Autism Therapy: sensory integration

definition of sensory integration: Neurological process that organizes sensation from one's own body and the environment. Sensory integration makes it possible to use the body effectively within the environment. Children with autism are believed to have difficulties integrating sensory information.

Sensory Integration Therapy for Children with Autism

Published Nov 6, 2009, last updated Dec 21, 2009

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:

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.
Journal of Autism and Developmental Disorders, by Bass, MM, Duchowny CA, and Llabre MM, published in 2009, summarized Oct 5, 2009

Therapeutic horseback riding may improve social skills in children with autism.

Children with autism who rode horses as therapy showed improvements in several social skills after 12 weeks of therapy. This study compared before-therapy and after-therapy scores on social skills tests for 19 children (5-10 years old). Children were improved in sensory seeking and sensitivity. They also had more social motivation and were less distracted. The authors said that this is the first study to measure the impact of horseback riding on social skills in children with autism.


Research in Autism Spectrum Disorders, by Van-Rie, GL, and Heflin LJ, published in 2009, summarized Sep 9, 2009

Sensory-based activities may help some children with autism stay focused on a task.

Children with autism may have sensory integration problems that make it hard to focus on school work and come up with the right answer. Some therapists use sensory activities that may help children with these problems. For example, children may swing slowly on a swing or bounce quickly on an exercise ball. Usually the children enjoy the sensory activities very much. The researchers wanted to find out if a reward system would motivate children to give correct answers to some questions. Three children (ages 6-7) were offered a choice of sensory activities to do before a session. That activity would then be their reward for answering 12 correct answers. The session started when the therapist asked the child to open their workbook. As their task, children were then asked to identify pictures of community helpers and safety. The children earned a token for every correct answer. They needed to earn 12 tokens in order to get the reward of going on the swing or the exercise ball. The researchers added an interspersal procedure by mixing questions that the child clearly knew the answer to with others that they might need to learn the answer to. The sensory activities as rewards helped two of the three children give correct answers when asked to identify what was in the picture. The interspersal procedure also helped motivate children to give the correct answers.


Sleep Medicine Clinics, by Malow, BA, and McGrew SG, published in 2008, summarized Jul 23, 2009

Melatonin and other therapies may help people with autism who have trouble sleeping.

People with autism may have sleeping problems, such as trouble going to sleep, trouble staying asleep, and night terrors. Sleep problems can occur because of medical problems (like epilepsy), psychiatric conditions (like anxiety), medications, behavioral habits, and sensory issues. Behavioral therapy is usually the first therapy that is tried to improve sleep habits. Parents are often included in a behavioral therapy plan. When behavioral therapy doesn't work, drug therapy may help. Some doctors suggest melatonin, which has few side effects. One large study showed that melatonin helped 85% of children with autism with sleep problems. Other therapy options include anti-epilepsy medications, antidepressants, light therapy, and tonsil removal. Improving sleep can improve the quality of life and the behavior of people with autism.


Medical Anthropology Quarterly, by Park, M., published in 2008, summarized Jul 2, 2009

Acting out imaginary scenes may help children with autism begin a process called the "healing of belonging."

This article described social science theories about the human need for belonging. Children with autism may have a need to find the feeling of belonging. The author believes that acting out imaginary scenes can help children with autism imagine things being better, and give them hope and desire to heal and belong. The author observed sensory integration therapy sessions for 5 preschoolers, and 3 of them had autism spectrum disorder (ASD). Over 27 sessions were observed, and 27 were videotaped. In the article, the author described the imaginary play of the children. Children acted out different scenes that they created. For example, one child was a bird sitting on phone wires who might fall off. Another child was a Tyrannosaurus rex dinosaur. Their choices may show how they currently feel (worried about falling down) or how they hope they might be (strong and powerful like a dinosaur).


The Whole Learning School, located in Plymouth MN, teaches children with autism and other developmental delays using a sensory approach. This small, private school focuses on visual, auditory, and touch as a means of making sure that each student can learn to the best of his ability. Another method the school uses to best work with the individual child is to group learners by ability and not by grade level. Ann Rooney, head of the school says, “All of our kids have processing deficits. The way they move information, process it and comprehend it is slower than their typical peer. So they need more opportunities to practice it, in shorter duration." The school environment is also about learning and becoming comfortable in social situations that will occur outside the school walls.

