INTERVIEW WITH LORNA JEAN KING -
A PIONEER OF SENSORY INTEGRATION THERAPY
Lorna Jean King OTR, FAOTA is one of the pioneers
integration therapy. Ms. LJK is an international lecturer on
this topic, and is the Founder and Director of the Center for Neurodevelopmental
Studies, Inc. in Phoenix, Arizona. This interview was conducted
by Stephen M. Edelson (SE) on June 9, l996.
How did you get involved in the area of sensory integration as
well as autism?
My interest in sensory integration started when
I was the Director of Rehabilitation at Arizona State Hospital.
I was very interested in the literature which indicated that the
vestibular system seemed to be involved in schizophrenia; that is,
many schizophrenics do not have normal responses to vestibular stimulation.
They have little or no post-rotary nystagmus.
Does this apply to those with childhood schizophrenia, since autism
was, at one time, confused with schizophrenia; or does this apply
to schizophrenia in general?
It seems to apply to what is termed "negative
symptom" schizophrenia, or early onset schizophrenia, but not
always to childhood schizophrenia. There have been many research
studies over the years showing involvement of the vestibular system
in schizophrenia. I knew that Dr. Jean Ayres, whom I had known earlier,
was working on the vestibular system which was involved in her sensory
integration theory. We began using sensory integrative treatment
with chronic schizophrenics and had quite marked success in improving
their ability to function. We also had a children's unit at the
State Hospital which housed several autistic children. Since we
had an opportunity to work with them, we used sensory integration
therapy with them and also had some very encouraging results.
Can you briefly describe what is the goal of sensory integration?
The goal of sensory integrative therapy is to
facilitate the development of the nervous system's ability to process
sensory input in a more normal way. Sensory integration is a term
for a process in the normal brain which pulls together all of the
various sensory messages in order to form coherent information on
which we can act. Basically everything we do requires sensory integration.
This normal process can be missing or very badly organized in some
people, notably autistic individuals.
I assume there are many theories of what went wrong with respect
to integrating different senses.
Yes, there are many theories, and several of them
make sense. Many years ago Bernard Rimland's book, Infantile
Autism, suggested that the problem with these children might
be in the reticular formation. This area in the brain is responsible
for keeping the brain alert and organized. Research by Bauman and
Kemper, and Courchesne has shown that the cerebellum is involved
in autism and
I think it is also a good candidate for the root of the problem.
What should parents look for when deciding whether or not to have
their child receive an evaluation for sensory integration?
Parents should look for things that indicate that
the balance system is not quite normal; for example late motor milestones,
or the child who falls and hits his face because he isn't getting
his arms out to break his fall. The child who is unusually fearful
of movement, or who lacks normal fear of falling, may not have normal
balance (vestibular) sense. The child who is very hyper-sensitive
to sensory stimulation is a candidate. These sensitivities include
over-reaction to noise, disliking to be touched or held. These are
the children who stiffen up rather than liking to be cuddled, scream
when their hair is combed or washed, or when they are bathed or
dressed. These are the types of behaviors which are most common
in children whose sensory integration systems are not functioning
There appear to be three major areas which are addressed with
sensory integrative therapy - - vestibular, proprioceptive, and
tactile. Could you describe each one for us?
The vestibular system, located in the inner ear,
relates us to gravity. It gives us our sensation of the weight of
our body. It also tells us where we are in space, standing up, or
on our head; whether we are falling, or turning our head. It monitors
our head and body movements in any direction. It works 24 hours
a day, and therefore is a very big source of input.
The proprioceptors are the neuroreceptors in tendons,
muscles and joints. They tell us where our foot is when we pull
it back to kick a ball, or how high our hand is when we reach up
to comb our hair. Because the proprioceptors are getting input whenever
we move, they also are a large source of sensory input. Proprioceptive
input can vary in intensity. When one jumps on a trampoline, there
is more intense input to the ankles, knees, and hips than there
is in walking. Pushing a wheelbarrow full of cement is more intense
input to the wrists, elbows and shoulders than pushing an empty
The tactile or touch system has three different
types of receptors. One responds to light touch, like touching a
hair on one's hand. This is a protective, alerting sense which makes
us check on what is touching us in case it might be dangerous, like
a bug crawling on the skin. The second receptor is for discriminative
touch, for example when you reach in a pocket and know by feel whether
you are touching your house key or your car key. We learn a great
deal more than we generally realize through this sense of discriminative
touch. The third set of touch receptors are those which receive
information about heat, cold, and pain.
Interestingly enough, children who do not process
sensory information efficiently often do not have good reception
of heat, cold, and pain input. As sensory integration becomes more
efficient through therapy, they often become more normally aware
of heat, cold and pain. Sensory integration therapy seeks to help
the child be less hypersensitive to light touch, better able to
use discriminative touch to learn, and more able to respond appropriately
to heat, cold, and pain, and thus be more safe from harm.
When a therapist offers sensory integration therapy, does it also
involve other senses, such as smell, taste, vision and hearing?
