ERIC Identifier: ED478564
Publication Date: 2003-05-00
Author: DiMatties, Marie E. - Sammons, Jennifer H.
ERIC Clearinghouse on Disabilities and Gifted Education Arlington VA.
Understanding Sensory Integration. ERIC Digest.
Michael is a third grade student who is waiting for the school bus. He is
challenged by sensory experiences during everyday activities that most of us
don't even think about. While he's still reeling from the battle with mom over
brushing his teeth (that peppermint toothpaste tastes like fire in his mouth)
the school bus pulls up. Michael runs past the bus monitor's haze of perfume and
sits at the back of the bus. In his heightened state, he becomes even more aware
of his new school shirt with its stiff label and that awful feeling like a wire
brush being poked into the back of his neck. The sensory experiences of the
movement of the bus, the sound of his excited classmates laughing and yelling
above the roar of the bus engine all contribute to his increased agitation. By
the time Michael arrives at school he is wound up and ready to unravel. There is
no time to wait for the bus monitor's direction...getting off the bus quickly
becomes a matter of survival and he resorts to pushing, shoving and finally
kicking his way out. Unfortunately, there is a price to pay for this seemingly
outward aggression...he can expect another trip to the principal's office.
This digest defines sensory integration and sensory integration dysfunction
(DSI). It outlines evaluation of DSI, treatment approaches and implications for
parents and teachers, including compensatory strategies for minimizing the
impact of DSI on a child's life.
WHAT IS SENSORY INTEGRATION?
Sensory Integration is a
theory developed more than 20 years ago by A. Jean Ayres, an occupational
therapist with advanced training in neuroscience and educational psychology
(Bundy & Murray, 2002). Ayres (1972) defines sensory integration as "the
neurological process that organizes sensation from one's own body and from the
environment and makes it possible to use the body effectively within the
environment" (p. 11). The theory is used to explain the relationship between the
brain and behavior and explains why individuals respond in a certain way to
sensory input and how it affects behavior. The five main senses are:
* Touch - tactile
* Sound - auditory
* Sight - visual
* Taste - gustatory
* Smell - olfactory
In addition, there are two other powerful senses:
vestibular (movement and balance sense)-provides information about where the
head and body are in space and in relation to the earth's surface.
proprioception (joint/muscle sense)-provides information about where body parts
are and what they are doing.
WHAT IS SENSORY INTEGRATION DYSFUNCTION (DSI)?
in sensory integration is the "inability to modulate, discriminate, coordinate
or organize sensation adaptively" (Lane et al., 2000, p. 2).
How efficiently we process sensory information affects our ability to:
discriminate sensory information to obtain precise information from the body and
the environment in order to physically interact with people and objects. An
accurate body scheme is necessary for motor planning, i.e., being able to plan
unfamiliar movements. It involves having the idea of what to do, sequencing the
required movements, and executing the movements in a well-timed, coordinated
Michael frequently bumps into others and drops items on the way to class
because of his poor body scheme. He often hands in crumpled assignments that
reflect the challenges of holding a pencil in his hand and making precise
movements to achieve legible handwriting. Concentrating on his school work
intensely may lead him to fall off his chair. To most people, Michael appears to
be a sloppy, clumsy, and forgetful child.
In gym class, Michael cannot master jumping jacks, somersaults make him feel
sick, and he has given up on ever being able to connect with a baseball. His
timing was always off. He resorts to being the class clown to cover up for his
difficulties. Michael certainly doesn't feel good about himself. He can't do
what other kids seem to do so effortlessly-and then there is the teasing...
modulate sensory information to adjust to the circumstances and maintain optimum
arousal for the task at hand. Sensory modulation is the "capacity to regulate
and organize the degree, intensity and nature of responses to sensory input in a
graded and adaptive manner" (Miller & Lane, 2000).
Sensory defensiveness, a type of sensory modulation problem, is defined by
Wilbarger and Wilbarger (1991) as "a constellation of symptoms related to
aversive or defensive reactions to non-noxious stimuli across one or more
sensory systems" (Wilbarger & Wilbarger, 2002a, p. 335) It can affect
changes in the state of alertness, emotional tone, and stress (Wilbarger &
Michael demonstrates many symptoms of sensory defensiveness, which affect his
attention, learning, and behavior. His teacher's instructions get lost in
competition with a clock ticking, the echo of peers walking and talking in the
hall. He is off task and he finds solace in humming or chewing on the end of his
pencil, sensory seeking behaviors that help ease the discomfort. Fortunately, he
has gym class before lunch. Running bases in gym class gives him a legitimate
opportunity for the "heavy work" that his body needs. It sure makes him feel
better and prepares him for the biggest challenge of all- eating lunch in the
HOW IS DSI IDENTIFIED?
DSI is identified through evaluation
by an occupational therapist who has advanced training in sensory integration,
using one or more of the following practices:
* Gathering information about the child's performance in daily life tasks
within the context of the classroom, school, and/or home environment.
* Skilled observation of the child: the therapist sets up a play environment
and observes the child's responses to different types of sensory input and motor
* Parent/caregiver sensory questionnaires /standardized checklists, e.g.,
Sensory Profile (Dunn, 1999), non-standardized checklists.