Read original article: An Education for All


The Jefferson School at Finan recently opened an autism therapy center. This Maryland facility is an offshoot of the Sheppard Pratt Health System. The center serves children from kindergarten through high school, although the current students range in age from 10 to 15. Children with severe autism are introduced to the facility one at a time so that individual therapy can be provided. The center has classrooms, library, computer room, and an “independent living area” where students are taught domestic skills. Therapies include occupational therapy and sensory integration therapy; the sensory room has a trampoline and swing. The goal of the program is for children to eventually be able to attend school.

Read original article: Autism Center Clicks for Students, Staff


An Oregon couple recently purchased Gentle Steps Children’s Therapy Program and renamed it Neurotherapeutic Pediatric Therapies. They focus on children with central nervous system disorders, multiple handicaps, and autism. The therapies they use are occupational therapy, physical therapy, and sensory integration therapy. They have also incorporated Therapeutic Listening, Interactive Metronome, TheraSuit, and the Universal Exercise Unit into their therapy offerings. Karen Belje, RN and co-owner of the clinic with her husband, encourages her therapists to help parents and caregivers learn home therapy programs for their children.

Read original article: Children's Therapy Clinic Open in Mac


Three Indian woman, who are qualified in special education, decided to open a school for autism and other developmental disabilities that would treat the whole child. They started a holistic program in the Anna Nagar region of India that they called Sankalp. While the syllabus comes from traditional education, Sankalp has adopted a multi-sensory teaching approach. The school is divided: The Open School is for children with a learning disability or dyslexia; The Learning Centre is for children with autism spectrum disorders. The autism portion of the school begins with early intervention and adds speech therapy and occupational therapy to regular academics. The focus of both schools is a holistic approach to teaching and treating the child.

Read original article: Catering to the Special Needs of Children



Please comment on this autism topic.

Responding to sports

Feb 22, 2010 by Anonymous

I have had my child enrolled in gymnastics as a form of physical therapy. I have lots of experience teaching swim lessons, and I use "aquatic therapy" as a means of therapy for her sensory problems and speech and social skills.


You might be more helpful at teaching children who normaly sabbatage their own products from obnoxioius undisciplined behavior by giving them applied time outs whenever they "just run into" a room, any room of the house except to go to the toilet, we all have to rush on that urge to go to the restroom lavatory at times. Not a good habit too. Anyway, at no time should a child be encouraged to run through a park ding dong unaware, a street to chase a ball where cars are. It shows them respect when we guide them to their play toys, participate in front of a therapist with them intercommunicative style of interest about thier childhood items. Also keeping aloof with the help of a good dr. to remain a disciplinarian parent that often makes too harsh remarks, bad errors, but means do as I say and not as I do and keeps the family goin. That is what the good dr. is for to notice the parents errors and correct them. I encourage the child-parent familiarity to be one of once upon a time and thats it for me. After adulthood a little more approval of talents, achievements, but a stauch, living room parent and a DO NOT EVER ENTER A CHILDS BEDROOM even if it is questionable what is going on, you either call 911 or stand at their doorarch and speak issues from there. A room of a kid is their absolute haven and never to be crossed in my book. Thanks for listening K.K.


Free Sound Therapy Home Programme

Jan 21, 2010 by Anonymous

Dr. Alfred Tomatis, a French otolaryngologist, is recognised as the modern day originator of sound or music therapy. In the early 1950's he developed an effective therapy method using altered music to treat conditions such as auditory processing disorder, dyslexia, attention deficit disorder and autism. Another French doctor, Dr. Guy Bérard, developed a similar method, Auditory Integration Training (AIT), which has found many followers in the USA. From personal experience I know that many clients report improvements in understanding, speech, balance, behaviour and emotional well-being after just two or three weeks of daily sound therapy.

 Sensory Activation Solutions (SAS) is an organisation with Centres in the U.K. and Turkey that provides a unique service for children and adults that face learning or developmental difficulties. When the established educational, psychological or medical services fail to provide adequate support, the SAS methodology often can provide practical solutions that result in noticeable improvements in daily life.

 You may be interested to check out their Free Sound Therapy Home Programme. Their Auditory Activation Method builds on the pioneering work of Dr. Tomatis and Dr. Bérard and has been specifically developed with the aim to improve sensory processing, interhemispheric integration and cognitive functioning. It has helped many children and adults with a wide range of difficulties, ranging from dyslexia and attention deficit/hyperactivity disorder to sensory processing disorders and autism. It is not a cure or medical intervention, but a structured training programme that can help alleviate some of the debilitating effects that these conditions can have on speech and physical ability, daily behaviour, emotional well-being and educational or work performance.

 There is no catch, it's absolutely free and most importantly often effective. Check it out at: http://www.sascentre.com/uk/uk_free.html.

