Sensory Integration Therapy for Children

Sensory integration therapy is used to support individuals with sensory processing disorders. Some psychiatric conditions which have sensory processing disorders include autism and ADHD. These conditions tend to show up early in childhood, some examples being difficulty regulating responses to sensory stimuli, or difficulty in expressing consistent interest towards certain matters. Sensory integration therapy utilises various techniques to help develop important life skills such as communication skills, social skills, and behaviour and learning abilities. 

Sensory integration therapy and its purpose

Sensory integration therapy (SIT), also known as Ayres Sensory Integration (ASI)¹ is a type of treatment that is performed mainly by occupational therapists and other multidisciplinary professionals. Through integrating sensory inputs that are present in everyday stimuli, individuals can practise and gain confidence in giving an appropriate adaptive response.² The purpose of SIT is to assist children who often struggle with psychiatric disorders in their sensory processing development. SIT is used mainly for children struggling with different health issues that include learning problems not limited to autism and ADHD, but also developmental coordination disorder, even childhood obesity.³  Essentially, SIT involves play-based sensory-motor activities with the child which influences the response to sensation, improves motor skills, and overall boosts concentration and social skills.⁴ 

Understanding sensory processing disorders

Different psychiatric disorders have various characteristics – some examples of psychiatric disorders that have sensory processing disorder (SPD) are autism and attention deficit hyperactivity disorder (ADHD). The meaning of sensory processing disorder fundamentally means when an individual has difficulty with processing input senses (light, sound, taste, touch, and smell), which causes them to adopt a fight, flight, and freeze response.⁵ 

STAR Institute categorises the types of sensory processing disorders by their primary patterns – sensory modulation disorder, sensory-based motor disorder, and sensory discrimination disorder. Under each primary pattern, there is an example of some of the subcategories.⁶ 

• Sensory modulation disorder: inability to control response to sensory stimuli.
• Sensory over-responsive: the tendency to react to sensory stimuli in a manner more expressive than most individuals find bearable in terms of quantity, timing, or duration.
• Sensory-based motor disorder: Difficulty with motor coordination, including balance, and complications in the performance of non-habitual and/or habitual motor tasks.
• Dyspraxia: Difficulty in planning and/or executing skilled motor movements, especially unfamiliar and new movement patterns.
• Sensory discrimination disorder: Difficulty discerning subtle details of objects, locations, people or other surroundings.
• Tactile discrimination disorder: Inability to distinguish or interpret higher-order visual/spatial aspects of touch, such as stereognosis and graphesthesia disorders, or characteristics of sensory inputs felt on the skin.

For more information regarding these subtypes, see STAR Institute’s resources linked here. By gaining insight into these different subtypes, common symptoms of SPD in children can be more readily identified. Hypersensitivity or hyposensitivity to sensory input, problems with motor skills and coordination, and difficulties with attention, behaviour, and emotional control in response to sensory stimuli are common signs of Sensory Processing Disorder (SPD) in children. These symptoms are sometimes expressed as what we deem as overreaction or underreaction to sensory experiences. 

Principles of sensory integration therapy

The sensory integration theory is the basis which sensory integration therapy expands from. It emphasises the importance of supporting movements that engage active and dynamic sensory-motor processes. The theory also highlights how integration of social and physical interaction, would prompt development and improvement for children with developmental and behavioural disorders.⁷ 

Children with SPD often have decreased sensory modulation and they lack the capacity to ignore or tune out redundant stimuli, causing them to feel overwhelmed. The goal of SIT is to assist children struggling with SPD to deal with daily stimuli that they are exposed to and modulate an appropriate response to these sensory inputs. Through integrating and simulating real-life situations, children can slowly develop independent postural stability and spatial orientation which are essential to daily lifestyle. 

A supportive environment that promotes exploration and self-regulation is fostered by offering enriched sensory experiences that are customised to the child's needs. This encourages active participation in meaningful sensory activities and facilitates adaptive responses to sensory stimuli through structured interventions. This environment is intended to enhance the praxis, integration, and sensory modulation abilities of the child. 

Assessment and diagnosis

The assessments that are used for evaluating and diagnosing sensory processing problems include standardised tests, clinical observations, and caregiver questionnaires.⁸ Based on the reviews of different studies that utilise the PRISMA criteria or Osteba Critical Appraisal Cards, it is shown that the tools most commonly used are the Sensory Integration and Praxis Test (SIPT), the Sensory Processing Measure, and the Sensory Profile.⁹ 

For children between the ages of 4 and 8 years 11 months, the Sensory Integration and Praxis Test is the main diagnostic instrument used to determine sensory integration dysfunction and praxis issues.⁹ In-depth clinical data on processing vulnerabilities within each sensory system, such as under- and over-responsiveness, sensory-seeking behaviour, and perceptual issues, are provided together with norm-referenced standard scores. Teachers and carers are essential in filling out the assessment forms since they see the child's reactions to many sensory experiences all day long.¹⁰ These evaluation instruments are often used in tandem to offer a comprehensive picture of the child's sensory processing skills and to guide focused intervention plans.

Early diagnosis is crucial to ensure suitable and timely intervention for affected children. By providing a supportive environment to accommodate the needs of children as early as possible, they will be able to experience earlier exposure to sensory input and allow tolerance to build. This helps to mitigate the sensory challenges that they will encounter in the future. Some essential sensory processing skills that it could help develop include but are not limited to motor skills, social interaction, and emotional regulation – all of which are paramount to overall functioning and daily participation. 

