Sensory Integration Disorder
The Hidden Handicap
Jillian Stansbury, ND
Sensory Integration Disorder (SID), also known as Sensory Integration Dysfunction or 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, SID 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, “Sensory Integration Disorder” and its associated symptom list was first coined by the occupational therapist, A. Jean Ayres, PhD (1920-1989) in the 1960s. Ayres noted that while integration of sensation is effortless for most people, 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 form, develops quickly after birth with the expansion of sensory processing, and becomes increasingly refined through adolescence. Without normal refinement of sensory signals, motor, intellectual and emotional development lack 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.1 Poorly integrated sensory input from the vestibular apparatus may cause poor balance and spatial orientation, and poorly integrated sensory input from the skeletal muscles may cause poor proprioceptive awareness.
Children with SID 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 or touch, or 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, and jump on everything, like 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, they may be diagnosed with this. Many children do not “wind down” easily and may have difficult sleep.
Different children with SID 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 an altered processing of these senses, but also 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 in SID, 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 but balanced manner. Normal physical sensory input may trigger a sympathetic “fight or flight” reaction, rather than an 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 hug them.
Tactile Sensitivity – This 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 to crash into walls and objects, repeatedly bruising, scratching, and injuring themselves, or to 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 – This 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.
Visual Sensitivity – Children may be sensitive to light and dislike being in the sun, or be 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 that of burning toast.
SID in Later Childhood and Adulthood
As the disorder is more obvious in younger children and, in general, is 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 or cause sufferers to feel constantly uneasy and anxious. SID may also be overlooked as a cause of anxiety disorder in both children and adults.2 Children with SID may be ostracized, or experience social isolation and resulting character challenges.3 These children are often poorly understood, with teachers urging parents to get the child tested for ADD; when this fails to help, they are labeled as uncooperative or poorly disciplined. Children may be delayed in their development of impulse control, prone to self-medication, have trouble fitting in, and be at risk for substance abuse, delinquency, and low self-esteem. 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.4 Other conditions that involve poor sensory neural integration are schizophrenia and Parkinsonism.1 Premature birth and brain injury may predispose to SID,1 but other factors are still being explored. Stress and Post-Traumatic Stress Disorder 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 also contribute to genetic expression of the disorder.
When SID is confined to muscle sensation and proprioception, the term Developmental Coordination Disorder (DCD) is also used. Researchers have reported that impaired cerebellar and basal ganglia function contributes to DCD.5 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.7 The actual brain abnormalities that underlie autism remain poorly understood; however, researchers show reduced somatosensory responsiveness to contribute early in life, leading to altered cortical integration and motor responses.7,8
Researchers are using various neuroimaging techniques, including EEG, MEG, and MRIs to map neurophysiological responses to auditory, tactile, and visual stimuli, which demonstrate the underpinning of sensory processing deficits common to autism, Asperger and SID patients.9 Individuals with autistic spectrum disorders have difficulty integrating sensory signals to the level of their awareness.4 Autism researchers also report that some neural pathways are underdeveloped while others are overdeveloped, compared with non-autistic subjects – a phenomenon being referred to as the disrupted cortical connectivity theory.10 As the brain’s wiring is somewhat plastic, individuals with SID also 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, and frontal gyrus and putamen, which make those affected more sensitive to external stimuli, and internal thoughts more difficult to inhibit.11 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.12 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 of SID
Oral medications are mainly palliative at present, such as 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 easily startled, easily irritated, distracted, and physically uncomfortable, shoes, clothing, lights, pencil sharpeners, silent doors and desks, etc, are important considerations for home and, especially, school. Various physical and occupational therapists offer physical activities aimed at being enjoyed to toddlers and grade school-aged children; however, many teens and young adults are becoming aware that they had this condition throughout their school years, did poorly academically, athletically, and in other areas, but received no treatment. Occupational therapists may also use body brushing and massage, music therapy, Transcutaneous Electrical Nerve Stimulation (TENS) devices, and wide exposure to different tactile sensations.13
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 system can be challenging, if not frustrating or downright harmful to the child’s development. “Listening Therapy” employs techniques aimed at strengthening auditory processing and comprehension, and works 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 be 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 them put together a home, school, physical therapy, and neuropsychiatric team to support their child with SID. Just naming the beast Ð SID Ð 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-9 code 781.99, Sensory Integration Disorder; or 782.0, Tactile Defensiveness and Disturbance of Skin Sensation) has been made.
Jillian Stansbury, ND has practiced in SW Washington for nearly 20 years, specializing in women’s health, mental health and chronic disease. She holds undergraduate degrees in medical illustration and medical assisting, and graduated with honors in both programs.
Dr Stansbury also chaired the botanical medicine program at NCNM and has taught the core botanical curricula for more than 20 years. In addition, Dr Stansbury also writes and serves as a medical editor for numerous professional journals and lay publications, plus teaches natural products chemistry and herbal medicine around the country. At present she is working to set up a humanitarian service organization in Peru and studying South American ethnobotany. She is the mother of two adult children, and her hobbies include art, music, gardening, camping, international travel and studying quantum and metaphysics.
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- Viaud-Delmon I, Venault P, Chapouthier G. Behavioral models for anxiety and multisensory integration in animals and humans. Prog Neuropsychopharmacol Biol Psychiatry. 2011;1;35(6):1391-9.
- Costello E, Blenner S, Augustyn M. “Different is nice, but it sure isn’t easy”: differentiating the spectrum of autism from the spectrum of normalcy. J Dev Behav Pediatr. 2010;31(9):720-2.
- Magnée MJ, de Gelder B, van Engeland H, Kemner C. Multisensory integration and attention in autism spectrum disorder: evidence from event-related potentials. PLoS One. 2011;6(8):e24196.
- Bo J, Lee CM. Motor skill learning in children with Developmental Coordination Disorder. Res Dev Disabil. 2013;34(6):2047-55.
- Bair WN, Kiemel T, Jeka JJ, Clark JE. Development of multisensory reweighting is impaired for quiet stance control in children with developmental coordination disorder (DCD). PLoS One. 2012;7(7):e40932.
- Moran MF, Foley JT, Parker ME, Weiss MJ. Two-legged hopping in autism spectrum disorders. Front Integr Neurosci. 2013;7:14.
- Marco EJ, Khatibi K, Hill SS, et al. Children with autism show reduced somatosensory response: an MEG study. Autism Res. 2012;5(5):340-51.
- Marco EJ, Hinkley LB, Hill SS, Nagarajan SS. Sensory processing in autism: a review of neurophysiologic findings. Pediatr Res. 2011;69(5 Pt 2):48R-54R.
- Kana RK, Libero LE, Moore MS. Disrupted cortical connectivity theory as an explanatory model for autism spectrum disorders. Phys Life Rev. 2011;8(4):410-37.
- Yu D. Additional brain functional network in adults with attention-deficit/hyperactivity disorder: a phase synchrony analysis. PLoS One. 2013;8(1):e54516.
- Orth M, Münchau A. Transcranial magnetic stimulation studies of sensorimotor networks in Tourette syndrome. Behav Neurol. 2013;27(1):57-64.
- Miller LJ. Sensational Kids: Hope and Help for Children With Sensory Processing Disorder. New York, NY: Perigee; 2006.