 




Scope of Ayurveda in ASD by Vaidya Prasad

Nov 13, 2009 by Anonymous

Trials with Ayurvedic medicines and treatments for their efficacy in ASD are going on at various centres in India and abroad. The main advantage of ayurvedic medicine is that it has got a magazine of safe therapeutic preparations of various forms which are developed by continuous trials and rectifications over thousands of years. There are many preparations like kwatha (decoction), churna (powder), arishta (self-fermented beverage), gudika (pill), ghrtha (medicated ghee), thyla (medicated vegetable fats) etc. In recent times, many of the herbs used in Ayurveda are proven to have excellent detoxifying effect as well as free radical- scavenging potential. The therapeutic preparations like kwatha are combinations of many herbs. These combinations are originally developed on the basis of ayurvedic principles. Till recent times these formulations were not given due consideration by the western scientists. But now the picture has changed. More and more ayurvedic preparations are under their evaluation. In Ayurveda, the compounds as well as single herbs are used for different purposes of health care like pacifying vitiated functional units called doshas, eliminating excessive toxic accumulations, providing targeted nutrients to tissues, tuning the mind-body coordination, sharpening the efficacy of sense-organs, and so on. These prescriptions are based on personalised evaluation of different aspects like body constitution, doshik status, power of digestion and assimilation, status of bowel evacuation, physical strength, mental constitution, and etc, which is done by experienced physicians. Mind is an important factor in the healing of any ailment. It is assumed that mind is like ghee, which is held inside a pot called body. If the ghee is hot the pot also gets warmed and if the pot is hot definitely the ghee also will be hot. You cannot expect warm ghee in a cool pot and wise versa. Similarly, food is given the supreme role in the healing process as well as in the maintenance of health. It is a basic concept in Ayurveda that there is no use for any medicine if one stick on to pathya (wholesome) food (as it brings about health spontaneously) and there is no use for any medicine if one stick on to apathya (nasty) food (as there is no scope for functioning of the medicine). In the context of autism, these assumptions are extremely important and seen exceptionally beneficial.

The care of autism, as per ayurvedic principles, is based on the protocol of a three-step intervention.

  1. detoxifying the body
  2. balancing the mind-body interaction, and coordination  and
  3. enhancing the mental abilities like comprehension, memory etc.

Again, though the stages are generalised the execution will be personalised.

The first stage is based on medicines almost completely. Medicinal preparations like purgatives, specific formulations for de-worming, for enhancing the functions of the liver and pancreas, for enhancing the digestive fire (Agni), and for regulating the intestinal motility are used in this stage. Certain preparations meant for squeezing out heavy metals from the tissues are also used. Turmeric, garlic, curry leaves, etc are having this advantage.

Second phase is mainly comprised of massages. Traditional methods like abhyanga (hot-oil massages), udwarthana (dry powder massages), pindasweda of various types, thalapothichil, pizhichil, etc are used here. These manoeuvres improve the muscle tone, reduce hyperactivity, create better motor coordination, and normalize most of the obsessive repetitive movements. Child sleeps well. The bowels become more regular at this stage. He/she will be more receptive to commands or suggestions. The demand for sensory stimulation slows down considerably and the symptoms like increased sensitivity to certain sounds (hyperacusis) slowly disappear. There will be oral medications parallel to the therapies and a few of these medications will be carried over to the next phase as well.

Third stage is very specific and sold not be started before the proper completion of the first two. This is an important point as there is a general tendency to mark the condition as mental retardation and to prescribe brain tonics and memory boosters to all autistic kids indiscriminately.

The major therapies in this stage are shirodhara (pouring of liquids like oils on the head), shirovasthi (holding of medicated oils on the head inside specially designed leather-rims), shiropichu (wetting the scalp with oil bandages), dhoopanam (fumigation with specific medicines) etc along with specific medications like kallyanakam kashayam, indukantham kashayam, gorochanadi gudika, balakanakapathradi kashayam, sidharthakam gudika etc. Certain specific herbs like sahadevi, sankhapushpi, vacha, vishnukranthi etc are also used. Follow up is done with ghee preparations like mahakallyanaka, mahapaisachika, brahmighrtha, saraswathaghrtha, etc.

It is seen that the classical ayurvedic treatment done systematically give promising results in kids diagnosed with ASD. But it should be emphasised that the level of improvements is different from child to child. Another important point is that these interventions are made in a corrective manner. The child gets relieved of a lot of physical problems and tantrums. But this will not make him/her a normal child. Intensive training and special education are needed to put him on track and to catch up the peers. This requires the dedicated involvement of parents, special educators, and skilled professional like occupational therapists.



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