sensory integration

Read “The Out of Sync Child.”

My son had these problems including others like chewing on his clothes etc. Not all people have all the different symptoms.

My son does not have any problem wearing anything now and he doesn’t chew on his clothes at all anymore. He used to only wear sweats but now prefers his gap khakis because he looks better in them.

My son has been in OT for over a year and I used the suggestions in the book to provide him with an appropriate sensory diet. It absolutely worked for him. It has worked so well that I don’t really even need to focus on it as much anymore. It has become rather automatic for me to recognize if he is over or under stimulated and to get him where he needs to be. We were with the loud relatives over christmas and we did need to find some quiet time to tame some of his behaviour. It is much better than it ever was before.

I also think that interactive metronome helped to integrate him.

Therapy has been used for many years to change the brain. A more clear example is fine motor issues. Sure it is a motor issue but a motor issue is a brain issue. By stimulating the area of the brain that involves controlling fine motor movement one makes new neural connections that further strengthen with use.

I would also be very careful of taking on a therapy that is short term and then just expecting the gains to be maintained long term. You have to use what you have gained. When a person has a deficit area they shy away from activities that use those areas of the brain. A child with fine motor issues hates to use legos, color and write. Therapy can be, making sure they do these activities to strengthen that area of the brain.

Some educators do not believe that sensory integration exists. I would suggest to those educators that they check out the work of real scientists who actually study the brain for a living.

Linda F, thanks very much for your reply. I will definitely look into this. I am not dismissing the claims of OT for sensory integration, I just want to know how it works. Does it help with the auditory aspect at all? Would it help an adult, such as myself? Or a teenager, such as my daughter?

My son also chews on his clothes. He also takes his arms out of his sleeves, but won’t wear short sleeves at all, even in the summer. He also won’t wear the new clothes we buy, even if he helped pick them out.

My daughter has difficulty with visual sensory integration. She can’t tolerate dim restauraunts. She said stripes make her dizzy. I appreciate any information you can give me. I will also look for the book.

Sensory integration is talked about as though it is one thing but in reality it is more likely many different things as it manifests differently in different individuals and the therapy required to help will be different depending on the symptoms. I am not an OT but I am an RN who has worked with occupational therapists and have seen miracles happen with brain injured patients. I have approached my son’s LD/ADHD as if he has a brain injury. I have looked at his specific difficulties and tried to target each area. We have seen some excellent results. When I got the big diagnosis LD it was daunting. As I have remediated his LD I started to see his ADHD more clearly. We have just taken it one step at a time remediating each problem as it became apparent.

One thing I will tell you about chewing as it related to SI; the child is most likely seeking oral stimulation. I found the way to deal with this was providing appropriate oral stimulation so that the innappropriate seeking of this need could be diminished. I brushed my son’s tongue, the insides of his cheeks, his lips, his gums etc etc… When I did this it stopped. Eventually we didn’t need to do it anymore. He did revert back once or twice and we would start it up again and he would stop again. He hasn’t needed to do it for about 6 months.

Other types of tactile defensiveness are dealt with through helping the child discriminate different tactile senses. Often if you were to hide something they can not discriminate what it is through the tactile sense. Improving this skill can help to get the defensiveness under control. Also, providing the child the opportunity to experience tactile stimulation that they find enjoyable will help them to discriminate better using this sense. To simplify, this sense is not working properly so it needs practice.
Things like letting the child brush his skin , or rub the skin with various textures. Try a massager that vibrates. Have the person discriminate various shapes like letters or numbers without seeing them. They are using the tactile sense to learn to discriminate different things. One thing do not force these activities on the person. The therapy needs to be guided by the patient.

For my own son I have found that balancing activities and deep pressure work to calm him. He has a hypoactive vestibular and actually will seek out this type of activity on his own. He has always been a banger and a crasher. He always loved to wrestle and I have learned that was a part of his seeking out deep pressure related to his hyporeactive vestibular. He at times needs help regulating these types of activities because too much will send him right over the proverbial edge, making him cranky, and difficult.

I am not an expert on SI but I am an expert on my son’s particular SI issues.

I would suggest you contact an OT who is certified in sensory integration. You can also just read about it on your own. I have found that this has been the most helpful part for me. As I understood what my son was going through I was able to help him deal with it. I don’t get mad at him for something he can’t really control. I can now stay objective and help him find solutions.

