Question: What Do Sensory Integration Therapists Do for Children with Autism?
What exactly does a sensory integration therapist do? What kinds of outcomes can parents expect for their children with autism and sensory processing disorder?
The idea behind sensory integration therapy is that it is possible to “rewire” the brain of a person with sensory processing disorder in order to improve their daily lives. The concept of sensory integration therapy was first developed by Dr. Jean Ayres, whose theories about neurology and sensory function are embraced by some in the field, yet questioned by others.
Practitioners of sensory integration therapy are usually occupational therapists. Their focus is on the tactile, vestibular and proprioceptive systems. In English, this means that SI therapists work on normalizing patients’ reactions to touch, help patients become better aware of their body in space, and help patients work on their ability to manage their bodies more appropriately (run and jump when it’s time to run and jump, sit and focus when it’s time to sit and focus, etc.).
If a sensory integration (SI) therapist has his or her own office, it may be equipped with a variety of unusual equipment, including swings, therapy balls, slides, ramps, a ball pit, and other sensory materials.
Testing for Sensory Issues
A trained SI therapist evaluates a potential patient for sensory defensiveness, hypersensitivity, and sensory cravings, using several different scoring techniques. Some of the standard tests include:
- Sensory Integration and Praxis Tests (SIPT) for children between the ages of 4 to 8 years, 11 months
- The Test of Sensory Integration for children between the ages 3 to 5 years (TSI)
- The Bruininks Osteretsky Test of Motor Proficiency for ages 5-15 years
- The PEERAMID for ages 6-14 years.
“Evaluation is complicated; it’s not a cookie cutter approach,” says Dr. Lucy Jane Miller, director of the Knowledge in Development Foundation, which specializes in sensory dysfunction and sensory dysfunction therapy. “Every child is different, so we need to know what type of vestibular and proprioceptive input does he need. I use stimulation during evaluation to figure out a child’s nervous system. I create a chart with 7 systems up and along the side. I try to figure out how each system affects the other. So I don’t just assume a child needs brushing — but try to figure out how I can use auditory input to affect tactile reactions, etc. By the time I get to the tactile system, it’s much more ready to be treated.”
Depending upon the needs of the patient (usually a child), the SI therapist may use various techniques such as:
- deep pressure therapy, which may include squeezing, rolling, etc.
- jumping on a mini or full-sized trampoline
- playing with a toy that vibrates, is squeezable, etc.
- gross motor play such as wall climbing, balance beam, etc.
- brushing and joint compression
The Sensory “Diet”
SI therapists also may develop a sensory “diet,” which may include a variety motor activities (spinning, bouncing, swinging, squeezing balls or silly putty, etc.), as well as therapist-provided interventions such as brushing and compressing arms and legs. The idea is that this “diet” will be provided throughout the day, whether by a trained therapist or by teachers, aides or parents. In theory, if a child receives appropriate intervention all day, he or she will be better able to take part in typical daily activities. Over time, say some therapists and parents, children are better able to focus, less likely to “stim” (flap, jump or spin inappropriately), and are often more comfortable in situations that involve a high level of sensory input.
Dr. Miller works specifically toward short term life skills goals such as the ability to stay in a loud space without over-reacting. In her practice, 20-30 sessions plus parent training is often enough to make a big difference in a child’s daily life. Other therapists, however, work with children over the long term – sometimes for years.
Until recently, scientists thought attention deficit/hyperactivity disorder (ADHD) was a childhood issue. But several studies show that attention deficit disorder (ADD), with or without hyperactivity, is a lifelong problem for up to five percent of adults. Unfortunately, adult ADHD comes with a series of devastating consequences from difficulty focusing at work to relationship woes and trouble paying bills. How do you know if you or someone you love is at risk? Read on.
Genetics and ADHD
“Far and away, the biggest risk factor for ADHD is genes,” says Scott Kollins, PhD, director of the Duke ADHD Program at Duke University Medical Center. And while the triggers for ADHD are unclear, studies show that one in four children with ADHD have at least one first-degree relative (parent or sibling) with the disorder.
When the distracted, irritable, rambunctious kids with ADHD grow up, many of them still struggle with the disorder. A Swedish study of children with ADHD found that 49 percent of the adults who were diagnosed with the disorder as children continued to have marked symptoms of ADHD at age 22, and 58 percent were abusing drugs or alcohol, living off a disability pension or welfare benefits, suffering from a severe psychiatric disorder, or facing a criminal conviction.
Nearly equal numbers of men and women have ADHD, but many more boys are diagnosed with the disorder than girls. “Boys tend to have more hyperactive and disruptive behaviors, which gets the attention of school administrators and others who can refer them to appropriate care,” says Floyd Sallee, MD, PhD, professor of psychiatry at the University of Cincinnati.
Environmental Contributors for ADHD
From an environmental perspective, in utero exposure to nicotine and heavy metals like lead increases the risk of developing ADHD in childhood. Such substances are toxic to developing brain tissue and can have sustained effects on behavior. “It’s not known how much exposure is necessary, but studies show a definite link,” says Sallee.
The impact of alcohol in utero on the development of ADHD is less clear. Fetal alcohol syndrome is not directly related to ADHD, but the symptoms of it — cognitive impairment and inattention — are similar. In adults who have ADHD, drinking can exacerbate symptoms, so it’s a good idea for those with the disorder to steer clear of alcohol.
When it comes to food, most experts agree that the link between food additives, sugar, and other potential culprits have been overblown. The issue hasn’t been studied in adults, but presumably the effects (or lack thereof) are the same. That said, you’d be hard-pressed to find anyone — ADHD or not — who doesn’t lack focus a few hours after a doughnut-and-coffee breakfast. A balanced diet is key.
Complicating Conditions of ADHD
ADHD does not occur in a vacuum. “The rates of just about every psychiatric disorder are higher among people who have ADHD,” says Kollins. In one study, 87 percent of patients had at least one psychological disorder such as depression or anxiety. People with ADHD are also much more likely to self-medicate with alcohol or drugs and have higher rates of substance abuse than adults without the disorder.
“You can develop secondary anxiety or depression from a lifelong history of demoralization because you can’t do well at your job or you chronically pay your bills late or you have difficulty managing your relationships — all of which are primarily due to your ADHD,” says Sallee. “Most adults don’t go to their primary health-care provider or mental-health professional because of their ADHD. They come because they’re having problems in their life.”
It doesn’t matter which came first — the depression or the ADHD. What matters is that you find a health-care provider who recognizes and treats both.