As a baby, Gracie was terrified of swings, her father, Andrew Dod, recalls. In fact, Gracie feared all sorts of toys that swung, spun, or swirled. On those rare occasions when she mustered the courage to mount a toy or swing, she'd scream until rescued. As she grew, Gracie walked unsurely, often clutching for the security of something solid. "A curb was like a cliff," says her father now. As a toddler, Gracie hated sand. At the beach, she wouldn't walk in it no matter how much she wanted to reach the ocean.
With preschool came full-blown anxiety attacks. "Bad feelings" were how she described these sessions, which she tried to rid herself of by shaking her arms and stomping her feet.
SID May Accompany Other Disorders
Gracie is one of the growing numbers of children diagnosed with sensory integration disorder (SID), a concept developed in the 1970s by the late A. Jean Ayres, PhD, a psychologist and occupational therapist who researched the issue of sensory processing and motor planning problems in children with mental retardation, primarily. Ayres' work led to the development of a specialized theory, known as sensory integration, that guides some occupational and physical therapy treatment used with children who often have diagnoses such as autism, Asperger's, developmental coordination disorder, learning disabilities, attention deficit hyperactive disorder, and others, says Christine Achenbach, MED, OTR/L, BCP, fieldwork coordinator and instructor in the Occupational Therapy Department at Elizabethtown College in Elizabethtown, Penn. But children can also have sensory integration issues without other diagnoses, says Achenbach.
Some of the signs of sensory integration disorder, according to Sensory Integration International, include:
- Extreme sensitivity (or underreaction) to touch, movement, sights, or sounds
- Social and/or emotional problems
- Activity level that is unusually high or unusually low
- Physical clumsiness or apparent carelessness
- Impulsivity, or lack of self-control
- Difficulty making transitions from one situation to another
- Inability to unwind or calm one's self
- Delays in speech, language, or motor skills
- Delays in academic achievement
If your child exhibits some of these symptoms, Achenbach advises that you consult your child's pediatrician and/or teachers who can arrange for an evaluation by an occupational or physical therapist trained in sensory integration disorder. The evaluation usually consists of both standardized testing and observations of responses to sensory stimulation, posture, balance, coordination, and eye movements.
For most of us, sensory integration occurs automatically. The brain registers sensory information, and then responds to that information with the appropriate response from the five senses, as well as from our sense of balance and forces of gravity, explains Achenbach ("I'm thirsty, so I'll get a glass of water," for example). Children with sensory integration disorder don't have the ability to make those connections, Achenbach says. They also may be exceptionally sensitive to external stimuli (or conversely, may appear to "shut down" when there is too much stimulation).
"We all have some sensitivities," says Achenbach, "but they typically do not preclude our participation in daily routine." Children with SID, however, who have heightened sensitivities, will live in fear, for example, that mom will unexpectedly turn on the vacuum cleaner, or that the doorbell will ring.
Some children with SID are on the other end of the spectrum, Achenbach adds, and appear not to register any sensory information. They may not respond when their name is called, might not recognize that a car is rushing toward them, may not respond to painful stimuli.
Standard Treatment Is Occupational Therapy
Treatment for SID usually consists of occupational therapy, which focuses on providing the child with different sensory experiences and helping him or her get used to those experiences, says occupational therapist Leann Mendelsohn of Silver Spring, Md. For children who have problems with balance, for example, therapy sessions may start off by having them roll on the floor, then move on to a therapy ball, then eventually even to the swings.
"By giving a child with SID these sensory experiences, they'll learn what they feel like and how to adjust to them," says Mendelsohn. "It's about learning to strike a balance between sensory input and integration of that input."
Treatment for SID often looks like play therapy, says Marie Mancini, clinical supervisor of occupational therapy at Children's Therapy Center in Oakville, Conn. In therapy sessions, which generally last from three to six months, the occupational therapist will work with the child in an effort to elicit "adaptive responses" -- making eye contact, for example, or finding objects in a sandbox.
Occupational therapy for SID works best when it's reinforced at school and in the home, says Mancini, who is also SIPT-certified (sensory integration and praxis testing).
"Children with sensory integration disorder will always have some level of difficulty," says Mancini, "but with therapy, they learn ways to compensate."
Gracie Dod is proof of that, says her father. Now 11 years old and in the sixth grade, Gracie's struggles continue but occupational therapy, vision and listening therapy, counseling, and "endless familial support" have "tempered Gracie's challenges," says her father.
Published Aug. 23, 2004.