SENSORY INTEGRATION DISORDER – THE HIDDEN HANDICAP

SENSORY INTEGRATION DISORDER – THE HIDDEN HANDICAP
Dr Jillian Stansbury

Sensory Integration Disorder (SID) also known as Sensory Integration Dysfunction and Sensory Processing Disorder, is a neurological condition involving an inability to integrate sensory information – spatial, visual, auditory, olfactory, gustatory, kinesthetic and tactile. Children may display symptoms of hyper- or hyposensitivity to various sensations resulting in learning issues, behavioral disorders, and proprioceptive and coordination disorders. Often misdiagnosed as ADD and ADHD, even though these more common disorders don’t quite fit, Sensory Integration Disorder is one of the newest entities to emerge on the autistic spectrum. I hope that readers will let me off the hook for providing botanical research, just this once. This is a newly emerging topic, and an important one, and no botanical or even pharmaceutical therapies have yet been explored.

SID – The Basic Dysfunction
The term and symptom list was first coined by A. Jean Ayres (1920-1989) PhD Occupational Therapist in the 1960s, who noted that integration of sensation is effortless for most people, but some children have such difficulty with processing sensation that it results in significant handicap, as hidden as it may be. Sensory integration begins in utero as the sense organs and nervous system forms and develops quickly after birth, with sensory processing expanding and becoming increasingly refined through adolescence. Without normal refinement of sensory signals, motor, intellectual and emotional development lacks a stable foundation, thus SID is associated with various learning and developmental disabilities. Sensations are not received or processed by the brain efficiently, and expected emotional, motor, language, or other responses do not develop or mature normally or as expected.(10) Poorly integrated sensory input from the vestibular apparatus may cause poor balance and spatial orientation, and poorly integrated skeletal muscles sensory input may cause poor proprioceptive awareness.
Children may tune inward to avoid overstimulation to various sensations around them, and yet be active in their own activities, and perhaps ignore other children. Children may prefer playing alone with toys than with other children where they cannot control the noise, touch, and may become irritated and overstimulated if forced into crowds, small spaces, and group situations. Or children may crave constant stimulation and are compelled to taste everything, step on everything, jump on everything, similar to hyperactive children but for different reasons. Students will be easily distracted in typical classrooms, and although they do not fit the diagnosis of ADD in the strictest sense, may be diagnosed with this. Many children do not “wind down” easily and may have difficult sleep.
Different children may be more or less able to integrate the various 5 senses, as well as positional and gravitation senses into the psyche. The disorder not only involves and altered processing of these senses, SID is a deficient ability to integrate all these sensations at once, predict what will happen (for example jumping off a high table, or stepping on a fragile toy), and make the most basic of decisions on what action to take, such as respond to a question regarding what they have just seen or heard, or take off a sweater when they are sweating. Children may also be poor organizers and the task of picking up their rooms may be so overwhelming as to drive them to tears of defeat and frustration. Although all of the sense organs are actually working properly, there is difficulty perceiving, interpreting, discriminating, processing and responding to the massive amounts of sensory input that is ongoing.

Symptoms in Early Childhood
SID occurs when normal sensation is not integrated into the autonomic nervous system in a homeodynamic, balanced manner. Normal physical sensory input may trigger a sympathetic “fight or flight” reaction, rather than the appropriate reaction. Children with SID therefore appear to display extreme, odd, or inappropriate reactions. Children for example may scream and cover their ears when a vacuum is used, or shriek as if injured when a relative attempts to hugs them.
Tactile Sensitivity – may include extreme sensitivity to touch as evidenced by sensitivity to tags in shirts, seams in socks, or shoes and clothes in general. Or a poorly developed tactile sense may cause children to roughhouse, or crash into walls and objects, repeatedly bruising themselves, scratching and injuring themselves, or may have poor balance and be extremely clumsy due to failure to develop normal coordination for their age. Children may fear jungle gyms, dislike messy finger painting, be on the late side for learning to ride a bike, and may not enjoy organized sports. Some children may choke or gag on food repeatedly due to poor coordination of swallowing reflexes and extreme sensitivity to textures of foods. Language and general motor skills may be slow to develop in some children, but will usually fully develop over time.
Aural Sensitivity – may include oversensitivity or unresponsiveness to sounds. Normal household sounds may appear to cause pain and traumatize the child. Or as with autistic children, some children with SID will not respond when spoken to, say “what?” frequently, be unable to remember what was said to them, and may became too confused to follow the simplest of directions. I saw one 14 year old boy with SID who so strongly disliked the sound of Styrofoam, his parents would store candy or cookies or items that they didn’t want him to touch inside a Styrofoam cooler, as they knew he would never touch it.
Visual Sensitivity – Children may be sensitive to light and dislike being in the sun, or sensitive to fluorescent lights and find them intolerable.
Olfactory Sensitivity – Some children may be overly sensitive to smells finding some distasteful to intolerable, or may not recognize some smells that require action such as the aroma of burning toast.

