INTRODUCTION TO SENSORY INTEGRATION THERAPY

Children with Autism Spectrum Disorders such as Autism or Asperger's syndrome with frequently have problems with sensory problems, including their sense of touch, smell, hearing, taste and sight. Wearing certain fabrics, tasting certain foods, or normal everyday sounds may cause emotional outbursts. The opposite is also possible - the child with an Autism Spectrum Disorder may feel very little pain or actually enjoy sensations we would dislike: strong smells, intense cold or unpleasant tastes.

Along with this will frequently be difficulties in movement, coordination and sensing where one's body is in a given space. The brain seems unable to balance the senses appropriately in cases of Sensory Integration Dysfunction. The brain may not be able to filter out background stimuli yet admit what is important, so the person with Autism or Asperger's may have to deal with overwhelming amounts of sensory input day and night.

How sensory integration therapy typically works

The main form of Sensory Integration Therapy is a type of occupational therapy 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 main principles:

• Just Right Challenge (the child must be able to meet the challenges through playful activities)
• Adaptive Response (the child adapts behavior to meet the challenges presented)
• Active Engagement (the child will want to participate because the activities are fun)
• Child-directed (the child's preferences are used to initiate therapeutic experiences within the session).

Sensory Integration therapy is careful to not provide children with more sensory stimulation than they can cope with. The occupational therapist looks for signs of distress. Children with lower sensitivity (hyposensitivity) may be exposed to strong sensations, while children with heightened sensitivity (hypersensitivity) may be exposed to quieter activities. Treats and rewards may be used to encourage children to tolerate activities they would normally avoid.

For more information on Sensory Integration Dysfunction, see the Sensory Problems fact sheet.

Guidelines for children with heightened sensitivity

Parents can find it very distressing when if their child rejects hugs, cuddles and other demonstrations of affection. This can be interpreted as a personal rejection when it is a discomfort with unpleasant touch. These guidelines may help in more appropriate touch with autistic children who have hypersensitivity:

• The child may find it easier to initiate hugging than receive it

• Touch is often more tolerable when the child anticipates it

• Firm, unmoving touch is better than light or moving touch

• Light touch may be tolerable after firm unmoving touch
• Initial stimulation may be unpleasant but tolerated later.

sensory integration Therapy for different SENSES

Touch

The sense of touch varies widely between children on the autism spectrum. Many kids enjoy the feel of sticky textures. Try experimenting with glue, play dough, stickers, rubber toys, sticky tape. Other things that can be great for tactile sensation are water, rice, beans and sand.

Children with Autism often enjoy a sense of firm overall pressure, such as wrapping them up in blankets, being squashed by pillows and big hugs. These can form a great basis for play, interaction and showing affection. Experiences that may be claustrophobic can be liked, such as being squashed between mattresses, and making tunnels or tents from blankets over furniture. Read Temple Grandin's story and the development of her 'hug machine'.

"Our son hates light touches. But we now play 'monster attacks', where we pick him up, turn him upside down, spin him around, throw him on the couch, bury him under cushions then sit on him, yelling and carrying on the whole time! He loves it, and over time we worked in hugs and strokes at the end of it all. Now we can show him affection normally as well, and he is more comfortable with the rough and tumble play of other young boys". PDC (we strongly suggest caution if 'burying' a child under cushions, to avoid suffocation - Ed.)

Appreciation of firm pressure to light touch seems to be very common on the autism spectrum. Try using deep pressure with the palm of your hand instead of stroking or light touch. Some children love being tickled, while of course others will hate it.

Smell

Be aware of your child's response to the smell of substances too. Experiment with putting different fragrances in play dough or rice. If your child actively likes strong odors, find toys that specialize in this.

Sound

Experiment with talking toys, games on computers, musical instruments, squeaky toys and all sorts of music. Clapping together, rhymes, repeating phrases and tongue twisters are useful activities. Auditory Integration Therapy may help in dealing with sounds.