Or does sensory integration focus only on vestibular, tactile and
Sensory integration therapy works with all the
senses, but the vestibular, tactile, and proprioceptive senses are
important because they are such large sources of input. Of course,
they are connected to everything else. For example, the vestibular
system and the visual system are very closely associated, and often
a child's ability to use his eyes in a coordinated way will improve
as he/she receives enough vestibular input. Hearing is also very
important, of course, and one of the things that we offer is "auditory
integration training" which aims to help balance the way the
nervous system receives auditory input so that the child will not
be hyper-responsive to particular sounds or to auditory input in
general. This is a promising field.
Have you yourself seen changes as a result of auditory integration
Yes, we have had some children who have shown
increases in language and a decrease in sound sensitivity after
integration training. Not all children show improvement. Some
children show marked improvement, and others show a little improvement.
Well, that statement is true for a lot of treatments out there.
What advice do you give to parents of a recently diagnosed child?
I advise them to do a lot of movement activities
with the child. They should not force things on them, but encourage
climbing, walking, swinging. These activities will help develop
the vestibular system. For children who are hypersensitive to touch,
a massage with lotion or powder, or an extra-long rub down after
a bath may help to overcome oversensitivity. Many of the activities
one might suggest are things that one normally does with ordinary
children, but that are needed in much larger quantities by the autistic
If it is not obvious that a child has any sensory problems, would
you still suggest that he/she have a sensory evaluation?
Yes, I would. Based on our experience, which has
been pretty extensive, I would say that 85 to 90 percent of autistic
children have sensory integration problems. Some are much more obvious
than others. A therapist's trained eye may pick out subtle signs
which may be quite significant, but which a parent might not realize
were important. Often small gains in helping the child be less sensitive
to sensory input can make big changes in behavior.
Do you think these sensory issues are more common in those who
have a severe form of autism versus those who have a few autistic
I believe there are sensory integration problems
across the spectrum, but, yes, there are more severe problems in
some children than others. This does not correlate with intelligence.
Function in some realms may be quite normal, but the child may be
totally handicapped by extreme fears which are often sensory-based.
What are some things people might see soon after going through
sensory integration therapy?
I think the first thing that parents often observe
is a decrease in tantruming, less panic reactions, less fear, and
more willingness to interact with other people. Often eye contact
increases within two to three months, sometimes after only a week
What about their arousal level? Are they calmer?
Yes, They are usually calmer, and they are more
able to handle ordinary stimuli. Parents often report that they
can take their children to the restaurant without their becoming
upset. After a few months to a year, I think parents will notice
improvements in communication. We may see an improvement in oral
communication, but almost always there is a greater ability to communicate
needs either using gestures, signs, or pointing to pictures. As
a result, the frustration from not being able to communicate lessens.
We also see an improvement in the child's ability to learn, - learning
the meaning of numbers and the basic concepts needed for reading.
Is a person ever too old to benefit from sensory integrative therapy?
No, not really. We know that the nervous system
develops by making new connections between neurons throughout life.
As some connections disappear through disuse, other connections
can be formed as a result of new experience. So the brain is able
to make adaptations at any age. We have had good results with teenagers
and adults. A 39 year old is the oldest person we have worked with
recently, and that person made tremendous gains. Initially, he was
not able to be in any kind of a day care program because of his
aggressive behavior. After about six months of weekly treatment,
where his parents continued the treatment at home, he was able to
be in a day treatment program with no further problem. So the changes
in behavior can often be very important in older people.
How much sensory integrative therapy does a person need? Or does
it just depend on the individual?
I think that usually more is better. In our program
we work with children five hours a day, five days a week. Unfortunately,
this is not often possible. In the public schools a therapist may
see a child for a half-hour a week. This is not very adequate. I
am not saying that these children will not benefit, but it could
be a much faster process. Treatment does not go on forever. The
goal is to return the child to a normal classroom or a normal community
setting as soon as possible. Ideally, if we are able to start with
a pre-school age child, intensive treatment might go on for a year
or two and then could be scaled back to a follow-up schedule.
When families see a private practitioner, it is usually once a
week. Would you suggest that parents also provide some type of sensory
integration therapy for their children at home?
Yes, I think that is important. However, I think
that what is crucial is that parents understand the rationale for
doing these things and that this is not some sort of witchcraft.
Basically, there are good neurological reasons for swinging the
child, doing lotion rubs and things of this kind. I also think it
is important that parents do not feel victimized by the need to
do therapy. We believe that the whole family is important, not just
the handicapped child.
The siblings and the parents need time for themselves,
so we try to give the parents activities that are fun, that siblings
can take part in, and that the whole family can do. We tell them
that if there are days when you just don't have the time, or it
becomes a real chore, then skip that day. The child knows if the
parent is not enjoying the activities, and they won't want to do
it either. It is important that it not be a burden. It has to be
Should parents ask the therapist for suggestions on what to do
Absolutely. They certainly should ask. And most
therapists will give them lists without being asked. But if they
have not been given a list, they certainly should ask.