* Parent/caregiver interview: the therapist identifies specific functional
problems related to problems with sensory processing.
* Standardized tests of general development and motor functioning, e.g.,
Sensory Integration and Praxis Test Battery (SIPT) (Ayres, 1989).
* Clinical observations of posture, coordination, etc.
INTERVENTION FOR DSI
Fostering the child's participation in
normal everyday childhood activities or "occupations" is the main goal of
occupational therapy. Intervention starts when teachers and parents are taught
about DSI and intervention so they can develop strategies that help with
adaptation or compensation for dysfunction (Bundy & Koomar, 2002). Based on
information gathered, the therapist collaborates with teachers and parents to
design an intervention plan to address the child's sensory integration problems.
INTERVENTIONS BASED ON SENSORY INTEGRATION THEORY
consultation aims to educate teachers, parents, and older children about sensory
integration and to develop strategies to adapt to and compensate for dysfunction
* environmental modifications
* adaptations to daily routines
* changes in how people interact with the child (Wilbarger & Wilbarger,
Examples are reducing distracting visual materials in the classroom, giving
the child an alternative to a messy art activity, or refraining from wearing
perfume or bright, floral clothing.
A sensory diet is a strategy that consists of a carefully planned practical
program of specific sensory activities that is scheduled according to each
child's individual needs. Like a diet designed to meet an individual's
nutritional needs, a sensory diet consists of specific elements designed to meet
the child's sensory integration needs. The sensory diet is based on the notion
that controlled sensory input can affect one's functional abilities (Wilbarger
& Wilbarger, 2002b). A sensory diet can help maintain an age appropriate
level of attention for optimal function to reduce sensory defensiveness.
Wilbarger & Wilbarger's (200b) comprehensive approach to treating sensory
defensiveness includes education and awareness, a sensory diet, and other
professional treatment techniques. One such technique is the Wilbarger Protocol,
which uses deep pressure to certain parts of the body followed by proprioception
in the form of joint compressions. It is critical that this protocol is not used
in isolation and that it is initiated and monitored by an appropriately trained
The "How Does Your Engine Run?" Program (Williams & Shellenberger, 1994)
is a step-by-step method that teaches children simple changes to their daily
routine (such as a brisk walk, jumping on a trampoline prior to doing their
homework, listening to calming music) that will help them self-regulate or keep
their engine running "just right." Through the use of charts, worksheets, and
activities, the child is guided in improving awareness and using self-regulation
TRADITIONAL SENSORY INTEGRATIVE THERAPY
integrative therapy takes place on a 1:1 basis in a room with suspended
equipment for varying movement and sensory experiences. The goal of therapy is
not to teach skills, but to follow the child's lead and artfully select and
modify activities according to the child's responses. The activities afford a
variety of opportunities to experience tactile, vestibular, and proprioceptive
input in a way that provides the "just right" challenge for the child to promote
increasingly more complex adaptive responses to environmental challenges. The
result is improved performance of skills that relate to life roles, e.g.,
player, student, (Schaaf & Anzalone, 2001). This type of intervention may be
used along with other treatment approaches.
DSI can have a profound effect on a child's
participation in everyday childhood "occupations," including play, study and
family activities. Collaboration between the therapist, teacher, and parent is
the most efficient way to understand the child's behavior and unique sensory
needs. Together, they can implement strategies to support the child's
performance in roles and occupations across multiple environments.
Ayres, A. J. (1972). Sensory integration and
learning disorders. Los Angeles: Western Psychological Services.
Ayres, A. J. (
1989). Sensory integration and praxis tests. Los Angeles: Western Psychological
Bundy, A. C., Lane, S. J., & Murray, E. A. (2002) Sensory integration:
Theory and practice. Philadelphia: F. A. Davis.
Dunn, W. (1999). Sensory Profile. San Antonio: Psychological Corporation.
Kranowitz, C. S. (1998). The out of sync child. New York: The Berkley
Lane, S. J., Miller, L. J., & Hanft, B. E. (2000). Towards a consensus in
terminology in sensory integration theory and practice: Part 2: Sensory
integration patterns of function and dysfunction. Sensory Integration Special
Interest Section, 23(2), 1-3.
Miller, L. J. & Lane, S. J. (2000). Towards a consensus in terminology in
sensory integration theory and practice: Part 1: Taxonomy of Neurophysiological
Processes. Sensory Integration Special Interest Section, 23(1), 1-4.
Quirk, N. J. & DiMatties, M. E. (1990). The relationship of learning
problems and classroom performance to sensory integration. Haddonfield, NJ:
Author. Available: www.amazon.com.
Wilbarger P. & Wilbarger, J. (1991). Sensory defensiveness in children
aged 2-12: An intervention guide for parents and other caregivers. Denver, CO:
Avanti Educational Programs.
Williams, M. S., & Shellenberger, S. (1994). How Does Your Engine Run?
Albuquerque: Therapy Works.
Sensory Integration Resource Center - provides links to Internet resources
and research about Sensory Integration Dysfunction (DSI) for parents, educators,
occupational therapists and physicians. Available: http://www.sinetwork.org/%20%20%20