Sensory Integration Therapy
Sensory processing occurs in each of us and refers to the way our central nervous system receives sensory messages from the environment and our body, processes those messages, and turns them into “adaptive” motor or behavioral responses. The term “adaptive” means our ability to respond appropriately (adaptively) to some change that occurs within our bodies or in the environment around us. For example, we perceive that we are hungry and respond “adaptively” by getting something to eat. Or, we hear a loud alarm in the school building and respond “adaptively” by quickly and calmly leaving the building. The successful completion of any daily task and our controlled emotional responses depend on our ability to efficiently process incoming sensory information.
What is SPD (Sensory Processing Disorder)?
Sensory Processing Disorder (SPD) occurs when sensory input is not perceived by an individual, is not interpreted correctly, or is not organized into adaptive responses. One may be defensive or fearful of certain sensory input, be relatively unresponsive to certain sensory input, have significant postural or coordination issues, seek unusual amounts of sensory input, or struggle discriminating between subtle differences in sensory input. It is important to note that many of us have sensory preferences or difficulty at times processing sensory information.
This is not indicative of a sensory processing disorder. Only when children, adolescents or adults experience symptoms that are chronic, occur in clusters, and impact day-to-day function do we then consider the possibility of SPD. And, while you may have the occasional bad day, true SPD often results in persistent motor incoordination, behavioral problems, social and relationship difficulties, anxiety, depression, challenges performing simple daily tasks at school or work, or other significant disruptions to daily life.
What Causes SPD?
Researchers at the STAR Institute for Sensory Processing Disorder and their colleagues with the SPD Scientific Work Group are working hard to answer this very question. Dr. Lucy Jane Miller, occupational therapist, research scientist, teacher, and founder of the STAR Institute for Sensory Processing Disorder, explains some of the current research behind the possible causes of SPD in her book titled Sensational Kids, Hope and Help for Children with Sensory Processing Disorder. Some studies indicate a hereditary component to SPD, but there is also evidence for prenatal, birth and environmental influences. It is likely that a combination of these factors causes SPD, but only continued research will discover the degree to which each plays a part.
The first step to treating SPD is recognizing when it exists. Many children and adults are misdiagnosed or improperly treated. Sometimes SPD is associated with other diagnoses that are easy to see such as autism or other developmental disorders. Sometimes, however, children or adults with SPD may not have a concurrent diagnosis and appear typically developing, but don’t always move or behave typically. Their sensory processing disorder may manifest itself via subtle motor incoordination or social, behavioral or emotional difficulties. They may fail at school, struggle in a marriage, suffer from anxiety, or seem out of control. Their “disability” isn’t obvious. Parents often get blamed for not parenting correctly and families and friendships fracture under the stress of it all. Others with SPD can be very high functioning or high achieving, but still struggle with daily life.
At Pediatric Therapies, our occupational therapists design and implement very individualized intervention programs based on components central to the STAR Model, including a focus on regulation, relationship, and sensory integration therapy. Whether we are treating a child or an adult, the goal of our intervention is to facilitate “adaptive” responding to typical sensory input through fun, meaningful and relationship-rich activity. What is “meaningful” to one child or adult may not be to another, necessitating that each session be completely individualized. We are always promoting that “just right challenge” so our clients are accomplishing new skills and experiencing success at it.
An intentional and essential element of our programming also includes parent/family involvement and education. Our joy is seeing children and families generalizing new-found skills and realizing the extraordinary possibilities that await them beyond our clinic walls! Armed with knowledge about SPD and confident in your ability to help yourself and/or your child, you become equipped to build and support a sensory lifestyle, as Dr. Miller calls it; a new way of living and responding. You no longer avoid, miss out on, compulsively seek, misinterpret, become confused by, or simply react to sensory input, but instead learn to live a joy-filled life in a sensory-filled world!
Making Sense of the Senses
We are all familiar with the 5 senses (or sensory systems) we learned about in grade school (vision, hearing, taste, smell and touch), but therapists familiar with SPD are interested in more than just those senses. You actually have 8 senses! Each of these senses makes it possible for us to process the unique type of sensory information they are specialized for. They are better called “systems” because it is not just your eyeball that sees or your nose that smells, but rather a complex interaction involving those body parts, neurological pathways, and the brain. Our 8 senses, or sensory systems, are:
- Visual System – This is the sensory system we use for processing visual (sight) information.
- Auditory System – This is the sensory system we use for processing auditory (hearing) information.
- Gustatory System – This is the sensory system we use for processing taste information.
- Olfactory System – This is the sensory system we use for processing smell information.
- Tactile System – This is the sensory system we use for processing tactile (touch) information and it has a role in our interpretation of pressure, temperature and pain as well. It is often a culprit in SPD and is one of the most important systems, as therapists, we use in sensory integration therapy.
- Vestibular System – This is the sensory system we use for processing movement information and information about gravity acting on our bodies and the position of our head. It also plays a role in our ability to balance and determine where we are in space. The receptors of this system are the semicircular canals and otoliths, which are located in both inner ears. Together, these structures help us detect both rotary and linear movement. Because of its vast connections to other parts of the brain, the vestibular system influences many things such as coordinated head and eye movements, posture, balance, reflex integration, and other bodily functions. It, too, along with the tactile system, is an important cornerstone of sensory integration therapy.
- Proprioceptive System – This is the sensory system we use to sense how our muscles and joints are moving and where we are in space. It also gives us information about how hard or soft our muscles need to work in order to successfully complete a task. Receptors for this system are located in our muscles and joints. We use this information in combination with vestibular input to move with coordination, fluency, and accuracy. Use of proprioception is perhaps the most important of these last three sensory systems (tactile, vestibular and proprioceptive) when implementing a sensory integrative approach to the treatment of SPD.
