Sensory Integration and OT

Most of us unconsciously learn to combine our senses (sight, sound, smell, touch, taste, balance, body in space) in order to make sense of our environment. Children with autism and sensory integration disorders have trouble learning to do this. Sensory integration therapy is a type of occupational therapy (OT) 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 key principles (1):
the child must be able to successfully meet the challenges that are presented through playful activities;
the child adapts her behavior with new and useful strategies in response to the challenges presented;
the child will want to participate because the activities are fun; and
the child's preferences are used to initiate therapeutic experiences within the session.

Sensory integration therapy is based on the assumption that the child is either overstimulated or understimulated by the environment (2). Therefore, the aim of sensory integration therapy is to improve the ability of the brain to process sensory information so that the child will function better in his daily activities (2).

A sensory integration room is designed to make the child want to run into it and play (1). During sensory integration therapy, the child interacts one-on-one with the occupational therapist and performs an activity that combines sensory input with motion (1, 2, 4). Examples of such activities include:
swinging in a hammock (movement through space);
dancing to music (sound);
playing in boxes filled with beans (touch);
crawling through tunnels (touch and movement through space);
hitting swinging balls (eye-hand coordination);
spinning on a chair (balance and vision); and
balancing on a beam (balance).
The child is guided through all of these activities in a way that is stimulating and challenging (1). The focus of sensory integration therapy is helping children with autism and sensory processing disorders combine appropriate movements with input they get from the different senses.
A parent can integrate sensory integration into the home by providing many different opportunities for a child to move in different ways and feel different things. For example, a swing set can be a form of sensory integration therapy, as can a ball pit or a lambskin rug.

On a daily basis, most people experience events that simultaneously stimulate more than one sense (5). We use our multiple senses to take in this varied information, and combine them to give us a clear understanding of the world around us. We learn during childhood how to do this (6). Thus, through childhood experiences we gain the ability to use all of our senses together to plan a response to anything we notice in our environment (5). Children with autism and sensory processing disorders are less capable of this kind of synthesis and therefore they may have trouble responding appropriately to differently stimuli.
Children with autism may also have a difficult time listening when they are preoccupied with looking with at something. This is an example of their difficulty in receiving information via more than one sense simultaneously (5, 7). Physicians who treat children with autism and sensory processing disorders believe that these difficulties are the result of differences between the brains of children with autism and other children (5, 7, 8).

The underlying concepts of sensory integration therapy are based on research in the areas of neuroscience, developmental psychology, occupational therapy, and education (1-3, 9). Research suggests that sensory information received from the environment is critical; interactions between the child and the environment shape the brain and influence learning. Furthermore, research suggests that the brain can change in response to environmental input, and rich sensory experiences can stimulate change in the brain.

While sensory integration therapy is not harmful, some forms of sensory therapy may be uncomfortable for the child. Children with autism and sensory processing disorders can be especially sensitive to certain types of sensory stimulation; the therapist should respond appropriately to each child. Children should be closely monitored for any negative reactions or self-soothing behavior which might indicate the child is feeling uncomfortable (4). True sensory integration therapy, however, should be child-directed, playful, and pleasant for the child (1, 12).

References
1) Schaaf, R.C., and L.J. Miller. 2005. "Occupational therapy using a sensory integrative approach for children with developmental disabilities." Ment.Retard.Dev.Disabil.Res.Rev. 11(2):143-148.
2) Dempsey, I., and P. Foreman. 2001. "A Review of Educational Approaches for Individuals with Autism." International Journal of Disability, Development and Education v48 n1 p103-16 Mar 2001.
3) Marr, D., et al. 2007. "The Effect of Sensory Stories on Targeted Behaviors in Preschool Children with Autism." Phys Occup Ther Pediatr. 27(1):63-79.
4) Baranek, G.T. 2002. "Efficacy of Sensory and Motor Interventions for Children with Autism." Journal of Autism and Developmental Disorders v32 n5 p397-422 Oct 2002.
5) Iarocci, G., and J. McDonald. 2006. "Sensory integration and the perceptual experience of persons with autism." J Autism Dev.Disord. 36(1):77-90.
6) Wallace, M.T., and B.E. Stein. 2006. "Early Experience Determines How the Senses Will Interact." J Neurophysiol.
7) Minshew, N.J., et al. 2004. "Underdevelopment of the postural control system in autism." Neurology. 63(11):2056-2061.
8) Waterhouse, L., et al. 1996. "Neurofunctional mechanisms in autism." Psychol.Rev. 103(3):457-489.
9) Boddaert, N., et al. 2004. "Superior temporal sulcus anatomical abnormalities in childhood autism: a voxel-based morphometry MRI study." Neuroimage. 23(1):364-369.
10) Dawson, G., and R. Watling. 2000. "Interventions to facilitate auditory, visual, and motor integration in autism: a review of the evidence." J Autism Dev.Disord. 30(5):415-421.
11) Ayres, A.J., and L.S. Tickle. 1980. "Hyper-responsivity to touch and vestibular stimuli as a predictor of positive response to sensory integration procedures by autistic children." Am.J Occup.Ther. 34(6):375-381.
12) Case-Smith, J., and H. Miller. 1999. "Occupational therapy with children with pervasive developmental disorders." Am.J Occup.Ther. 53(5):506-513.