I am not an Occupational Therapist, but I play one at home. I am the mother of one daughter and four sons, two of them identical twins, age five, who have been diagnosed with Autism. We adopted Isaiah and Isaac at the age of four weeks. Besides being preemie babies, one of the boys’ biggest hurdles has been their severe Sensory Integration Dysfunction. Unfortunately for them and other children with Autism, symptoms of SI Dysfunction are often misinterpreted as psychological problems or just plain bad behavior. According to the "experts," if SI Dysfunction is neither recognized or addressed, it is possible that these may well develop into such problems.
Higher cognitive functions—such as learning--depend upon having normal sensory
integration. If a child cannot make sense of the sensory input he receives, then he is always stuck at the level of trying to make sense of his world and cannot learn or behave appropriately.
The concept of sensory integration is not a new problem, but a new label, and comes from the work and research done by A. Jean Ayres, Ph.D., OTR. Sensory experiences include touch, movement, body awareness, sight, sound, and the pull of gravity.
#9; The process of the brain organizing and interpreting all this information at the same time is called sensory integration.
For example, I can sit and type this paper while music is playing, while I can hear my husband rattle his car keys, and the children are
giggling and wrestling in the next room and the dog is warming my bare toes. I can do this because my senses are integrated properly and I am able to filter out what is not important and focus on the sights and sounds that are most important: my typing this article.
Some signs of sensory integrative dysfunction are being overly sensitive to touch,
movement, sights or sounds. When my twin sons were infants, they screamed each time I held them, and fought all types of personal care. Every bath, every diaper change, every time I dressed them they howled in pain. When I walked them in the stroller they screamed nonstop. Actually, they screamed nonstop period. For three years until we discovered the use of Sensory Integration Therapy, my boys were miserably overwhelmed by their world. They were easily distracted, manic in their "play," (although they really didn’t play but just moved from one thing to another at lightening speed), were impulsive, lacked self-control, and had no ability to calm themselves. Once they started crying, there was little one could do to stop them. In fact, they began screaming every morning before their eyes were open to the day, and didn’t stop until they fell asleep exhausted at night.
Other signs of sensory integrative dysfunction are being under-reactive to touch,
movement, sights or sounds. Social and emotional problems, physical clumsiness or
apparent carelessness, and difficulty making transitions from one situation to another are
also signs of SI Dysfunction. My sons screamed and had tantrums at every single transition. They screamed going into the van, they screamed coming out of the van. They screamed going into their high chairs, they screamed coming out of their high chairs.
Spanking did not mean anything to them. They simply looked at us as if to say, "what was
that?" They could not "feel" or "empathize" with the idea of anyone’s disapproval but their own.
Delays in speech, language, and motor skills and delays in academic achievement can also point to Sensory Integrative Dysfunction. In fact, many children diagnosed with ADD, ADHD, BI-polar, dyslexia, and many other disorders may actually have these disorders as a result of poor sensory integration.
To have a child diagnosed with SID, an evaluation is conducted by a qualified
occupational or physical therapist with special training and credentials in sensory integration. The evaluation will tell the therapist what types of therapy should be recommended. The interesting thing about this therapy is that the therapist should send home a list of activities recommended for the child to do AT HOME! And do you know what I found the most amusing about this? They were activities that many of us as home educators just naturally do with our kids! Therefore, sensory integration is something that is easy to implement into our daily routines.
I am continually amazed how God created all our senses to work together! Our senses give us information inside and outside our bodies. Most of us are familiar with our "Far Senses." The "Far Senses," when speaking of sensory integration, are: smell, taste, seeing, hearing, and touch. These are the ones we are most familiar with. But Dr. Ayres discovered three other body-centered sensory systems that provide the sense of oneself in the world.
1. The Tactile Sense: this sense processes information about touch through our skin.
2. The Vestibular Sense: this sense processes information through the inner ear regarding our balance, gravity and movement.
3. The Proprioceptive Sense: this sense processes information through the muscles, ligaments and joints about our body’s position and parts of our body.
According to Dr. Ayres, "over 80% of our nervous system is involved in processing or organizing sensory input, and thus the brain is primarily a "sensory processing machine."
When I learned of this for the first time, I said to myself, "Eureka! This is old news! This is what the Moores, and Charlotte Mason and many other home educators have been saying for years! Give our kids good work to do, let them move their muscles and play instead of worksheets day after day and watch them grow and learn!"
We live in rural Indiana, and to get to an Occupational Therapist we must drive one hour for the children to see her for 30 minutes. Our best plan has been one in which our OT provides us with ideas to work on at home, and she is used more as a consultant to our home program. I will list these home activities in each area of the three senses that Dr. Ayres wrote about.