Liz,

Based on your “lab rat” posting, I think you might want to look into the clinical studies that have been done on sensory integration therapy. So far, there are no well-controlled double blind studies demonstrating the effectiveness of the therapy for LD or ADHD symptoms. That doesn’t mean it wouldn’t work for you or that it doesn’t work at all. It just means that there is currently insufficient evidence to say that it works for the majority of those with such symptoms. People tend to get upset when I post this information, but I keep doing it because I think it is important for us all to be educated consumers. As parents of children with ADHD or LD, we often have to make difficult decisions about where to spend our money and what avenues to pursue to help our children. We can do a better job of that if we know what the evidence is that supports the effectiveness of a particular therapy. If you are interested, here is a link to a recent article discussing the lack of research supporting the effectiveness of SI therapy: http://www.nasponline.org/publications/cq312si.html

Andrea

I think that what you say, Andrea, about lack of proof of the existence of sensory integration can easily be said for ADD/ADHD as well. In fact, it can be stated for much within the world of diagnosing LD’s. There are no blood tests. Still, we know that certain therapies and interventions work to help people with a certain constellation of symptoms function more like most other people. What’s true of ADD/ADHD is also true of sensory integration: We can help these people by using certain methods. In some cases, the methods are even similar. As an example, deep pressure helps SI kids but it also helps most ADHD’ers.

I read the article here on LDonline written by a child psychologist questioning the existence and remediation of sensory integration. Frankly, his argument could also be used as an argument against his own profession: psychology. Where’s the quantifiable proof that it works?

I’m not a sensory integration OT but I work daily with them. This is what I know: IT WORKS. I’ve followed several kids for a period of over three years now as they work almost daily with OT’s. I’ve also seen other kids through the same period of time whose parents have NOT hired OT’s to work with their kids. There’s a big difference in the two groups. There’s also a big difference between the kids who began SI therapy early and those who began it later. After about third grade, it’s diminishing returns. The same could be said for reading remediation - we want to get to those kids early too because we know how much easier it will be for them to progress as compared to an older child.

Through repeated exercise, the brain does change. For whatever reason (and this is still really a brave new world of research), SI kids didn’t pass through the usual developmental stages. Good SI therapy gives this to them. They practice and practice. They also learn techniques to calm themselves down or to revv themselves up, depending on what’s needed. Could they learn this on their own? Maybe. Some of us did. Some of us also learned coping strategies on our own to compensate for our weak reading or math skills. Do we then say that we shouldn’t offer remediation in math or reading because people can compensate? Of course not. Same should be true for SI issues.

I’m sure we’ll learn loads more about SI in the future. We may learn that some of the work is more useful than others. We’ll learn different ways to help these kids. But the point is, for now, this is what we’ve got. It’s imperfect (so is therapy and meds for ADD/ADHD; so is psychology) but it’s helpful. It frustrates me immeasurably when people, especially those in the field of psychology (another very imperfect field), debunk the work of sensory integration experts. I have to question whether it’s sour grapes because it may be taking clients away from them.

I agree that OT is helpful. My own child had six years of it, beginning at age 5. Some was SI based, some not. I don’t know if it was the methods used, the practice, the placebo effect, the Hawthorne effect, maturity, other remediation, all or none of the above that helped my son to improve. I’m just glad he eventually gained basic competence with a pencil. I don’t discourage people from getting OT for their kids, I just want them to understand what they are getting into. I’m lucky to be financially able to provide multiple interventions for my son and OT was one of them. Some people can’t afford to do that and need to think carefully about where they expend their resources. If you have to choose between potentional treatments, it is important to have all of the information.

I don’t think that the article I mentioned, or the research into SI therapy has questioned the existence of a constellation of symptoms that we call sensory integration dysfunction. That makes the situation different, at least to my way of thinking, from the ADHD diagnosis example you posit. The issue is whether SI therapy has been proven to improve those symptoms in most people who have them. So far, the research does not show conclusively that it does, or that it improves symptoms associated with ADHD or LD. By contrast, reliable research consistently shows that stimulants and atomoxetine do reduce ADHD symptoms in most people who take these medications. To be sure, questions remain as to the long-term safety and efficacy of these treatments, but the research is solid that these treatments work for the majority (not all) of those with ADHD. SI therapy may well be an effective treatment, but so far, the research does not support that conclusion. Perhaps the answer to the problem is for more research to be done, but I don’t agree that those who point out the absence of scientific support are engaging in sour grapes tactics.

Andrea

My son also used to chew his clothing, and now he doesn’t . He did OT for about a year several years ago, and more recently IM. I’m not sure when the chewing stopped but he is much better at regulating himself, so I don’t think he needs that type of stimulation anymore. I think its human nature to want oral stimulation actually. My daughter who is not LD and has no issues and is the most self regulated child I know has been sucking her thumb since she was born. She has always been able to calm herself, and I think this is one of the reasons why.

