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Eating an ice cream cone. Hanging on the monkey bars. Finger painting in art class. These are just some of the fun activities that kids engage in every day. But for children with sensory processing disorders (SPDs), even the simplest activities can offer big challenges. Sensory integration is the ability to use the senses to take in information, put it together with prior knowledge and memories, and create meaningful responses. Children who have sensory processing disorders, formerly called sensory integration disorder, don't put all the pieces together correctly, impacting their motor and/or behavioral output. An estimated 16% of children have sensory processing disorder1, which is often misdiagnosed as ADHD.
Neurologic Traffic Jam
The theory of sensory integration disorder was first put forth by A. Jean Ayers, PhD, an occupational therapists and neuroscientist. Ayers compared it to a neurologic traffic jam.2 Three sensory areas are commonly involved in sensory integration. The tactile system takes in information via touch. Children with tactile dysfunction are often picky eaters, refusing to eat certain foods because of the texture. They also withdraw from physical touch and avoid typical childhood pursuits that he or she conceives as "dirty," like playing in the sandbox. The vestibular system gives someone information on the position of their head in space. It also helps to control eye movements, keeping them synchronized and able to focus on and follow objects smoothly, as well as the ability to move the eyes separately from the head. Kids who are hypersensitive to vestibular stimulation are afraid of swings, slides and even walking up stairs. Hyposensitive kids, on the other hand, purposely seek out movement by running, jumping and crashing into things. The proprioceptive system gives people awareness of their body's position in space. It also allows for fine motor control. Children with proprioceptive dysfunctions have issues with posture and balance, and are often messy eaters. 3
Who's at risk for developing a sensory processing disorder? According to Rochelle G. Doctor, MA, OTR, SIPT Certified, co-owner of Artistic Quality Therapy Associates in New York City, children who were born prematurely, often have a tendency towards SPD. Many children (and adults) have "glitches in the wiring" of the nervous system, resulting in SPD. Ms. Doctor and other therapists ADVANCE spoke to also said children on the autism disorder spectrum have a high probability of having sensory integration problems.
Signs of a Sensory Processing Disorder
Issues like being a messy eater, a clumsy kid, a child who can't sit still and concentrate in school, or who is a control freak, can all be underlying signs of sensory processing disorders. Other symptoms include problems with fine motor skills, such as gripping pencils and fastening buttons. Many children with sensory processing disorder also have low muscle tone and trouble with coordination, as they can't tolerate movement in space. Children with SPD may have behavioral and emotional issues or learning difficulties. 
Susan Hill, OTR/L, occupational therapist, La Rabida Children's Hospital, Chicago painted a picture of a "typical" sensory integration disorder diagnosis: "You get a referral for a 'clumsy child.' The mother describes her 5-year-old son as always on the go, very strong and strong-willed. The school wants him tested. They're concerned that he not only seems to fall a lot, but he's very active and tends to get in fights at school. When you bring him in for testing he is very active, 'all over the place' as he explores the treatment space, appears disorganized in his movements and has a hard time following directions. You observe that he has mild weakness and a degree of joint instability."
Therapy can help these children better adapt to the world around them. In the clinic, there are various creative modalities and exercise that physical therapists and occupational therapists use to address sensory integration. Therapy for sensory processing disorders is highly personalized and depends on the child's age and the degree to which it affects their life.
Doctor begins by asking parents, "What's easiest part of the day and what's the hardest part of the day?" Can the child sit down in class? Does he push people away? Is she a picky eater? Do they cringe at loud noises? She then uses that info to narrow down where the child needs the most assistance. Along the same lines, Hill and Shirael Pollack, MSPT, director, Watch Me Grow in New York, both give their young patients a sensory profile to discover where they are on a spectrum. For example, Pollack will put them on a therapy swing and see if they can stabilize.
Teamwork in Therapy
Once a diagnosis has been made, therapists use different tools to help their young patients. "One of the best therapy tools is the team of therapists themselves. The therapy team at La Rabida consists of about 20 occupational therapists, physical therapists, speech language pathologists, developmental therapists and social workers who work who closely with one another to develop treatment strategies and support as the need arises," said Hill.
At La Rabida, sensory boxes filled with textured balls, brushes and vibrating devices help kids who have tactile sensitivities. A sand/water table and a bin of beans are also used to get patients exploring the sense of touch. These tools are also helpful in getting children to coordinate using both of their hands. Children explore their vestibular systems on therapy swings, which help with coordination and balance.
Other tools for vestibular and proprioceptive awareness inside the gym include balance boards, trampolines, therapy balls and bolsters. Patients who lack body awareness or who have low muscle tone are helped with weighted vests, which make them more aware of their body's position in space.
Pollack echoes Hill's sentiment about the importance of teamwork. "Working in a collaborative environment is very important," she said. The therapy gym offers physical therapy, occupational therapy and speech therapy. At Watch Me Grow, Pollack and the other therapists use suspended equipment and a zip line to assist patients who have vestibular challenges. A ball pit helps with sensory input and kids jump on trampolines to improve their proprioceptive awareness. Patients also focus on gross motor skills. Problems like the inability to climb stairs or catch and throw balls stem from impaired gross motor skills.
Fine Motor Study
On the other end of the spectrum, therapists must also pay attention to fine motor skills. Doctor, for example, works with kids who have problems with dressing themselves, so they get used to maneuvering buttons and zippers and the feel of clothing on their skin.
When dealing with a child with sensory processing disorders, "strategies need to be incorporated into all areas," remarked Pollack. Therapy does not begin and end at the clinic. The family's involvement is crucial in getting the patients on the path to recovery. A sensory diet is an important part of the therapy process. It "eases us into the day," said Doctor. "It's structured to give kids the sensory input they need to function on a day-to-day basis and process the stimuli form the environment. A child may press him or herself between couch cushions for tactile input or start the day with jumping jacks. Jumping on a trampoline is another way kids can get ready for the day. Doctor also suggested, "Look at their daily routines and see what can be adapted." Resistive activities, also known as "heavy work," such as pushing, pulling, lifting and carrying, are ideal for proprioceptive input. For instance, a child can push the grocery cart through the supermarket or pick up a heavy laundry basket.
Getting teachers on board with the sensory diet is another key ingredient, said the therapists ADVANCE spoke with. Often, children with sensory processing disorders will have trouble sitting through class. Therapists can give teachers ideas to help children self-regulate so their bodies are ready throughout the day. "If a child tends to fidget or get out of their seat at school, I may suggest that the child sit on an inflated, textured cushion which will allow for some movement," advised Hill. Another in-school idea is to have the student with SPD pass out papers, erase the blackboard or be involved with some sort of chore that is not disruptive to the rest of the class.
Sensory processing disorders are not just limited to children. "We all have some form of sensory processing disorders," said Hill. It's how we adapt that helps us become the people we are today." Adults will tailor their routines to compensate for undiagnosed SPD. For example, avoiding amusement parks because they don't like the rides can be a sign of vestibular dysfunction. Doctor noted that often when she's talking with a child about limitations, a parent will chime in and say, I can't do that either.
Although children diagnosed with a sensory processing disorder experience the world in a different light, therapy can help them manage the various stimuli they receive throughout the day and put them together to create a meaningful experience.
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Danielle Bullen is an Associate Editor at ADVANCE and can be reached at dbullen@advanceweb.com.
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