SID in Later Childhood and Adulthood
As the disorder is more obvious in younger children and a relatively new diagnosis and discussion, less is known about the more mature manifestations of this disorder. The tactile and other symptoms do appear to lessen with time, but teens and adults are likely to have some aspect of the disorder, and have developed various coping mechanisms. Teens and young adults with SID may be at increased risk for depression, anxiety, underachievement, behavioral issues and difficulty in school. Poor visual-spatial orientation can cause a sensation of dizziness and cause sufferers to feel constantly uneasy and anxious, and SID may overlooked as a cause of anxiety disorder in both children and adults. (13) Children with SID may be ostracized or experience social isolation and resulting character challenges. (12)These children are often poorly understood with teachers urging parents to get the child tested for ADD, and when this fails to result in help, become labeled as uncooperative or poorly disciplined. Children may be delayed in their development of impulse control, prone to self-medication and be at risk for substance abuse, delinquency, low self-esteem, and have trouble fitting in. Due to the many similarities with autism and Asperger’s syndrome, the other most common neural integration disorders, SID is considered to be on the autistic spectrum. Other conditions that involve poor sensory neural integration are schizophrenia and Parkinsonism. Premature birth and brain injury may predispose but other factors are still being explored. Stress and Post Traumatic Stress Syndrome may cause or exacerbate the underlying condition.

Medical Research on SID
Disorders from brain injury to fetal alcohol syndrome can result in altered sensory processing, but many researchers contend that SID is its own separate diagnosis. Some researchers report preliminary genetic research suggesting that SID is inheritable but that other factors may contribute to affect genetic expression of the disorder.
When SID is confined to muscle sensation and proprioception alone, the term Developmental Coordination Disorder (DCD) is also used. Researchers have reported that impaired cerebellar and basal ganglia function contributes to DCD.(1) The inability to process sensory input from the musculoskeletal system can cause “motor learning” deficits.(6) Children on the autistic spectrum, for example, have been shown to be less able to perform rhythmic jumping to verbal cues compared to age matched controls. The actual brain abnormalities that underlie autism remain poorly understood but researchers show reduced somatosensory responsiveness to contribute early in life, leading to altered cortical integration and motor responses. (5)(2)
Researchers are using various neuroimaging techniques including EEG, MEG, and MRIs to map neurophysiological responses to auditory, tactile and visual stimuli, that demonstrate the underpinning of sensory processing deficits common to autism, Asperger’s and SID patients. (11) Individuals with autistic spectrum disorders have difficulty integrating sensory signals to the level of their awareness.(7) Autism researchers also report that some neural pathways are underdeveloped while others are overdeveloped compared with non-autistic subjects – a phenomena being referred to as the disrupted cortical connectivity theory.(8) As the brain’s wiring is somewhat plastic, those with autism and SID display increased neural connections in some pathways and decreased connections in others, compared to children developing more typically.
ADD and ADHD researchers report that neural pathways unique to these conditions have been identified that travel through the left insula, left cingulate gyrus, frontal gyrus, and putamen that make those affected more sensitive to external stimuli and internal thoughts more difficult to inhibit. (3) Gilles de la Tourette syndrome (GTS) may also include increased sensitivity to external and internal stimuli, poor integration and hyper-responsiveness that cannot be suppressed. (4) The pathways that are more poorly connected impair complex cognition and higher reasoning. This underconnectivity appears to underlie autistic spectrum disorders and the increased connectivity in the frontal and posterior brain may develop as coping mechanisms in those affected.

