Most of us unconsciously learn to combine our senses (sight, sound, smell, touch, taste, balance, body in space) in order to make sense of our environment. Children with autism have trouble learning to do this. Consequently, their play schemes are limited to the few habitual manners that they use when interacting with the world.
Occupational therapists use sensory integration therapy to help a child with autism play like other children. Sensory integration therapy involves placing a child in a room specifically designed to stimulate and challenge all of the senses. During the session, the therapist works closely with the child to encourage movement within the room. Sensory integration therapy is driven by four key principles (1):
Sensory integration therapy is based on the assumption that the child is either overstimulated or understimulated by the environment (2). Therefore, the aim of sensory integration therapy is to improve the ability of the brain to process sensory information so that the child will function more adaptively in his daily activities (2).
A sensory integration room is designed to make the child want to run into it and play (1). During sensory integration therapy, the child interacts one-on-one with the occupational therapist and performs an activity that combines sensory input with motion (1-3). Examples of such activities include:
The child is guided through all of these activities in a way that is stimulating and challenging (1). So, the focus is on integration of movement with the different senses.
A parent can integrate sensory integration into the home by providing many different opportunities for a child to move in different ways and feel different things. For example, a swing set can be a form of sensory integration therapy, as can a ball pit or a lambskin rug.
On a daily basis, most people experience events that stimulate more than one sense simultaneously (4). We use our multiple senses to take in this varied information, and combine it to give us a clear understanding of the world around us. We learn during childhood how to do this (5). Thus, through childhood experiences we gain the ability to use all of our senses together to plan a response to anything we notice in our environment (4). Children with autism are less capable of this kind of synthesis and therefore they have trouble reacting to different stimuli and formulating more appropriate responses.
Children with autism have a difficult time listening when they are preoccupied with looking with at something. This is an example of their difficulty in receiving information via more than one sense simultaneously (4, 6). Physicians who treat children with autism believe that these difficulties are the result of a difference between the brains of children with autism and others (4, 6, 7).
The underlying concepts of sensory integration therapy are based on research in the areas of neuroscience, developmental psychology, occupational therapy, and education (1, 2, 8). Research suggests that sensory information received from the environment is critical; interactions between the child and the environment shape the brain and influence learning. Furthermore, research suggests that the brain can change in response to environmental input, and rich sensory experiences can stimulate change in the brain.
The effectiveness of sensory integration therapy is controversial and there are very few well-designed studies upon which to base a clear assessment of whether or not it works (1, 2, 9). Approximately half of the reports in the scientific literature show some type of effectiveness with sensory integration therapy, and half show no benefits at all (1). Some researchers suggest that sensory integration therapy would be more useful for younger children than for older children (3). Some experts suggest that sensory integration therapy be discontinued if effects are not apparent during a specified time frame or if the child has a negative reaction (3).
Successful sensory integration therapy has been able to decrease sensitivities to touch and other stimuli (1, 10). The result is that the children are better able to play, learn, and interact with people and surroundings (1, 10).
While sensory integration therapy is not harmful, some forms of sensory therapy may be uncomfortable for the child. Children with autism can be especially sensitive to certain types of sensory stimulation; the therapist should respond appropriately to each child. Children should be closely monitored for any negative reactions or self-soothing behavior (3).
True sensory integration therapy, however, should be child-directed, playful, and pleasant for the child (1, 11).
Sensory integration therapy is frequently included as a component of occupational therapy (2). The cost of occupational therapy may be covered by the government through the Individuals with Disabilities Education Act (IDEA). Private occupational therapy can be expensive (approximately $100/hour or more).
Sensory integration equipment is relatively low-tech, but can be moderately expensive (3). These include anything from large bins of rice that a child can climb into to an indoor swing set.
Autism is a condition covered under the Individuals with Disabilities Education Act (IDEA). Services covered by IDEA include early identification and assessment by an occupational therapist. This law protects the rights of patients with autism and provides guidelines to assist in their education. It covers children from birth to age 21 (U.S. Department of Education, http://www.ed.gov/index.jhtml ). Pediatricians can provide contact information for your state's early intervention program (for children 0 to 3 years old). School districts will coordinate special services for children 3-21 years old.
An excellent overview of sensory integration can be found in: The Out-of-Sync Child: Recognizing and Coping with Sensory Processing Disorder, Revised Edition (Paperback) by Carol Stock Kranowitz and Lucy Jane Miller.
Sensory integration equipment can be purchased online through many sites. These include: Abilitations ( http://www.abilitations.com/), Bright Start Therapeutics (http://www.bright-start.com), and Southpaw Enterprises (http://www.southpawenterprises.com).
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