- Interoception – Interoception is our internal sense of what is happening within our organs and body. These sensations include things like our ability to detect when we’re hungry, tired, have to use the bathroom, or are cold. It helps our bodies regulate things such as heart rate, respiration, and temperature. There are many types of interoceptors depending on the internal function. For example, you have chemical receptors that monitor salt levels and prompt you to drink when you become thirsty. There are pressure-sensitive receptors in your bladder that let you know when it’s time to use the bathroom. Researchers are even exploring the connection between our body’s internal state and our emotions, cognitive functions, and sense of self. Interoception is an important sensory ability and often plays a role in individuals with SPD.
Dr. Lucy Jane Miller, in her book Sensational Kids, Hope and Help for Children with Sensory Processing Disorder, describes 3 basic patterns of Sensory Processing Disorder, each with their own subtypes. It not unusual to demonstrate characteristics common to more than one pattern or subtype, or to have more than one sensory system involved. In fact, this is more the norm than not, allowing for a multitude of possible profiles. Symptoms among different individuals vary greatly as can the severity and impact on daily function. This makes careful diagnosis critical and more importantly, individual treatment planning essential.
Pattern 1: Sensory Modulation Disorder
Sensory Over-Responsive (SOR)
Individuals with sensory over-responsiveness respond too quickly, too intensely, and for too long a duration to sensory input that most of us find tolerable. They over-respond or react “defensively” to sensation (sometimes referred to as sensory defensiveness), often with a fight or flight response – e.g. react aggressively to being touched, cover their ears to avoid sound, become overly emotionally reactive in even minor sensory situations, etc.
Sensory Under-Responsive (SUR)
Individuals with sensory under-responsiveness don’t react, take longer to react, or require a higher intensity of sensory input before they react than most people. They are often quiet, seem unaware of their environment, and can be difficult to engage in relationships or activities. If their tactile and vestibular systems are involved, they may demonstrate uncoordinated motor movements and postural difficulties. If interoception is involved, they may have difficulty potty training or detecting pain or temperature differences.
Sensory Craving (SC)
Sensory cravers have an insatiable need for sensory input and often seek it in less than optimal ways and at less than optimal times. They are described as always “on the go” and often have difficulty judging personal space. They crash, bump, run, jump, touch everything, play rough with their friends, talk all the time, can be overly affectionate, and are often disorganized and dysregulated. This particular subtype is often mistaken for Attention Deficit/Hyperactivity Disorder.
Pattern 2: Sensory-based Motor Disorder
Dyspraxia occurs when individuals have difficulty forming an idea about what they want to do (ideation), sequencing the series of steps it takes to get it done, and/or executing those steps efficiently. Dyspraxia is most notable when attempting novel motor tasks, as previously learned skills don’t easily generalize into new accomplishments. For example, even though an individual may be able to walk up and down stairs, they may not easily generalize that skill into climbing a ladder. Like postural disorder, it is often the vestibular, proprioceptive and tactile senses that are the problem. These individuals tend to be uncoordinated, accident-prone, and disorganized. They can break toys because they can’t figure out how they work and they often prefer more sedentary activities because they can’t exert the motor skills needed to successfully complete large motor tasks.
Like dyspraxia, the vestibular, proprioceptive and tactile senses influence problems here. Individuals with postural difficulties struggle with stabilizing their body while moving – e.g. fall over when squatting to pick up a toy, or fall out of a chair while reaching for their pencil. They may even have challenges at rest – e.g. difficulty maintaining a sustained standing position. These individuals frequently have low muscle tone, poor control of their bodies, and are often unsafe.
Pattern 3: Sensory Discrimination Disorder
Sensory discrimination is our ability to accurately perceive, attach meaning to, and determine similarities and differences between varying input. It is our ability to interpret very specific qualities of sensory input – e.g. is that a “p” or a “q”, did you say “tag” or “tap”, is that a spider crawling on my arm or my shirt sleeve, etc.? When we don’t have this ability to discriminate well, our movements can be awkward, our interactions with others confusing, and our response to sensory input can be slowed as we attempt to “figure it out”. We can have difficulty in any sensory system:
- Visual: Difficulty perceiving or interpreting visual information (e.g. is that a “p” or a “q”?)
- Auditory: Difficulty perceiving or interpreting auditory information (e.g. did I hear “tag” or “tap”?
- Gustatory: Difficulty perceiving or interpreting taste information (e.g. is that food too spicy or just right?)
- Olfactory: Difficulty perceiving or interpreting smell information (e.g. not perceiving the smell of a skunk)
- Tactile: Difficulty perceiving or interpreting touch information (e.g. is that a quarter or a dime in my pocket?)
- Vestibular: Difficulty perceiving or interpreting movement information (e.g. am I moving forward or backward?)
- Proprioceptive: Difficulty perceiving or interpreting positioning of muscles and joints information (e.g. do I need a lot or a little force to open that screen door?)
- Interoception: Difficulty perceiving or interpreting internal body sensations (e.g. am I full and need to stop eating?)
Our team of expertly trained occupational therapists are eager to help you and/or your child understand SPD and get the answers you seek! For more information on Sensory Processing Disorder, please visit the STAR Institute for Sensory Processing Disorder website at www.spdstar.org.
Request Sensory Integration Therapy Information
If you are interested in learning more about sensory integration therapy you can request information or if you would like to speak with someone we welcome your questions by phone at 615-377-1623.