What are Sensory Integration Problems?
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We have a high energy four year old, Marcus. He’s definitely a handful, but we always thought his behavior was “all boy”. Last week his pre-school teacher who knows him (and loves him!) has asked us if we have ever thought of having him “evaluated” for “sensory processing”. She says that compared to other kids his age he has more trouble settling down and that he can’t always do some of the fine motor tasks that other kids his age can do. We don’t know if she’s being over cautious and we’re not sure what she is talking about. Should we be worried?
I don’t know whether you need to be worried, but I will say that a pre-school teacher who loves your child is someone whose observations should be given weight. At the same time, you may want to begin by learning more about what she is noticing so that you can decide on the next best steps. Why don’t you ask her to make a list of the specific behaviors she sees that seem different from other boys his age (it is true that boys this age are often more active and “wild” than most girls). Then compare what she tells you to what you see at home and in other settings. That way, you can begin looking at what influences affect Marcus’s behavior. It’s important to pay attention to what helps him do well in each setting, not just what causes problems!
Pre-school teachers iare often very tuned in to how children respond to different types of sensory input. Children who have variability in their ability to process sensory stimulation can, at times, have difficulty in some situations. We don’t want to evaluate, label or diagnose children unnecessarily, but we do want to help kids who may need a little extra consideration as we plan for their busy days at school and at home. So here’s a brief explanation of sensory processing that will help you understand what the teacher is saying to you.
Your Child and “Sensory Processing”
Everyone learns and acts by using their senses: vision, hearing, touch, balance, spatial awareness. We don’t notice how we combine sensations, we just do it. Imagine yourself driving a car: You look all around with special attention to what is directly ahead; you listen for unusual noises such as sirens while ignoring ordinary sounds of traffic; you feel your hands on the wheel and your foot on the gas and know how much to turn or press down to get the car to do what you want, you judge space and movement to decide when to merge lanes. All of this happens at the same time, and most of us don’t think about it, even though it probably took us awhile to integrate all these sensations into our actions.
Sensory processing (sometimes called sensory integration) is the neurological process of organizing the information we get from our bodies and from the world around us for use in daily life. Some sensory processing occurs developmentally, that is, it becomes easier as out brains mature (that’s one reason we don’t teach an 8 or 12 year old to drive!) Young children gradually develop the ability to organize sensation. However, some children have more difficulty than others processing and organizing sensations. They have behaviors that are not common for other children their age. A child with difficulties in sensory processing may overreact or underreact to sensory stimulation and behave inappropriately in situations where other children the same age can behave well. The phrase “Out-of-Sync” has been used to describe this condition in which a child is not responding in an ordinary way to ordinary sensations.
Most children with sensory processing difficulties are healthy and bright and have competent parents. Their behavior may seem mysterious to adults. These children must struggle to tolerate ordinary sensations, to plan, organize and predict their actions, and to regulate their attention and activity levels. They are too young to understand their own behavior and they cannot learn to manage it well unless the adults around them learn about how to help them.
Although some children will have so many difficulties in their behavior that they should be evaluated at a very young age and get special treatment, many children have very mild symptoms in only a few areas and the issue of sensory processing may not even be considered. Parents often figure out how to begin helping a child on their own and see great improvement. They learn to modify the environment and expectations to help their child succeed. The first steps always begin at home, since parents are the ones who see the child in many situations and are often far more aware of the range of behaviors that others see only sporadically.
These are the areas to think about in understanding your child’s responses to sensation.
HYPO and HYPERSENSITIVITY:A child can be undersensitive (hypo) or oversensitive(hyper) or a combination of the two. Fatigue and hunger will worsen any child’s ability to process sensation, but the hyposensitive child may not feel hungry or tired until he’s starving or exhausted.
MOVEMENT: A child who is hyposensitive will seek more stimulation in this area. Running, climbing, swinging, rocking—all will be present, and can be nonstop. The child may be a risk-taker because of the need to push himself. “Daredevil” behavior is common. However, the child may be able to sit and focus very well, so the perception of “hyperactivity” as in ADHD doesn’t fit. The hypersensitive child may be bothered by any activity that requires a lot of movement or gross motor skills—he may get very anxious about being in a situation where other children are jumping, running and climbing happily.
TOUCH: The hyposensitive child may be unaware of pain, temperature, or how an object feels, and may seek more stimulation by chewing, tasting or rubbing an object. He may overstuff his mouth while eating and then gag on his food. He may want to touch and manipulate everything he sees. He may love wrestling and tickling and seek out these activities even when inappropriate. A child may have both over and under reactions, or he may be different on different days. (Since all young children learn by touch and handling more than by listening or watching, this characteristic may be developmental.)