Andrea,

You posted once that your child grew out of SI issues. Now, you could have a child who remained with SI issues well into adulthood as Liz has experienced. You would never know for sure if he grew out of this or if the OT you provided really helped.

Sometimes I look at my son and it is easy forget how he was before all the interventions. Sometimes I just want to believe that he never really had a problem and that he just outgrew issues. When I look honestly at the way things were and the way things are I know that therapy did help him.

I am glad I didn’t put him on meds because if I had I would probably have stopped there and he wouldn’t have been able to achieve the permanent changes in his brain that were achieved through therapy.

I am not knocking meds but just talking about my experience. I have no doubt that meds would have helped his attention and even some of his motor issues. I may still even use them at some point if his attention does not grow with him and he gets to the point where he needs them to succeed. In the meantime, if I can find answers that will allow us to not go down that road, I will find them.

Then I am sure I will look upon him as a child that just outgrew his issues. It is funny that is how the rest of our family sees it. I am the one who worked with him the most and know the best what it took for him to outgrow things.

Linda,

I agree. I really don’t know why my child has improved. I’d like to think it was because of the help we provided him, but there really is no way of knowing whether he would improved without those interventions. I choose to believe that interventions made the difference because it makes me feel useful. One thing is for sure — his problems have not disappeared. My son has ADHD and a neurological disorder that continues to affect his coordination. He has improved but will never be “cured”. My husband has the same symptoms, as does his father and his brother. My older son has them in milder form that does not rise to the level of a “diagnosis”. What I think is important about choosing treatments is whether those treatments will give the child a way around the brain problems that are the cause of the symptoms. In my child’s case that meant OT (lots!), special education appropriate to his gifted intellect and medication for his ADHD. Those things seem to have worked for us.

Andrea

Andrea,

Let me explain why I get quite irked at the idea that some knock Occupational therapy.

I had a distant relative visit. He was a 13 year old boy who really was very sweet. I had never met this boy before. He was on many meds for his adhd. I think 3 or 4 in total. Despite all of these meds he had some serious problems that were very obvious to me. His mom couldn’t handle him and had thrown him out. His dad was getting remarried and that is how the boy ended up with us. He needed a break from this kid while he got adjusted to his new relationship.

This child had obvious sensory integration issues. Big, neon sign issues. He could not play bop it as well as my motor impaired 6 year old, he was clumsy and uncoordinated. He apparently had trouble with impulse control, but I suspect an innappropriate sensory environment played a role as he didn’t have this problem with us.

All the doctors and parents knew to do was to throw in some more meds. It wasn’t working and no one told this family about his sensory integration issues. I think his life would have been different if this was dealt with.

This boy didn’t grow out of this problem and probably never will. Meds helped him somewhat, but for this boy, and I think others, they are not a panacea.

Linda,

I hope you don’t think I’m knocking OT — certainly that is not my intention. I think OT is incredibly important. It is important to remember though that sensory integration therapy is not the only OT out there. Seven years ago my then 5 year old son was evaluated by a pediatric neurologist who diagnosed his DCD and suggested occupational therapy. He told me that the research to date did not show that sensory integration therapy was an effective treatment and urged me to make sure that the OT we chose used both SI methods and more traditional methods. All these years later, the research still doesn’t conclusively support the effectiveness of SI therapy. It doesn’t disprove it either. So, once again, we parents have to jump in and try to make reasoned choices in the absence of conclusive evidence. My solution to the SI issue was to make sure that the OT my son received was targeted in a practical way to his specific problems and that the therapist was not wedded to only one theory of how to help him. The same symptoms in my son that an occupational therapist would call sensory integration disorder are viewed by medicine as ADHD, developmental coordination disorder and Prechtl’s syndrome. Is everyone just using different words to describe the same thing or are we talking about several different disorders operating at once? I really don’t know. I have wondered if the SI issues that are so common in kids with LD or ADHD aren’t just indicators that there is any underlying brain disorder. It makes sense to me that this is the case, but again, I really don’t know. What I do know is that it usually takes more than just one kind of treatment to help these kids. Just giving medication is probably not going to be enough, as you point out. Sometimes, just OT or IM or neurofeedback or whatever is not going to be enough What I am trying to do is make people aware of the need to look for scientific validation when evaluating treatment choices, medication or otherwise. OT can do a lot, but it isn’t going to cure ADHD. Medication won’t do that either. In fact, I’m not aware of any kind of treatment currently available that offers a cure. The best we can do right now is offer symptom control and improvement. What you choose to achieve that depends on the child and the family, but it is important to educate yourself before making that choice. Obviously you and I have done that. Others are still in the process of doing so and they are vulnerable to irresponsible people who may promise a lot more than any treatment can deliver. That’s why I keep putting the information out there.