Types of sensory integration therapy techniques

The following bullet points show the typical sensory integration therapy techniques that can be used.¹¹ The techniques can differ depending on the child’s personal needs. 

• Play-based activities: The main SIT medium is play. Occupational therapists provide engaging exercises that test a child's capacity for sensory processing. These activities utilise a variety of senses. E.g. Playing with swings, trampolines, big balls, and other sensory-rich equipment.
• Swinging and spinning: Vestibular (balance and movement) feedback is frequently provided through swinging and spinning exercises. Children's balance, coordination, and ability to control their arousal levels can all be enhanced by these exercises.
• Deep pressure activities: Proprioceptive input is provided by deep pressure activities, like squeezing or covering a child in a blanket, which aids in the development of body awareness and soothing reactions in the child.
• Weighted vests and blankets: Deep pressure and proprioceptive input are applied with the use of weighted vests and blankets. They can support kids in feeling more centred and grounded.
• Brushing protocol: The Wilbarger Brushing Protocol calls for applying deep pressure to the child's skin with a soft surgical brush. It is thought that this method enhances sensory processing and lessens tactile defensiveness.
• Therapeutic listening: Using music that has been created to boost a child's auditory system is known as therapeutic listening. It is thought to improve self-regulation and sensory processing.
• Changes to the environment: Occupational therapists can advise making changes to the child's surroundings to lessen sensory disturbances or provide opportunities for sensory exploration.
• Visual stimulation: Playing with colourful lights or tracking moving objects are two examples of visual stimulation activities that might enhance attention and visual processing.
• Oral motor activities: Activities that involve the mouth, such as blowing bubbles or chewing food, can enhance oral sensory processing and assist with speaking and eating.
• Sensory diet:  A sensory diet is a customised plan that includes sensory activities throughout the child's daily routines.

Implementing sensory integration therapy

In order to address the complex requirements of children with sensory processing issues, collaboration among a diverse team of therapy providers is crucial. Occupational therapists, speech therapists, physical therapists, educators, psychologists, and doctors all bring special knowledge and viewpoints to the table. They collaborate to create tailored intervention programmes that address many facets of the child's growth. Occupational therapists are essential to Sensory Integration Therapy because they apply sensory-based therapies that improve functional skills and sensory processing abilities. Physical therapists deal with balance and motor coordination problems, while speech therapists concentrate on enhancing social and communication skills. Educators also work in tandem with therapists to develop sensory-friendly environments and modify educational settings to meet the child’s needs.

Optimising the efficacy of interventions requires that therapy be individualised to meet the needs of each patient. Every child is different, with strengths and problems that call for tailored strategies. For instance, a child may benefit more from working with speech therapists than educators if they need more assistance with communication and social interaction skills. Professionals can address particular areas of difficulty and encourage each child's optimal growth by customising therapy to meet their needs.

The development and enhancement of social and communication skills depend heavily on the engagement of parents and other carers. Although experts provide assistance, parents and other carers are an integral part of the team that will help the child to apply the techniques that they learn in therapy sessions into practice. It is their duty to provide a setting that is supportive of the child's development and to incorporate practices and activities that do just that. 

To guarantee success and reduce frustration for both the child and their carers, realistic goal-setting is crucial. Setting realistic and attainable goals would be more feasible and less frustrating. This approach also can ensure improvement albeit its “slower” impression, fostering a feeling of achievement and inspiring sustained endeavour towards the child's growth.

Challenges and considerations

Accessibility and affordability are significant challenges for many families seeking therapy and support for children with sensory processing difficulties. Affording therapy, in addition to daily expenses, can be considered a privilege, as it often comes with significant costs. 

Therapy sessions frequently require caregivers to be present and actively participate in learning alongside the child to reinforce techniques and activities essential for improving the child's condition. However, this necessity can pose challenges for working parents or caregivers who may struggle to afford the time away from work or other responsibilities. 

The combination of financial constraints and time commitments can make accessing therapy services difficult for families. Despite these challenges, prioritising regular therapy sessions and incorporating therapy techniques into daily routines can help maximise the benefits of intervention for children with sensory processing difficulties. Consistency is crucial in therapy for children with sensory processing difficulties. While one session alone may not significantly impact a child's development, the cumulative effect of regular sessions and consistent practice is essential for facilitating growth and progress. 

Future directions and research

Studies involving people with SPD are part of the growing body of research in SIT. This change is a result of a greater understanding of the long-term effects of sensory processing issues and the requirement for interventions that are customised for each person at every stage of life.

 For example, resources such as the Sensory Integration Education website, which offers information on the most recent advancements in sensory inclusion and therapy approaches, provide access to current research findings and updates in the field. Therapy approaches are continually assessed and improved as science advances to better serve people with SPD.  There is also a notable increase in media attention and awareness-raising efforts surrounding SPD and fostering a greater understanding and facilitation for individuals with sensory processing difficulties. This heightened awareness contributes to improved recognition and management of SPD, highlighting the importance of continued education and training for professionals and caregivers alike. 

Summary

SIT assists children with SPD to develop fundamental motor skills, regulating their responses to sensory input, and enhancing their social and communicative abilities. These goals are accomplished through the use of sensory-rich environments, tailored therapeutic approaches, and sensory-motor activities. 

Occupational therapists, speech therapists, physiotherapists, educators, and other specialists work together to provide children with SPD with complete care. Maintaining consistency can be challenging for families due to factors like conflicting schedules, financial constraints, and other responsibilities. These issues need to be addressed to ensure consistency and effectiveness of SIT. With continued research and advancements in therapy practices, there is hope for better outcomes and an enhanced quality of life for children with SPD.