Some children on the autism spectrum respond to music but not voices, in which case music therapy may help. Try speaking in a melodic or “sing-song” voice and see if the response improves. Try different tones of voice, pitches, and gauge your child' reaction. Loud or unexpected sounds generally won't be liked. Explain noisy toys to the child first then introduce it at a distance. In extreme cases, it may be worth introducing noise-making toys using social stories.

Sight

As you can gather, parents may need to play detective in finding the sensations their child is enjoying. Autistic kids were often reported as staring at nothing when young by their parents, when they were actually entranced by the movement of shadows on a wall, or listening to wind moving through the trees outside. Parents may need to work hard to find the things their child enjoys visually. It could be anything that is long and narrow. I might be things of a precise shade of orange. A preference for looking at straight lines is often reported. There are many toys that aim at stimulating sight with bright color schemes and flashing lights. Remember your child probably won't want to be taken by surprise! In some cases, visual therapy may be able to help.

Proprioceptive system

The Proprioceptive System helps children (and adults) to locate their bodies in space. Autistic children often have have poor proprioception and will need help to develop their coordination. Therapy may include playing with weights, bouncing on a trampoline or a large ball, skipping or pushing heavy objects.

Vestibular system

The Vestibular System is located in our inner ear. It responds to movement and gravity and is therefore involved with our sense of balance, coordination and eye movements. Therapy can include hanging upside down, rocking chairs, swings, spinning, rolling, somersaulting, cartwheels and dancing. All these activities involve the head moving in different ways that stimulate the vestibular system. Be careful to observe the child carefully to be sure the movement is not over stimulating.

Back and forth movement appears less stimulating than side-to-side movement. The most stimulating movement tends to be rotational (spinning) and should be used carefully. Ideally activities will provide a variety of these movements. A rocking motion will usually calm a child while vigorous motions like spinning will stimulate them. Merry-go-rounds, being tossed on to cushions or jumping trampolines can be real favorites with some children. Experimenting and careful introduction of each activity is the way to go!

Learning new skills involving movement

Skills such as tying shoe laces or riding a bike can be difficult as they involve sequences of movements. Therapy to help in this area may use swimming, mazes, obstacle courses, constructional toys and building blocks.

Difficulty with using both sides of the body together

Crawling, hopscotch, skipping, playing musical instruments, playing catch and bouncing balls with both hands are some of the many activities that can help with bilateral integration.

Hand and eye coordination

Activities may include hitting with a bat, popping bubbles, throwing and catching balls, beanbags and balloons.

Is Sensory Integration Therapy a proven treatment?

Although Sensory Integration Therapy is widely used and supported by anecdotal evidence, there is as yet little research that would establish it as an evidence-based treatment. One study found only poor quality evidence providing either no, or at best equivocal, support for Sensory Integration therapy (Dawson and Watling 2000). There have been many studies done but these have not been conducted rigorously enough for Sensory Integration Therapy to be considered an evidence-based treatment, despite it being widely used as an intervention for Autism and other developmental disorders.

I can't afford these therapies, or they don't exist in my area

The good news is that as with many intervention therapies, they can be done at home by the parents. When finances are a problem, you may be able to have one or two sessions with an occupational therapist who is experienced in Sensory Integration Therapy to get advice on home-based therapies. Contact your local Autism or Asperger's association as they will be able to put you in touch with free or low-cost services.

When there are no services in your area, you can still do home-based therapies. This fact sheet offers some ideas and there are many books available on Sensory Integration Therapy. Also, some Autism associations may respond to email enquiries from parents in remote regions.

Sensory issues are explored further in the Sensory Problems fact sheet.

Click here to read an interview with Lorna Jean King on Sensory Integration Therapy

Click here for the full range of Asperger's and Autism fact sheets at www.autism-help.org
This autism fact sheet is licensed under the GNU Free Documentation.