Last week we had a look at what Sensory Integration is, and what Sensory Integration problems are on a neurological level.  In this post we examine how they present in the child, at home or in the classroom, and how they are identified by occupational therapists.  It may seem like a lot of new terminology, but as you read on you will see examples and perhaps recognise these signs in some children you know.

What do Sensory Integration difficuties look like?

Difficulties with sensory reactivity can present as over- or under-responsivity to sensory input and modulating sensory information. A child with a well-modulated nervous system adapts effectively to changes in the environment and is able to maintain a level of arousal and attention appropriate to the task at hand. The child is able to block out irrelevant information, attend to relevant information and respond appropriately and adaptively. This enables the child to engage in a meaningful manner in activities of daily life.

A child who is over-responsive to sensations experience difficulties with filtering sensory inputs and may experience sensory inputs more intensely than most other children. Over-responsiveness may lead to a fight, flight or freeze response to non-threatening stimuli.
A child who is under-responsive to sensations may not respond, or show a less intense response, to normal sensory stimuli. These children may appear to “miss” sensory information from their bodies or the environment.

Difficulties with sensory perception result in difficulties in identifying, discriminating and interpreting sensations.

Children who struggle with discriminating the spatial and temporal characteristics of sensory input will have problems with tasks such as knowing how hard to press on their pencil, finding an object in a bag without looking, adapting the body during balance activities or learning the spatial orientation of numbers and letters.

Postural and ocular control and bilateral integration difficulties will be noticeable in the performance of daily tasks.

Children may struggle with postural and ocular control, which may present as a slouched posture during table-top activities, problems with making postural adaptations while moving during sporting activities, or struggling to maintain visual contact with a moving object such as an approaching ball.
They may also experience challenges with integrating the two sides of the body. This may lead to difficulties with bilateral tasks such as throwing and catching a ball, cutting, dressing and motor sequences like skipping and galloping.

Difficulties with praxis will be noticeable in the child’s physical interactions with objects, people and the environment.

Children can experience challenges regarding visual- and visual-motor planning, tactile perception and difficulties with imitating, planning and/or sequencing motor actions.
Challenges may also occur in the planning and coordination of new motor actions (this function is known as “praxis”). Children who struggle with praxis may appear clumsy, and uncoordinated, may be hesitant to engage in new motor activities, or may appear as though they do not know what to do with or how to use objects in the environment.

How are Sensory Integration problems identified?

To make a diagnosis of sensory integrative dysfunction, there needs to be evidence of a deficit in processing of vestibular(movement), proprioceptive (body position) or tactile (touch)sensory inputs.

An occupational therapist trained in Ayres Sensory Integration(ASI®) will utilise various standardised and non-standardised assessments to collect information regarding the child’s ability to process sensory information. Currently, the Sensory Integration and Praxis Tests (SIPT) are the international golden standard for testing sensory integrative functions. In addition other tests, checklists and clinical observations are used in conjunction with collateral information from parents/caregivers and educators are used to assist in identifying sensory integrative dysfunctions. Based on the assessment information, the occupational therapist will develop a hypothesis regarding the underlying sensory integrative difficulties or dysfunctions that contribute to the child’s problems/challenges in activities of daily life.

Assessment in ASI® is an on-going process. Continuous assessment and observation during therapy as well as continued interaction with parents/caregivers and educators are of the utmost importance to guide intervention towards optimally supporting the child.

[This piece was initially written for the SAISI promotional pamphlet and adapted by Karen Powell]

SAISI Contact Details:

P.O.Box 14510 Hatfield Pretoria South Africa 0028

Tel: 012 3625457

Fax: 0866523658