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):
- the child must be able to successfully meet the challenges that are presented through playful activities (Just Right Challenge);
- the child adapts her behavior with new and useful strategies in response to the challenges presented (Adaptive Response);
- the child will want to participate because the activities are fun (Active Engagement); and
- 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
Raising a Sensory Smart Child: The Definitive Handbook for Helping Your Child with Sensory Processing Issues
References
- 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.
- 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.
- 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.
- 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.
- Iarocci, G., and J. McDonald. 2006. "Sensory Integration and the Perceptual Experience of Persons with Autism." J Autism Dev.Disord. 36(1):77-90.
- Wallace, M.T., and B.E. Stein. 2006. "Early Experience Determines How the Senses Will Interact." J Neurophysiol.
- Minshew, N.J., et al. 2004. "Underdevelopment of the Postural Control System in Autism." Neurology. 63(11):2056-2061.
- Waterhouse, L., et al. 1996. "Neurofunctional Mechanisms in Autism." Psychol.Rev. 103(3):457-489.
- Boddaert, N., et al. 2004. "Superior Temporal Sulcus Anatomical Abnormalities in Childhood Autism: A Voxel-Based Morphometry MRI Study." Neuroimage. 23(1):364-369.
- 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.
- 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.
- 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.
- 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.
- 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.
- Case-Smith, J., and H. Miller. 1999. "Occupational Therapy with Children with Pervasive Developmental Disorders." Am.J Occup.Ther. 53(5):506-513.
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Free Sound Therapy Home Programme
Jan 21, 2010 by AnonymousDr. 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 AnonymousTrials 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.
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.
School
Aug 31, 2009 by AnonymousWe are a special school for children on the autism spectrum and typical developing siblings. Our arts based educational and sensory curriculum and mixed age classrooms provide a way for all children to actively participate within a supportive atmosphere. In this tranquil setting each child feels a sense of belonging, friendship, and the opportunity to experience the magic of childhood.
*Philosophy & Curriculum:
We offer a holistic approach in which the connection between school, home, service providers, and community becomes collaboration where each member is connected with a natural ease. Jordan Lake School of the Arts offers an individual curriculum for all students in a retreat like setting. Having a five students to one teacher ratio, and small class size we can provide attention to each child. Multi-age classrooms offer a stress free environment to learn in both roles as guide and apprentice. While children on the spectrum benefit from observing peers and having a structured means of learning social skills, typical developing siblings grow from experiential education and the support of friends who truly understand and share similar experiences. Different is normal here. At JLSA, we all understand and are respectful and supportive of one another. We have local artists participating in workshops as well as rotating their artwork in our space. Our art shows offer an opportunity for families to socialize without anxiety, and students to experience large group functions in the company of compassionate people while meeting inspiring members of the community. Our amenities include an enormous tropical greenhouse, courtyard, and outdoor class space, as well as a home like educational setting.
Parents and grandparents are welcome and encouraged to participate in the day. Workshops and afternoons with community speakers are great opportunities for families to share in experiences together at school and we all benefit from the communication and shared experiences that flow from school to home. Parents are also invited to join us for nature hikes and gardening, and to bring their talents and teach us about their specialty. We hope adults will take painting or yoga classes offered in the building, or enjoy hiking trails and the lake, assured that your children are being compassionately cared for and well educated.
www.jordanlakesa.com
919-672-4281
A magical vacation...
Aug 20, 2009 by AnonymousOkay. Here goes.
We had a wonderful vacation. I can only say that now, a few days later, after I’ve been given time to ponder and reflect. I wrote a blog on the airplane home, but after reading it now a few days later, I think it was a little harsh so I’m doing a re-write. I liken it to childbirth. After the baby is out and you’re thrilled to be a parent, you don’t really remember the agony of it all. You even start thinking about when you’ll have another one.
To be honest, most of the trip was exhausting to us. We learned a lot, which is a good thing. We’ll do things a bit differently next time, whenever that turns out to be. We think the kids had a great time; at least they’re saying that they did now. They were not very well-behaved for a large portion of the vacation. In fact, Donald Duck himself had to break up a fight between Thomas and Hayley at Chef Mickey’s at the Contemporary Resort. We were suitably mortified, I can assure you. We were, needless to say, disappointed in the kids and their behavior. We had hoped that they would be magically wonderful, since every Disney employee we ran into wished us a “magical” day. Even when I called the front desk for extra towels, I was wished a “magical” evening. I should have asked for “magical” towels.
There were two main pieces of advice that we received prior to our vacation that we should not have taken as gospel truth. The first was that autistic children can improve dramatically (magically!) while at Disney World. I really thought that this would happen for Thomas, since he is one of those kids who requires more stimulation than other kids. And Disney World is sensory overload extraordinaire. I’ll just say that Thomas has never acted more autistic in his life. I was quite disappointed. I’m not saying that I thought we’d spend ten days (too long, by the way, but more on that later) in Disney World and come home with a cured boy, but I at least thought that he might be better while on vacation. He was worse. And his badness rubbed off on his sister. Hayley copped an attitude most of the time which I’m sure has nothing to do with the fact that every Disney employee who crossed her path called her “princess.” I was called princess a couple times, but I know I’m not a princess. Trust me, I know. For Hayley, the jury in her brain is still out.
