respond in a more organised way to sensations and movement. When the therapist is doing their job effectively and the child is integrating sensory input accurately, it looks as if they are merely playing.
Collaboration with the Parent and Teacher
Because Occupational Therapists often only see the child once or twice a week for therapy, it is important to include the parents and teachers in the intervention process.
- The therapist will work with parents and teachers to create specific sensory-rich activities to do throughout the day that are tailored to the child’s sensory needs. This is known as a sensory diet. Teachers play an important role in making the classroom a calm and happy place for a child with sensory processing disorder by implementing these sensory strategies to help the child interact and participate with their peers.
- Awareness of the child’s sensory profile is key to understanding their behaviour and helping them manage the world around them. The more a parent and teacher can learn about sensory processing and how it impacts the child specifically, the more they can respond to them appropriately.
- Parents can also help by making changes and adaptions at home. For example, the Occupational Therapist may suggest creating a quiet space with reduced visual and auditory input at home or buying tools such as weighted blankets, fidget toys or chewable toys to help with self-regulation.
- Raising happy children: The key to a calm connected child (Lizanne du Plessis)
- Sensory Integration and the Child (Jean Ayres)
- The out of sync child: Recognising and coping with sensory processing disorder (Carol Kranowitz)
Website and Blogs
- Sensory strategies to aid in concentration: http://successcentre.co.za/2022/02/18/sensory-strategies-to-enhance-your-childs-concentration/
- Sensory Intelligence: https://sensoryintelligence.com/
- Understanding sensory issues: https://www.youtube.com/watch?v=4-jqtlwfw5M
- Sensory Processing Disorder: https://www.theotpractice.co.uk/how-we-help/conditions/sensory-processing-disorder
- Sensory Integration: Is Lack of Sensory Integration behind My Child’s Poor Academic Performance? https://ilslearningcorner.com/2016-10-sensory-integration-is-lack-of-sensory-integration-behind-poor-academic-performance/
- What is a sensory diet: http://www.developmentalpathways.com/what-is-a-sensory-diet
- Autism resources: https://www.autismresources.co.za/