The Tactile Sense
In a typical child, the tactile sense gives them information that is necessary for learning and interpreting his world. A typical child will understand the "feel" of things. Feeling the warmth of a hug or the roughness of sandpaper means something to him, and he can recognize them for what they are. Through these senses he learns about his world and can organize his thoughts about it.
The tactile sense affects the following everyday skills:
· Tactile perception
· Body awareness
· Motor planning
· Visual perception
· Academic learning
· Emotional Security
· Social skills.
Children with Tactile Dysfunction may exhibit behaviors in three main ways:
1. Tactile Defensiveness (Hypersensitivity).
2. Under-sensitivity to touch (Hyposensitivity)
and 3. Tactile Discrimination.
1. Tactile Defensiveness.
Children who exhibit tactile defensiveness basically are terrified of and cannot handle being touched in a light way. They may reject touch from anyone but their mother. (And some, like my twins, may not learn to accept touch from their mother without therapy.) Kissing is too light, so they will prefer a hearty hug. They make big deals out of minor scrapes or splinters, avoid showers because the drops feel like thorns (my twins say "it hurts"), fuss about getting new shoes or socks or clothes, avoid touching or eating certain textures, and won’t like having their teeth brushed. These are just a few examples.
In other words, light touch throws the child into a "flight or fight" response.
2. Under-responsiveness to touch.
Children who are under-responsive to touch will constantly need to touch objects and people. If they get hurt, they don’t seem to notice. In some instances, these children may seem unaware of touch altogether unless the touch is very intense. Can a child be both tactile defensive and under-responsive to touch? Yes! The child may scream when someone brushes by him in a line, but not even notice if he breaks his wrist.
3. Poor Tactile Discrimination.
A child with poor tactile discrimination may not even be able to tell what body parts have been touched without looking at them. He seems out of touch with his hands as if they were unfamiliar to him. He can also be fearful of the dark or have difficulty performing certain motor tasks without cues such as zipping and buttoning. He may rub or bite his own skin, prefer extra spicy foods (my boys love picante sauce!), and enjoy vibration and movement that provides strong sensory feedback. When my twins were just a few months old, their favorite thing to do was to put the foot of their big brother’s
bouncing bumbler toy in their mouths. This was one of the few things we discovered would keep them calm for short periods of time! They loved the vibration, and the thing wiggled them from head to toe.
Activities at Home to Develop Tactile Integration
Now for the fun part! The following are some things you can do (and are probably already doing!) at home to help your out-of-sync child integrate his tactile sense.
· Bath time! Who says your child only needs one bath a day! This is a great
opportunity to encourage the use of a variety of textures against your child’s skin. There is a method of brushing called, "The Wilbarger Protocol" that I am not able to share with you in detail because it is copyrighted. But our OT
asked that I brush the boys every two hours for two weeks. I have also heard
it recommended to do the brushing once every 90 minutes. I can tell you what
I do with my boys. I simply take their arms, and using a surgical brush,
loofah, or thick washcloth, pretend I am painting them, with 10 strokes to each
area of their arm in long gentle movements. I do the same with both legs and their back. (Never massage a child’s stomach!) This can also be done with
lotions, shaving cream, soap, vibrating massagers, whatever your child enjoys
most! This is to promote calmness and improved behaviors. Children with
poor tactile integration have a difficult time learning. By "brushing" we are
helping the brain to make connections in its circuitry. It affects the brain’s ability to process and organize information. Some children cannot handle this type of stimulation. If this is the case, start with just a little area on the arm and very gradually work your way up to the bigger strokes to the point your child can tolerate it.
· Water Play. See? I told you we were already doing this! One of the things my husband did this summer was to hook up the sprinkler and let the kids run through it and jump into the pool. Remember how my boys don’t like showers? They are learning to, thanks to Daddy’s sprinkler! Kids can also paint with water on the sidewalk or driveway, and use squirt bottles. My twins love to squirt people and windows!
· Finger Painting. Keep introducing this activity no matter how much your child dislikes it. Don’t force them to put their whole hand in the goo, but encourage them to start with just a finger tip. You can use peanut butter, pudding, shaving cream—whatever you think will get your child to touch it and get his hands messy. This is of course a great way to teach letters and numbers because if he messes it up, he can erase it with his hand!
· Sand play, using rice or dried beans, pasta, cornmeal, popcorn, even mud! Hide objects inside the sand and ask them to find the object without looking by feeling for it.
· Feelie Box. Cut a hole in the top of a box and place different objects inside that are interesting. See if your child can tell you what it is.
· Oral Activities. Blowing whistles and kazoos, blowing bubbles, drinking through straws, chewing on gum or rubber tubing is helpful for children who need oral stimulation. (They usually exhibit this need through biting themselves, their clothes, or others.) I have also read these are great activities for kids with Apraxia (motor problems in speech).