Your program uses Temple Grandin's Hug Machine. How is this working
We have some children who like it a lot. They
spend quite a bit of time, almost every day, in it. But there are
also children who are not interested. The Hug Machine is a good
method for applying sustained pressure, which is one of the most
effective calming techniques. Some children prefer other methods
of getting sustained pressure, such as being wrapped in elastic
bandages for a time.
Could you comment on the relationship between behavior and sensory
People need to be re-educated to understand that
behavior is always communication, - it is always telling us something.
People often use the word "behavior" to mean "bad
behavior". Often the child does not know any other way to tell
us. It is our business to find out what the behavior is communicating.
Often sensory sensitivities are actually painful and the child's
behavior is an attempt to escape. By being observant, finding out
what triggers the "behavior", we can modify the environment,
and help the child find acceptable ways to cope, such as teaching
him to wear ear phones to protect himself from too much noise. As
we use sensory integrative therapy to raise the child's threshold
for arousal, and provide calming inputs, we can see improvements
Let's talk about problems at school and how to handle them.
There are many problems at school that can be
dealt with effectively by simply changing the student's environment,
such as protecting the child from noise. One of the important ways
is for the teacher to use a very low tone or to whisper when she
really wants to get a child's attention, rather than raising the
voice. The teacher may try to teach all of the children to use quiet
tones. In our program, we talk about using "your indoor voice"
inside, which means talking quietly.
We also find that sitting on a beach ball or a
T-stool can help the child attend. This provides extra vestibular
and proprioceptive input which helps the nervous system organize
and process information better. We have a large box at our Center
that is lined with pillows and a bean bag chair. When we see that
a child is beginning to get upset or stressed, we invite the child
to get in the box and look at a book or listen to a tape. We use
this as a preventive method to short-circuit "bad" behavior.
In other words, we give the child a respite from a situation that
is getting too stressful. We have found that this works quite well.
We do not use "time out" as a consequence for disruptive
behavior, because that may be rewarding, if all the child wants
is to get out of a noisy, stressful situation. We find that prevention
works much more effectively.
How about the home environment? I guess it would also be a good
idea for parents to have a secure quiet place for their child if
things become too stressful?
Yes, it is important to have a place where the
child can retreat for a little while. The child should not be allowed
to retreat all the time, but he or she can retreat when things are
too stressful. It is also important to find ways that are calming
for a particular child. It may be as simple as having a rocking
chair in their room, or having a swing . It could also include wrapping
the child in a nice big quilt for just a few minutes. This can be
very calming. Basically, parents need to find out what works with
What about stereotyped or self-stimulatory behavior?
In general, self-stimulating
behaviors are attempts at calming - behaviors that a child has
found which make him or her less upset and more calm. Sucking the
thumb and biting the nails are examples of stress relieving mechanisms
that normal people use. The autistic child's calming methods may
seem bizarre, but they usually involve biting or chewing or sucking,
or rhythmic rocking - another universal calming input. We try to
help the child find socially acceptable methods of relieving stress.
Sometimes giving the child something to have in his/her hands to
play with will discourage hand flapping, for example. Things such
as playing with a "koosh ball" or a musical toy may work.
When children chew their shirts as well as other things, I often
suggest to parents to give their child a toothbrush to chew. The
bristles are stimulating, and it is somewhat socially appropriate.
I agree. Actually, the best toothbrushes for
this are called "nook brushes". This is the toothbrush
that babies are usually given. There are other alternatives. For
instance, we may get a length of aquarium tubing or a boat key float
and put a loop around the child's neck. When the child starts chewing
on his shirt or his wrist, we say "here, chew on this for a
while". It has a very satisfying chewy texture. Often the inappropriate
chewing will diminish in a few weeks. Chewing is definitely a stress-related
Some therapists and teachers allow the child to engage in self-stimulatory
behaviors as a reward after the child works on a task for a certain
length of time. What do you think about this method?
I think it is better than forbidding the child
to engage in these behaviors, but I think it is even better to give
them a more socially acceptable alternative behavior. If you let
them engage in these behaviors as a reward, you are essentially
saying that the behavior is socially acceptable.
What do you think of those programs that teach a child to inhibit
these self- stimulatory behaviors?
It depends on how important the behavior is in
relieving stress. If the behavior is important to the child in calming
himself and relieving stress, he will probably just develop another
one, which may be even less socially acceptable. The long-range
solution is two-fold. Through therapy, facilitate the raising of
the child's threshold for arousal, and help the child learn self-calming
techniques that are acceptable.
Could you describe the Center for Neurodevelopmental Studies?
The Center is a non-profit corporation founded
in 1978 to provide the most advanced neurodevelopmentally based
therapeutic methods for autistic and other developmentally delayed
children and adolescents. The Center's main program is a state certified
school called The Developmental Day School. At present there are
39 students ranging in age from two to twenty two. Most, but not
all, of the students are autistic. The school provides a tightly
integrated program which combines occupational therapy, speech therapy
and music therapy with academic or pre-academic training. The staff
to student ratio is one and a half to two. In addition to the school,
the Center also provides individual therapies to children from other
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