Andrea

I think you are right that SI does exsist and that it is just called different things by different people. Whatever you call it and however you do it, it needs to be addressed.

I think IM helped my son’s SI issues as much or more than OT did. Even the IM needed follow-up so that he used his new skills or they would have been lost.

I don’t think that all kids with adhd need meds. It bothers me when I get that message. The school has alluded to the idea that I am medicating him. They have said that if he is on a new med they need to have it documented. This came about because I have admitted to them that he is adhd and we discussed the changes from last year. They have assumed the fidgeting and other things changed because of meds but it really is related to IM and other at home OT that I have done.

My son is a marginal case. He is not the extreme ADHDer. His attention can go in and out and still does. I am working to help him gain the self control he needs to have it be more in than out.

I am in the process of reading the book “The Out of Sync Child.” I can see some aspects of SI dysfunction in my kids, but the book focusses on the tactile and sensorimotor issues only. What about the inability to screen or filter out or habituate to noises, sights and lighting? These are my problems and my children’s problems. My children are not noticably clumsy. In fact, my daughter was singled out by her dance teacher and Tae Kwon Do instructor as particularly graceful. So do my children have SI dysfunction? Or is this simply another symptom of ADHD?

I really think there is an underlying neurological reason for the inability to habituate to new sensations (sounds, feelings, visual, smell, and taste). We are all bombarded with an array of sensations but most people habituate to them, whereas the ADHD child has a harder time doing so. I am still not sure that OT will help my children.

What are the chances that I will find someone locally who does this sort of therapy? What are the chances that my insurance pays for it, or that I can afford it?

I would love to find someone locally who does the Interactive Metronome therapy, as my older daughter is a musician and I think could benefit from this therapy, whether or not it helps with ADD. But, alas, I went to the IM website and found there is nobody locally who provides it. Will that be true of OT for SI dysfunction?

I am just a tired mom, trying to do the best for my kids. But I have alot on my plate. I have 6 kids, ADD myself, and I have an ADD husband. I have limited time and limited money.

I still have a question about whether SI addresses the “far senses” problems that I and my children have.

You ask some excellent questions. I really don’t think it matters what you call it. SI is really just a group of symptoms. It is many things as you have seen. My son’s SI issues are not the same issues you may be dealing with.

I really agree about the underlying neurological issue point. It does seem as though some LD/ADHD children fail in what is normal development to habituating specific senses. The toddler who sucks her thumb is developmentally normal but the second grader still biting on shirts needs help. (Then there is the mom who still bites her nails, yikes.)

I think some call the inability to differentiate and filter sound CAPD. My son does not have these issues so I have no idea what works to help.

Visual issues really do run the gammet. They can vary so much. I did some wonderful visual perception exercises that really helped my son read graphs and discriminate patterns better, but it didn’t cure his visual tracking issues. We are doing different exercises that work on those. Then he also needs to learn to visualize symbols, so, yet another program, seeing stars seems to have helped with that.
In the end we will be seeing a vision therapist because I do believe his biggest issues are still in the visual realm. I have tried to take this one piece at a time. This is a marathon and not a sprint. I really haven’t spent a ton a money. I am pretty much a do it yourselfer choosing to tutor and do other things myself. I have found that when I take this boy to experts they only scratch the surface and tell me things I already know. I just know him so well at this point.

I would say, “Get specific,” share specific problems with people on these boards especially the parenting a child with LD board. I have found just so much help from the real experts; parents on the front lines.
Also, some great teachers many of whom have lived through this as parents.

Linda:
My daughter that I believe is ADD also chews her clothes. Last year she destroyed a couple of shirts and a winter coat. When I would catch her with her clothes in her mouth I would call her a ” Gerbil” and tell her to quit chewing on her stuff. She has been a thumb sucker from birth. This year we are having sock problems. I can not tell you how many pairs of socks I have purchased that just are not right! We are also not liking pants that are a little stiff feeling like jeans. They cant be tight around the waist they have to be soft. Getting dressed in the mornings is getting stressful.

You mentioned oral brushing. Did you use a soft toothbrush? How long did you do the brushing and how often? Could the same brushing work for her sock problem?
Darcy