Sensory Integration; How Children Process The World

Jean Ayres, an early occupational therapist and advocate for individuals with special needs, shared “Sensory Integration is characterized as a dynamic process which sorts, orders and eventually puts all of the individual sensory inputs together into a whole brain function.” All 8 senses are integral as they interact with the environment from birth throughout the lifespan.

The 8 Senses are: Tactile (touch), Auditory (sound), Olfactory (smell), Gustatory (taste), Vestibular (perception of body movement), Proprioception (where one’s body is in space) and Interoception (internal bodily processes). To most, these senses are an innately part of them, without any notice; to those with sensory processing challenges, these senses may illicit atypical responses.  A loud birthday party, interacting with peers, getting messy with finger paints or trying new foods: these examples may seem fun and exciting for some, but for many it may cause dysregulation and shut down.

Some children with sensory processing challenges need more input from their environment to feel their best. They seek more touch, movement, and visual stimulation. Whether a child needs more or less input, or is registering too much or too little, it is very important to help foster an awareness and incorporate sensory strategies throughout their daily life. An analogy that has always remained with me is the comparison between SPD and Diabetes: an individual does not take one shot of insulin but consistently and intermittently monitors their sugar levels. For our children with sensory processing challenges, it is important that we provide them the appropriate dose, intensity, type and duration of sensory input to foster wellbeing. We will explore this topic and how occupational therapy can help.

According to the APP, there is not one specific definition of Sensory Processing Disorder rather subtypes & categories of diagnosis. Children who experience symptoms of SPD or have challenges processing sensory input, may experience one or many of the following symptoms:

Over-Responsiveness or Under-Responsiveness:

Over-Responsiveness: A child may respond with heightened reactions to sensory input. These impressions may feel noxious, uncomfortable, overstimulating or painful. A child can be over-responsive to any of the senses. The following examples may be indicators that your child is over-responsive to sensory input:

• Defensiveness: Pushing, yelling, or reacting when someone is too close, a sound is too loud, a movement is too scary, or a body signal is hard to overcome.

• Avoidance: Removing oneself from a stimuli that causes unlikely harm, disruptive behaviors to remove oneself from an activity.

• Overstimulation: Shut down due to too much input in a child’s environment; a way to block out external information.

• Reactivity: Big reactions for little problems including: social exchange, daily routines, transitions, and unexpected change in plans.

An occupational therapist’s role for the over-responsive child is to provide a just-right challenge by incorporating organized sensory input through creative playful approaches. A child who is over-responsive may benefit from increased proprioceptive input, slowly incorporating self-initiated vestibular input, tactile desensitization, and applying organized musical programs or social stories to decrease fear.

Under-Responsiveness: A child may be under-responsive which means registering decreased levels of sensory input. Registration is the term used to describe how one responds to sensory input. Low Registration can be explained as a child who needs more of certain inputs to feel just right! More movement, speed, spice, temperature, light and volume are some of the ways a child with low registration feels more alert or engaged. Some children with low registration become “sensory seekers” as they are searching for more sensory input to feel organized internally. The following examples may be indicators that your child is under-responsive to sensory input:

• Low Arousal or Low Affect

• Distractibility or an Inability to focus: “Zoned Out”

• Lethargy

• Seeking constant movement/motion

• Seeking touch, closeness to others, decreased understanding of personal space

• Wanting MORE… spinning, crashing, pressure

• Messy, unaware of food on face, twisted socks

• Decreased sense of pain

Praxis and Posture

Although researched and treated by multiple disciplines, occupational therapists have a crucial role in treating children with motor planning and postural insecurity challenges. The “clumsy child” may be experiencing a number of different underlining difficulties. We are going to take a moment to explain how sensory input from one’s environment can impact a child’s quality of movement.

The child with hypotonia, or “low-tone”, presents with decreased resistance through muscles, therefore, they may receive sensory feedback differently than children with “normal tone.” Caregivers may observe this as having a hard time maintaining an upright position, endurance for anti-gravity activity or floppy in nature.  Children presenting from low-tone receive less feedback from the environment, therefore impacting a child’s body awareness, posture and coordination. Proprioception is the feedback the joints receive to understand where one is in space. A child who presents with decreased body awareness, increased falls and poor postural control may benefit from the following activities:

• Self-Initiated Proprioceptive “Heavy Work” & Vestibular Input

  • Pushing heavy carts or carriages

  • Washing the windows

  • Jumping on a trampoline

  • Pulling oneself on a scooterboard in prone

  • Climbing a rock wall

  • Yoga

  • Crashing onto couch cushions *with supervision

  • Crawling up an incline

  • Animal Walks

Decreased processing of proprioceptive, vestibular, tactile and visual input effect how one moves their body. Praxis, defined as the skill of ideation, motor planning and motor execution to complete a task encompasses how a child uses their senses to engage with their environment and how they use that information to move their bodies. Through clinical observation and standardized testing, a therapist can assess a child’s strength, tone, and sensory integration to better understand the foundational challenges a child is having with movement. It should be noted that reflex integration practices provide sensory rich experiences to address non-integrated reflexes.

Sensory Modulation, Emotional Regulation and Adaptive Responses:

Self-Regulation is defined as the ability to adjust to changing conditions through internal processes that are coupled with behaviors to maintain a sense of control (Blanche, Roley & Schaaf, 2001). As occupational therapists we are trained to help children build awareness of how they feel. Whether a child is frustrated, angry, happy, excited, or scared, emotions are the blueprint to meaningful participation in education, play and home settings. The ability to regulate oneself is a developed skill. The development of expressive language, sign language and choice making does help the growing child feel more “in control.” As a child gets older, frustration tolerance, modulation of sensory input, and internal regulation are skills that lead to healthy classroom participation, peer interaction, and community participation. 

Modulation is the ability to maintain that “just right” state as he or she interacts with sensory information in their environment. Some examples of appropriate sensory modulation are the ability to play at recess and transition back into the classroom with the ability to internally calm and get back to work or hear a loud ambulance drive by without shut down or prolonged negative responses. 

Here are some strategies if you find your child has trouble modulating sensory input or regulating themselves:

• A cozy corner or calming space: children’s play tent with strung lights

• Calming Music

• Dimming Lights

• Implementing Deep Breathing or other Grounding exercises before an over-stimulating event (birthday party, restaurant, play-date)

• Sucking: Sports water bottle, sugar free lollipops

• Reducing Visual or Auditory Stimulation in his or her environment

• Stating Expectations of what is coming next and using simple language

• Movement Breaks, Fidgets and Sensory Input to support sitting/attention, ex: Floor Chairs with backs, increasing visual boundaries (Carpet Squares, Colored Tape, Cube Chair), a weighted blanket or plush toy to hold during carpet time

If Sensory Modulation and Sensory Regulation are challenging for your child, an occupational therapist can be instrumental. Tiny Transformations provides classroom observations, child screenings and recommendations for accommodations to help your child feel and accomplish their best in all settings.

The sensory system is a complex and wonderful part of the human body. It is what makes a concert so energizing, a meal delicious, and watching a summer sunset so captivating. Our job as occupational therapists is to help children process and make sense of the unbelievable amounts of information they receive.

Danielle MacCourtney, MS, OTR/L, ATP