Autism Therapy: sensory integration

What is it?

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. Sensory integration therapy is a type of occupational therapy (OT) that places 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⁾:

1. the child must be able to successfully meet the challenges that are presented through playful activities (Just Right Challenge);
2. the child adapts her behavior with new and useful strategies in response to the challenges presented (Adaptive Response);
3. the child will want to participate because the activities are fun (Active Engagement); and
4. the child's preferences are used to initiate therapeutic experiences within the session (Child Directed).

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 better in his daily activities ⁽²⁾.

Recently another sensory-related therapy has been reported called Sensory Stories ⁽³⁾. Sensory Stories are similar to social stories (see Social Stories Therapy Fact Sheet ) in that they use individualized stories about sensory situations that an individual child may encounter, and then provides instructions on appropriate behaviors for the child to use in response ⁽³⁾.

What's it like?

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, 2, 4)}. Examples of such activities include:

• swinging in a hammock (movement through space);
• dancing to music (sound);
• playing in boxes filled with beans (touch);
• crawling through tunnels (touch and movement through space);
• hitting swinging balls (eye-hand coordination);
• spinning on a chair (balance and vision); and
• balancing on a beam (balance).

The child is guided through all of these activities in a way that is stimulating and challenging ⁽¹⁾. The focus of sensory integration therapy is helping children with autism combine appropriate movements with input they get from the different senses.

A parent can integrate sensory integration into the home by providing many 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.

What is the theory behind it?

On a daily basis, most people experience events that simultaneously stimulate more than one sense ⁽⁵⁾. We use our multiple senses to take in this varied information, and combine them to give us a clear understanding of the world around us. We learn during childhood how to do this ⁽⁶⁾. 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 ⁽⁵⁾. Children with autism are less capable of this kind of synthesis and therefore they may have trouble responding appropriately to differently stimuli.

Children with autism may also 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 ^{(5, 7)}. Physicians who treat children with autism believe that these difficulties are the result of differences between the brains of children with autism and other children ^{(5, 7, 8)}.

The underlying concepts of sensory integration therapy are based on research in the areas of neuroscience, developmental psychology, occupational therapy, and education ^{(1-3, 9)}. 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.

Does it work?

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, 10, 11)}. 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 ⁽⁴⁾. It is also possible that it might work for some children and not others. 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 ⁽⁴⁾.

Successful sensory integration therapy has been able to decrease sensitivities to touch and other stimuli ^{(1, 12)}. The result is that the children are better able to play, learn, and interact with people and surroundings ^{(1, 12)}.

Is it harmful?

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 which might indicate the child is feeling uncomfortable ⁽⁴⁾.

True sensory integration therapy, however, should be child-directed, playful, and pleasant for the child ^{(1, 11, 15)}.

Cost

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) of 2004. Private occupational therapy can be expensive (approximately $100/hour or more).

Sensory integration equipment is relatively low-tech, but can be moderately expensive ⁽⁴⁾. These include anything from large bins of rice that a child can climb into, to an indoor swing set.

Sensory Stories that can be adapted for individual children are available online at www.sensorystories.com. A collection of 30 Sensory Stories, which can be adapted for the individual child, is available for about $150 through this site.

Resources

Healing Thresholds has partnered with Flag House, which is a great resource for in-home sensory solutions. They sell large sensory toys such as an adjustable tilt balance board and Snoezelen equipment.

Healing Thresholds has also partnered with Natural Learning Concepts which is a good source for large sensory toys as well as smaller sensory items.

Sensory integration equipment can be purchased online through many other sites as well. These include: The Adaptive Child, Pacific Pediatric Supply, The Child Inside, and SticKids. Sensory Stories information is available at www.sensorystories.com.

Autism is a condition covered under the IDEA of 2004. 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).

Pediatricians can provide contact information for the state early intervention program (for children 0 to 3 years old). School districts can coordinate special services for children 3 to 21 years old. For some additional coverage information in the U.S. go to: http://www.asha.org/public/coverage/autism.htm. In addition, there is a listing on this Web site for state early intervention centers.

Several books that might be useful:

The Out-of-Sync Child: Recognizing and Coping with Sensory Processing Disorder, Revised Edition (Paperback) by Carol Stock Kranowitz and Lucy Jane Miller. 2006. Perigree Trade.

Raising a Sensory Smart Child: The Definitive Handbook for Helping Your Child with Sensory Processing Issues (Paperback) by Lindsey Biel and Nancy Peske. 2009. Penguin.

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References

1. Schaaf, R.C., and L.J. Miller. 2005. "Occupational Therapy Using a Sensory Integrative Approach for Children with Developmental Disabilities." Ment.Retard.Dev.Disabil.Res.Rev. 11(2):143-148.
2. Dempsey, I., and P. Foreman. 2001. "A Review of Educational Approaches for Individuals with Autism." International Journal of Disability, Development and Education v48 n1 p103-16 Mar 2001.
3. Marr, D., et al. 2007. "The Effect of Sensory Stories on Targeted Behaviors in Preschool Children with Autism." Phys Occup Ther Pediatr. 27(1):63-79.
4. Baranek, G.T. 2002. "Efficacy of Sensory and Motor Interventions for Children with Autism." Journal of Autism and Developmental Disorders v32 n5 p397-422 Oct 2002.
5. Iarocci, G., and J. McDonald. 2006. "Sensory Integration and the Perceptual Experience of Persons with Autism." J Autism Dev.Disord. 36(1):77-90.
6. Wallace, M.T., and B.E. Stein. 2006. "Early Experience Determines How the Senses Will Interact." J Neurophysiol.
7. Minshew, N.J., et al. 2004. "Underdevelopment of the Postural Control System in Autism." Neurology. 63(11):2056-2061.
8. Waterhouse, L., et al. 1996. "Neurofunctional Mechanisms in Autism." Psychol.Rev. 103(3):457-489.
9. Boddaert, N., et al. 2004. "Superior Temporal Sulcus Anatomical Abnormalities in Childhood Autism: A Voxel-Based Morphometry MRI Study." Neuroimage. 23(1):364-369.
10. Dawson, G., and R. Watling. 2000. "Interventions to Facilitate Auditory, Visual, and Motor Integration in Autism: A Review of the Evidence." J Autism Dev.Disord. 30(5):415-421.
11. Case-Smith, J., and M. Arbesman. 2008. "Evidence-Based Review of Interventions for Autism Used in or of Relevance to Occupational Therapy." Am J Occup Ther. 62(4):416-429.
12. Ayres, A.J., and L.S. Tickle. 1980. "Hyper-Responsivity to Touch and Vestibular Stimuli as a Predictor of Positive Response to Sensory Integration Procedures by Autistic Children." Am.J Occup.Ther. 34(6):375-381.
13. Cox, A., et al. 2009. "The Effects of Weighted Vests on Appropriate In-Seat Behaviors of Elementary-Age Students With Autism and Severe to Profound Intellectual Disabilities." Focus on Autism and Other Developmental Disabilities. 24(1):17-26.
14. Stephenson, J., and M. Carter. 2009. "The Use of Weighted Vests with Children with Autism Spectrum Disorders and Other Disabilities." J Autism Dev Disord. 39(1):105-114.
15. Case-Smith, J., and H. Miller. 1999. "Occupational Therapy with Children with Pervasive Developmental Disorders." Am.J Occup.Ther. 53(5):506-513.