Children and adults typically can become annoyed and distracted by noisy sounds or the discomfort of certain types of sweaters. Interventions are only warranted when the child is so affected by these stressful sensory stimuli that she or he with- draws from social interactions, engages in hyperactive and impulsive behaviors, and becomes aggressive, which may result from a “flight or fight” response to uncom- fortable sensory stimuli. A child also can develop hyposensitivity to sensory stimuli.
For example, a child may be insensitive to pain, e.g., may not blink after being burned.
A number of sensory integration therapies have been developed. There is a paucity of studies that show the effectiveness of these treatment modalities (Baranek,2002; Schaaf and Miller,2005; Hodgetts and Hodgetts,2007). Treatments such as the use of prism lenses, physical exercise, and training in auditory inte- gration have been investigated but methodological problems limit their validity.
Sensorimotor handling has not been supported by research (Baranek,2002).
Occupational therapy is the main type of treatment for SID. Occupational therapy consists of putting a child in a room that is set up to stimulate and challenge the child’s five senses, sense of movement, and proprioception. The child is offered a degree of sensory stimulation that she or he can handle and is also encouraged by the therapist to move within the room. The emphasis is on improving the child’s ability to tolerate and integrate sensory stimuli.
There are four principles that underlie occupational therapy for SID patients.
First, according to the “just right challenge” principle, the child participates in play and must be able to handle the tasks that are presented to him or her during these play activities. Second, in the adaptive response principle, the child formulates new and effective techniques to the tasks that are offered. The third principle, “active engage- ment,” assumes that if the play activities are fun, then the child will want to engage in these activities. Finally, according to the “child directed” principle, the wishes of the child are followed in developing play activities or tasks for the treatment.
Sensory Integration Treatment 129 The occupational therapist can treat children with hyposensitivity by presenting the children with strong sensory stimuli, e.g., use of vibrations or rubbing items.
The therapist should design play activities that promote stimulation of the senses, e.g., finger painting or playing with play dough.
For children with hypersensitivity, the occupational therapist can offer the chil- dren peaceful activities such as listening to quiet music or gentle rocking in a room that has soothing lighting. The therapist can use rewards and treats to get children to engage in activities that they usually would refrain from doing.
In addition to improving the child’s ability to tolerate and integrate sensory stim- uli, occupational therapists and other clinicians focus on changing the environment to improve the way the child functions in different settings (Biel and Peske,2005;
Kane,2004). Parents and teachers can change the child’s environment in many ways to help them cope with sensory integration problems (Kane,2004). Children can be given soft, tag-free clothing so that they do not feel pain from their clothes rubbing their skin. Kane (2004) recommends that for children who have sensitivity to touch, teachers should never touch the child from behind and when they do touch the child, they should use firm pressure on the back or shoulder instead of using a gentle touch.
Teachers should line up children with sufficient space between themselves to mini- mize touching. Kane (2004) also recommends the use of chair pillow or cushion for children with sensitivity to touch.
For children who have problems with positional awareness, it is recommended that teachers use markers or masking tape to delineate the child’s personal space (Kane,2004). Teachers should place these children’s desks along the side of the room away from student traffic, and they should ensure that the children be allowed an ample view of where other students are walking. The teacher should also permit children to select where they sit during story time.
Some children at school need more sensory stimuli to help them maintain their focus. Kane (2004) recommends that teachers permit these children to sit on an air cushion pillow that is filled slightly with air. This type of cushion enables children to experience movement without them leaving their desks. For children who need more sensory stimuli, teachers should allow them to climb or run during breaks and exercise periods. The teachers should also give these students opportunities to perform repetitive movements, e.g., washing their desk or erasing the blackboard.
Kane (2004) also recommends that teachers should never discipline these children by taking away their recess or physical education periods.
Some children at school may also need additional sensory stimulation of their hands and mouths (Kane,2004). These children should be permitted to keep a water bottle at their desks. They should be allowed to chew on a straw, coffee stick, or other suitable item. In addition, these children should be encouraged to have a small squeeze ball in their pocket.
At home, non-fluorescent lighting can be used to minimize the child’s inability to tolerate room lighting. Children also can be given ear plugs to cope with emergency drills during school time.
Some occupational therapists also develop treatment approaches for adults with sensory integration difficulties.
References
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