· Hands-on Cooking. Didn’t I tell you we already do this? Let your child help make cookie dough, bread dough, meatloaf in a shallow pan by kneading it with their bare hands.
· Pets and Hands-on Science Projects. Uh, maybe I shouldn’t have mentioned those two in the same sentence, but they are both great for developing tolerance for tactile stimulation. Our two dogs have given the twins countless experiences with learning good and gentle touch. Our dogs deserve some type of award for the ministrations they have received from our little guys!
· People Sandwich. When the boys were smaller, their favorite thing to do (besides screaming non-stop) was to take all the cushions off the couch and pile them on each other. You can also play this by having your child be the salami, and lie down on a cushion. Pretend you have a big knife and with a sponge or washcloth, smear their arms, legs and torso with pretend mustard, etc. Then cover the child with another cushion or pillow. When you press firmly down on the pillow to squish out the excess mustard, the child is feeling deep, soothing pressure! My boys LOVE this activity.
Deep firm backrubs—rubbing downward.
· Hideaway. Kids with Sensory Integration issues love being under a table or inside a big box. In fact, my little ones used to hide in the same box even as babies. This is a good spot for some "time out" when things get a little out of hand. It is very calming.
The Vestibular Sense
There are two components to the vestibular system: Defensive and Discriminative.
Vestibular dysfunction occurs when there is inefficient processing in the brain of sensations that are perceived through the inner ear. If this is not working properly, the child will be oversensitive to movement, or under-sensitive or both. The Vestibular sense affects the following everyday skills:
· Gravitational security
· Movement and balance
· Muscle tone
· Bilateral coordination
· Auditory Language processing
· Visual spatial processing
· Motor planning
· Emotional security
A child with this disorder may be intolerant of movement because her brain can’t
regulate movement sensations. Instead, it processes way too many and her vestibular
system is overloaded. It is easy for these children to become overexcited. The child may also avoid sliding and swinging or even riding a bicycle. Moving in circles may make her head ache. Because of gravitational insecurity, she may be terrified of her feet leaving the ground. I myself suffered with this as a child and refused to go down the slide because the climb up frightened me, and I was also terrified of the teeter totter and swing. Children with this disorder can seem to be willful, cautious, a sissy, be afraid of elevators and
escalators, and need constant reassurance and intervention from a trusted adult. My Isaiah
is this way. Whether riding the camels at the zoo or riding the escalator—he was terrified.
Learning to ride a bike was terrifying and confusing because his feet had to leave the
ground. These children also don’t like to have their heads tilted when washing them,
because there is that constant fear of falling. No wonder the twins screamed during bath
time! Isaiah will now hesitantly climb up a ladder to slide down a slide, but he is hesitant
to do so the first time. What a smile I see on the way down! And to see him want to do it
again is an awesome reward.
These are the kids that are constantly on the move. They crave more and more
movement because the brain is not interpreting the movement messages correctly. These
kids like to hang upside down, run instead of walking everywhere, will rock or spin
constantly, and climb. The world is a ladder to this child and she moves without caution.
At-Home Activities for Developing Vestibular Integration
· Rolling. Cut out the bottom of a cardboard box so the feet, arms and head can stick out and let your child roll down a grassy hill. Or wrap the child up in a blanket of beach towel.
· Jumping on a Hippity Hop. This is a big ball with a handle.
· Swinging: In a blanket, a hammock, a swing. If the child is afraid of his feet leaving the ground, let him start with his feet touching the ground or hold the child in your lap.
· Spinning. Merry-go-rounds, Sit’n’Spins. Never spin a child without their permission, and do not spin them too vigorously as this can set off seizures. We use my office chair to spin. What fun!
· Sliding. Sitting up, lying down, in many different ways slide! Another great slide activity is to attach a rug to a board and slide down steps. The texture is great for the skin and provides some tactile input as well as vestibular.
· Riding vehicles. Trikes, bikes, and scooters. Scooters really help with balance, motor planning and motor coordination. They are highly recommended. (Uh, come to think of it, I’m a klutz and I never could do the
· Jumping on a trampoline. A trampoline with a padded safety guard is a great way to improve vestibular processing, balance responses and lower body and trunk strength. It should always be used with adult supervision.
· Sitting on balls. Whether a large therapy-type ball or a twelve-inch ball, this is great for improving balance.
· Rhythmic rocking. This can be used to either help your child organize their thoughts, be energized or calmed. We use it for all three! Of course, my favorite one is the calming, all snuggled in on Mom’s lap.
· Other activities: Jogging, walking on low curbs/walls, somersaulting, climbing up and down stairs; doing activities on the stomach on the floor, swing or therapy ball such as Legos and other small toys; riding, balancing and walking on a seesaw.