The second thing that we were told to do over and over again by everybody we talked to was to take a break in the middle of the day. Go back to the room, go swimming, take a nap, have a snack, re-charge the old batteries and then go back to the parks in the evening, fresh as daisies. Here’s what happened to us: We got on the bus to go back to the hotel, and during the bus ride the kids fell asleep. We made the trek back to the hotel room where the kids, having rested quite enough on the bus, would be bouncing off the walls just as Jonathan and I wanted to curl up and take a nap. Ha! So we maybe would take them swimming or watch cartoons for a while and then head out again. So this way, the kids were great for the rest of the day but Jonathan and I were completely frazzled and every little thing the kids did wrong set us off. The grown-ups were the cranky ones by day’s end. So some of the best days we had were ones where we went all day long, taking for our “break” a sit-down meal for lunch.
Despite our “go all day long” routine, I managed to pack on twelve pounds! Yes, despite walking around in the hot and humid Florida sun, sometimes toting a child on my back, I managed to gain several pounds over the course of the ten days. I can sum it up in two words: brownie sundaes. We did the basic Disney Dining plan which included one snack, one “quick-service” (fast food) meal and one sit-down table-service meal per person per day. Both the quick-service and the sit-down meal included a dessert for adults. Well, what are you supposed to do but order the dessert and scarf it down? We’d already paid for it! Next time, we think we’ll skip the dining plan, although it was very nice not to have to budget for food which can be a very inexact science. The food was all paid for before we left so that any extra money we brought could be used for incidentals and suchlike. We actually spent very little cash because we didn’t have to pay for food while we were there.
Again, in hindsight, it was a wonderful vacation but not without its ups and downs. We thought the kids would be better than they were. At the end of the trip, we decided that the kids were still a little too young to truly appreciate what they were enjoying. I don’t mean that we expected them to sit us down, look us in the eyes and say, “Mom, Dad, we know just how great an undertaking this has been for you, we understand the cost involved and we truly appreciate everything you’re doing for us. We will always treasure this time with you in our memories.” I don’t think I’ve even said that to my own parents now, who took us all to Disney World when I was in eighth grade. I can say that I have a huge appreciation for them having done it, and I understand what kind of planning and budgeting went into it.
Also, as I hinted at before, ten days was just straight-up too long. Next time, we’ll stay for maybe a week and get better accommodations. The All-Star Movies Resort was fine, but it was clear that it was Disney’s version of the nosebleed section given its proximity to the parks and the clientele. It was rather noisy and we dealt with rude people a lot. Really, at Disney in general, it’s every family for themselves, and those who realize this sooner rather than later will have a better time in general. Jonathan and I, being pushovers, care about other people’s feelings and were shocked at some of the rudeness we witnessed.
So next time – this hypothetical “next time” – we’d stay for shorter in a better hotel, rent a car so that we weren’t constantly at the mercy of the Disney Bus System and ditch the dining plan so that we could eat (less) outside the World and probably spend less. Everything at Disney is so expensive! I read that Disney will ride a money horse until it drops and boy, was that ever true! Plus, if you do the Dining Plan, Disney’s got you – all your money and you’re never leaving the parks until they shuffle you onto the bus to the airport and drop-kick your luggage to its final destination, and they don’t really care where that might happen to be. Our bags did show up, but somewhat smashed.
So that was our trip. If you have any questions, let me know. Now, we gear up for school! Hayley had her kindergarten assessment with Mrs. H. yesterday and she did a swell job! Pre-school really paid off in that respect. After her little interview, we went and visited Thomas’ new classroom and saw his teacher again. After seeing his teacher and class again, Thomas is much more…okay…with going to first grade. Plus, I told him that I’d make him cold pizza to eat for lunch. So that was great! I feel like he’ll be okay now and that he understands he’ll be at school all day and eat lunch with his friends. He’ll get a recess which will really help him out and Mrs. H. said that he will have sensory breaks in her classroom a couple of times per day or as needed. Thomas was pleased to hear that. When we were in his new classroom, he noticed many similarities between his kindergarten room and the first grade room which made him very happy. There was a chart on the wall for the weather, lots of numbers to count the days and the old “green-yellow-red light” cards on the wall to track everyone’s behavior.
As we walked home from school, I asked him again how he felt about it. I said, “So how do you feel about first grade now? Do you think you’ll like it?” He replied, “I think it’ll be great!” I really, REALLY hope he means it! School starts next Wednesday.
I can’t wait, for my own sake. It’s been one hell of a rough summer.