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Issues encountered in  Children with Autism related to dysfunction in Sensory Integration

Most of the children of Autism have Sensory Integration (SI) issues which come in between their ability to learn and respond to environment appropriately.  Some of the problems related to SI dysfunction are Hyperactivity, oversensitivity to touch/ smell/ sound, being scared of moving equipments / scare to climb down stairs, poor eye contact, they also has lack of awareness about own body or about the surrounding and kind of  lost in own word, motor mannerism, poor imitation skills, lack of appropriate play behavior etc.  Children might show this behavior which are not just behavior but it has sensory and neurological base which need to be addressed at that sensory level rather working on superficial behavior level. Such as forcing child to rock/ or climb down stairs when they getting panicked about it.

Sensory Integration (SI) and its Implications

Sensory Integration is an “innate neurobiological process to organize sensory input from the body and environment so that body can be use effectively in the environment.  It is integration and interpretation of sensory stimulation from the environment by the brain. Sensory integration focuses primarily on three basic senses—tactile (touch), vestibular (movement), and proprioceptive (pressure). A general theory of sensory integration and treatment has been developed by Dr. A. Jean Ayres in 1960s.  When sensory input is not integrated or organized appropriately in the brain and produces varying degrees of problems in development, information processing, and behavior.

Tactile System: This system provides information to the brain about the various types of touch  that includes light touch, different textures,pain temperature and pressure. It plays a vital role in perceiving things around us and in the environment, and also serves as a protective reactions for survival

Dysfunction in the tactile system can be seen in either the child seeking or avoiding certain kinds of touch or textures. The child can  withdraw himself  when being touched, or be a picky eater like refusing to eat certain 'textured' foods and/or avoid/like certain  types of clothing, resistive behaviour while cutting hair, nails, or brushing teeth or washing face,does not like to be messy or fingers getting dirty, (i.e. by clay, while picking up textured food,mud, finger-paint),  It also lead to a mis-perception of touch and/or pain (hyper- or hyposensitive) and may lead to  decreased awareness of self in environment, irritability, distractibility, and hyperactivity.

Vestibular System: The vestibular system refers to structures within the inner ear (the semi-circular canals) that identifies varioos movement  of head and body in plane or various directions. For example, the vestibular system tells you when your head is upright or tilted (even with your eyes closed).

Dysfunction leads to under or over active vestibular system.Some children may be hypersensitive to vestibular stimulation and have vestibular insecurity(e.g., swings, slides, ramps, inclines). They may also have trouble in execution of movements needed to   climb or descend stairs,ramps or ladder; and they may be apprehensive  in balancing self on uneven surfaces..

On the other extreme, the child may be always occupied in actively seeking very intense sensory experiences such as excessive  spinning around self,running in circular manner in a room,looking for  spinning  objects, or  body whirling, that is, they are trying continuously to gratify their vestibular systems.

Proprioceptive System: The proprioceptive system refers to components of muscles, joints, and tendons that provide awareness of body position, joint or kinesthesia sense. For example, the proprioceptive system is responsible for  mechanical corrections or adjustments needed by the body  to function appropriate consciously or subconsciously.It also allows us for  manipulation of  objects for gross and fine motor movements, such as climbing,jumping,pulling,pushing, and fine movements like  typing ,painting writing , using a spoon to drink or eat and buttoning or unbuttoning.

Some common signs of proprioceptive dysfunction are  sloppiness,and clumsiness,  imbalance,wide base gait, a lack of awareness of body position in space, odd body posturing, difficulty in change of position,walking backwards, crawling, difficulty manipulating small objects (buttons, snaps),

Another dimension of  proprioception is praxis or motor planning. This is the ability to plan and execute different motor tasks. When this system doesn’t work properly dyspraxia occurs in which a  children struggle with various activities involving motor planning in areas of  self care , play,  sports, handwriting,

Implications: A child may be over- or under-responsive to sensory input,so arousal level of child in play will be high or low, hyperactive or hypotonic,energetic or lethargic. Or can fluctuate between these extremes.

Gross and/or fine motor coordination problems are also common when these three systems are dysfunctional and may result in  delay in speech/language and  academic or scholastic areas.Behaviorally, the child may become easily irritable, impulsive, distractible, and show delay in motor planning. Some children may face  difficulty  in adjustments  to new situations and may react with stimming, frustration,  or aggression,or self isolation.

Evaluation and treatment of children with sensory integrative dysfunction  is performed by occupational therapists.

The therapist's general goals are:

(1) to provide the child with controlled  sensory input to organize   the central nervous system, and help integration of senses.
(2) to assist the child in  experiencing sensory information, by inhibiting and/or modulating the the sensory input
(3)  to assist the child in  processing the senses and respond in  a more organized manner.

Role Of Occupational  Therapist as a SI Therapist.

Occupational Therapist having specialized training in Sensory Integration are allowed to give SI. As Occupational Therapist have their foundation knowledge of Medical, Psychological, Anatomical, Physiological, ergonomics, Sensory and motor development and a holistic approach makes them competent enough to give SI Therapy.

SI set ups.

Jean Ayres Sensory Integration (SI) is implemented in Specialized Clinical Setting where there is enough opportunity for multisensory input. Safety is taken into consideration where children are getting exposed to different vestibular proprioceptive equipment such as swing, trampoline, and trapeze.

However environment can be modified so that principles of Sensory Integration can be implemented at home, school and community environment. Such as having Trampoline at school where children can go and jump in between the class as 5 minutes break in order to fulfill their sensory needs which further enhance their ability to focus on studies.  Or having tactile activity at home for children such as finger/hand painting, texture board at home or playing in sand/ grass, playing with grains.

Parental Training / Teachers training

Parental education about the sensory issues and reason of behavior child exhibit is most important to understand the child problem and trying to support him to better cope with environment loaded with multiple sensory inputs such as sounds, touch, smells etc.  Even teachers at school needs to be educated about SI issues so they won’t force child to be in noisy environment or with loud music when child has hypersensitivity with sound. Parents know their child best so even they can inform the teacher about the sensory issues their child is facing. Also parents and teachers can expose them slowly and gently to different sensory input to improve their response towards environmental stimuli such as sounds, touch etc.