Treatment
Oral medications are mainly palliative at present, such anxiolytics and sleep medications. Many children with SID may be misdiagnosed with ADD or ADHD but do not respond to medications for this condition.
The mainstay of early childhood therapy might be alternative schooling with appropriate physical activities to support the development of proprioception, tactile sensation, aural comprehension and integration, and motor skills. Because many students are startled easily, easily irritated, distracted, and physically uncomfortable, shoes, clothing, lights, pencil sharpeners, silent doors and desks, etc. are important home and especially school considerations. Various Physical and Occupational Therapists offer physical activities aimed at being enjoyed by toddlers and grade school aged children, but many teens and young adults are becoming aware that they had this condition throughout their school years, did poorly academically, athletically, and in all areas, but received no treatment. Occupational Therapists may also use body brushing and massage, music therapy, Transcutaneous Electrical Nerve Stimulation devices, and wide exposure to different tactile sensations. (9)
In school settings, children may be able to type and use a computer with more ease than pen and paper due to limited dexterity. Children may follow instructions and learn more readily with demonstrations and activities than with lectures or purely oral instructions. Tutors and specialized instruction may be optimal as navigating the public school systems may be challenging, if not frustrating, to downright harmful to the child’s development. “Listening Therapy” employs techniques aimed at strengthening auditory processing and comprehension, and will work better than punishing children for not “paying attention.” Calming techniques from reading, to meditation, to breathing, to yoga, to the “body tapping” offered by some practitioners with apparent success, should be cultivated from a young age. Many naturopathic therapies may employed in this arena, from nervine teas, to lavender oil bedtime massages, to Epsom salt and herbal bathtub soaks.
One of the best things that practitioners might do is help parents navigate the quagmire of the educational system, and help parents put together a home, school, physical therapy, and neuropsychiatric team to support a child with SID. Just naming the beast – SID – can be a powerful step at arming parents and educational professionals with a place to start. Schools will often work with learning disabled children more efficiently when a diagnosis (ICD-12 781.99 Sensory Integration Disorder, and 782.0 Tactile Defensiveness and Disturbance of Skin Sensation) has been made.

1 – Res Dev Disabil. 2013 Jun;34(6):2047-55. Motor skill learning in children with Developmental Coordination Disorder. Bo J, Lee CM.
2 – 2013;7:14. Two-legged hopping in autism spectrum disorders. Moran MF, Foley JT, Parker ME, Weiss MJ.
3 – PLoS One. 2013;8(1):e54516. Additional brain functional network in adults with attention-deficit/hyperactivity disorder: a phase synchrony analysis. Yu D.
4 – Behav Neurol. 2013;27(1):57-64. Transcranial magnetic stimulation studies of sensorimotor networks in Tourette syndrome. Orth M, Münchau A.
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6- PLoS One. 2012;7(7):e40932. Development of multisensory reweighting is impaired for quiet stance control in children with developmental coordination disorder (DCD). Bair WN, Kiemel T, Jeka JJ, Clark JE.
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8 – Phys Life Rev. 2011 Dec;8(4):410-37. Disrupted cortical connectivity theory as an explanatory model for autism spectrum disorders. Kana RK, Libero LE, Moore MS.
9 – Sensational Kids: Hope and Help for Children With Sensory Processing Disorder (New York: Perigee, 2006).
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11 – Pediatr Res. 2011 May;69(5 Pt 2):48R-54R. Sensory processing in autism: a review of neurophysiologic findings. Marco EJ, Hinkley LB, Hill SS, Nagarajan SS.
12 – J Dev Behav Pediatr. 2010 Nov-Dec;31(9):720-2. Different is nice, but it sure isn’t easy”: differentiating the spectrum of autism from the spectrum of normalcy. Costello E, Blenner S, Augustyn M.
13 – Prog Neuropsychopharmacol Biol Psychiatry. 2011 Aug 1;35(6):1391-9. Behavioral models for anxiety and multisensory integration in animals and humans. Viaud-Delmon I, Venault P, Chapouthier G.



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