A child who is hypersensitive may be unable to handle touch from others and may be upset by feeling certain textures of clothing or food. Labels on clothing, tight shoes or heavy jackets may upset him. Pain may cause dramatic reactions and lead to fears or phobias. The child may be extremely resistant to hair or face washing and may shrink from hugs or tickling.
PROPRIOCEPTION: This is the ability to perceive one’s own position--the unconscious sensation of body movement necessary to balance, walk through a group of people, avoid bumping into walls and furniture. This can apply to large and small motor activities. A child with difficulty in this area may bump into objects or people, break toys with rough handling, throw objects too hard, or be unable to master the twisting or stacking of small objects. He may be awkward or clumsy. The child may kick or stomp to figure out where he is in relation to furniture and floors. Manipulating objects may be difficult because the feedback for the right amount of pressure to use doesn’t register.
VISION: A child may be hyposensitive and need to touch objects to supplement his sight, even though vision tests fine. The hypersensitive child will be distracted or bothered by light, may not like bright colors, and may avoid looking at people’s faces or making eye contact. An overly sensitive child may need a completely dark room to be able to sleep.
SMELL/TASTE: If hyposensitive, the child will be unaware of bad odors may not be fussy about the taste of most food (although textures can still be a problem). He may crave certain tastes, sweet and salty, especially, to get the stimulation he seeks. If hypersensitive, the child will notice differences in foods and may be extremely discriminating and fussy about what he will or won’t eat.
SOUNDS: If hyposensitive, he will seek out loud noises. If hypersensitive, he will be bothered by loud noises and may be distracted or avoid noise that others don’t notice at all. He may put his hands over his ears and cry when he doesn’t like certain music or the noise of a crowd.
SELF-REGULATION: A child may be unable to calm himself once he is aroused. Other children may be able to get excited and wild and then return to quiet behavior, but a child with difficulty in this area will keep going. He doesn’t appear to be defiant or trying to test limits—he just can’t stop unless an adult helps him calm down.
These sensory problems, because they are confusing and unpredictable, will often lead to parents and teachers reacting to the child as if the behavior was intentional and the primary response may occur after the misbehavior. Since the child can’t predict or control his behavior without help BEFORE the situation occurs, the child and adults will be frustrated and probably angry. Because of this pattern, the child with these sensory issues may be seen as having psychological problems or Attention Deficit Disorder, Parents may be labeled as poor disciplinarians, “unable to control their child”.
There are many ways to help children who have difficulty processing sensations. The first step for parents is to observe their child in a variety of settings and to notice when their child is doing well. What is happening then? Most parents will begin to see a relationship between environmental situations and the kind of behavior they want to encourage and discourage. Those observations point the way for the next steps.
Many, many children will be helped by a combination of a modified environment, planning and preparing for challenging situations, and learning self-soothing skills. If the area of sensory difficulty is small and parents and teachers tune in to these issues, these children will develop good coping skills and do very well. If a child’s sensory issues are more complex, it will help to have an evaluation by an Occupational Therapist who has training in Sensory Processing Disorders.
Treatment, whether home and school based or with the assistance of an Occupational Therapist, helps the child process all the senses so they can work together. Treatment helps the child balance and integrate the “near senses”: the vestibular sense (inner ear) which processes information on movement, gravity, and balance; the tactile sense (skin) which processes touch; and the proprioceptive sense (muscles, joints) which process information about body position and body parts and the “far senses” smell, taste, touch, sight, and sound.
Many of the treatment activities are simply fun, and parents will enjoy helping their child with them. Activities such as water play, drawing in sand, playdough, finger paints, making music, bubble blowing, gentle petting of stuffed animals or pets, swaddling dolls or being swaddled, back rubs, playing going up and down stairs, pushing and pulling manipulating small toys and objects, moving through obstacle courses, playground games, balloon games, clapping and tapping –and of course, these are all good activities for any child.
If any of these descriptions sound like your child, you may want to read the excellent book, The Out-of-Sync Child: Recognizing and Coping with Sensory Integration Dysfunction, by Carol Stock Kranowitz. If Marcus’s teacher hasn’t read the book, get her a copy. The book describes children who have somewhat complex sensory issues, but many parents will find the descriptions very familiar even if their own child’s behavior is less pronounced. A companion book, The Out-of-Sync-Child Has Fun, is also worth reading for more practical ideas. Try some of the suggestions, all of which are worthwhile for every child, and see if the approach works for your child. Then if you think it would be helpful to go further, ask the teacher and your child’s pediatrician for suggestions about the best places to have Marcus evaluated by an Occupational Therapist.