The Proprioceptive Sense
Proprioception is considered the "position sense." It sends messages about whether the muscles are stretching or contracting, and how the joints are straightening out or bending. When this sense is functioning smoothly, we can tell without looking at ourselves if we are seated, or our hands are holding something. This type of perception is needed for throwing and catching a ball or moving up or down stairs. It is considered an "unconscious" sense of body movement. The skills that are affected by the proprioceptive sense are:
· Motor control and planning
· Grading of movement
· Postural stability
· Emotional security
The child with a poor proprioceptive sense will have difficulty interpreting
sensations about the position and movement of his head and limbs. Motor planning is very
difficult and the child may be clumsy and easily frustrated. He may play too roughly with objects, spill milk, and break crayons while coloring. Because he has poor body
awareness, he needs to be able to see what his body is doing. Because each new movement and each new position throw him off guard, he is emotionally insecure. These kids like tight clothes, chew constantly on cuffs of shirts or other objects, deliberately bang into objects, frequently break objects, are very clumsy, and pick up an object with more force than is necessary.
At Home Activities to Promote Proprioceptive Integration
This is where we as home schoolers shine! Especially those of us who have
encouraged our children to participate in the chores at home. The most important
activity for these kids is carrying heavy loads! They can carry the laundry baskets, the
groceries, the garbage, firewood, toy boxes, books, pails of water…anything you can
think of that is heavy and needs transported— grab the kid with Proprioceptive Integration
dysfunction! Pushing and pulling is important, too. They can push the vacuum, the wheelbarrow, wagon, rake, sleds, or whatever else you can think of. This helps the child work up the muscles and joints. Some other activities include:
· Hanging by the arms. No, no, not by the fingernails. Let the child suspend herself from a bar in the doorway or the monkey bars at the park. When she suspends her weight, her muscles and joints feed sensory messages to her brain. She is also developing upper body strength.
· Pillow crashing/crashing into pillows. Now really, need I say more?
· Trampoline. Again, used with adult supervision and with a guard, jumping and play wrestling is a great way to improve proprioceptive processing skills.
· Bear hugs, pouring activities, ripping paper, "bumpity bump" on a tire swing, arm wrestling, leap frog.
· Weighted vests/blankets. These are generally used for calming. I have used weighted vests for my sons when going into a restaurant or store. It slows them down a little. But mainly it helps them "feel" their body, and they are less likely to have a desire to bang to know where their hands are. One caution about weighted vests is that they shouldn’t be used more than 20 minutes at a time because they lose their effectiveness.
By now you have noticed that these activities don’t need the supervision of an
Occupational therapist, but can be implemented under the guidance and love of caring and attentive parents. In his hot new book, "The Child with Special Needs, Encouraging Intellectual and Emotional Growth" Dr. Greenspan emphasizes the need for our
special children to develop good sensory integration in order to move on to higher cognition. He says what home schoolers have always said: that every child, no matter what the label, is unique and different from any other child, and that the vital key to the best outcome is
constant interaction with a loving parent. Finally! The world is beginning to see what we’ve known all along: Parents make the best teachers. And they especially make the best teachers for Special Needs children. The book emphasizes the importance of floor play and constant interacting between the parents and the special needs child. He also has a section in his book that speaks of getting siblings involved in floor play with their special needs brother or sister. I think this is a great book to quote to school districts who are giving anyone a hard time about home schooling their special needs child. There is no way a school can provide the continual one on one floor time that Dr. Greenspan speaks of in his book. I am particularly fond of a paragraph found on page 437:
"Most often when a child becomes a teenager and is several years behind his
peers, we stop offering interactive therapies (which might build the basic skills) and
instead emphasize practical splinter and community-based skills, such as making things and handling money. As a result, the child’s cognitive education is halted and he never advances to more abstract levels of thinking and behaving. But why assume that because a child has not learned to think abstractly by age 15 he never will? Our brains continue to develop until our mid-50’s. Why not assume that if we continue to work with children in optimal programs, they can move up the ladder of milestones and become – at 20, 30, or even 40 – flexible, logical, abstract thinkers?"
Why not, indeed?
My twin sons have been in Mommy’s "Sensory Integration Program" for the last 3
years. To give an example of progress that has been made, when we began our sensory
program, the twins slept under their mattresses, and couldn’t stand the feeling of sheets on their bed. They chewed on their pillows and clothing, and craved constant movement and
deep pressure. I am happy to report they are now sleeping on top of their mattresses, and the sheets, blankets and pillows are no longer an issue. They have even learned to pedal a bicycle! And those are only a few of many issues that we’ve seen improvement in over time, that I believe are directly related to their improved sensory integration. Without good sensory integration, it will be difficult also for Isaiah and Isaac to develop a mature sense of right and wrong. And most of all, I want them to learn empathy so they will have a desire to please God.
"But strong meat belongeth to them that are full age, even those who by reason of use have their senses exercised to discern both good and evil."