Sensory Integration

Sensory integration is the most prominent and important program for autism, specialized in by the occupational therapist. It is they who determine where the sensory problem lies in the autistic child, and they work on organizing the autistic child's senses so that information arrives correctly and is analyzed correctly in the brain. On the other hand, it connects the different senses to function as a whole. The work of an occupational therapist specializing in sensory integration relies primarily on the sense of touch.

• Sensory integration theory: a historical overview:

Sensory integration theory seeks to explain specific learning and behavioral problems that are not due to central nervous system damage. The first to lay the foundations of sensory-neural integration theory was the American occupational therapist (Jean Ayres). She added other hidden senses to our five known senses: the vestibular sense, associated with the inner ear, which provides information about gravity (space, balance, movement) through the position of the head and body relative to the earth's surface; the sense of balance, which is located in the inner ear and lets us know the position of the head forward or backward even if we close our eyes. Ayres' focus on neural function and learning processes helped advance the understanding of "intelligence" as a result of sensory perception, sensory integration, and sensory processing. Her work led to numerous studies aimed at improving learning abilities through sensory integrative therapy, which helps children progress toward higher employment of mental abilities.

• The first to discover sensory integration theory:

It is Jean Ayres, an occupational therapist, in 1972. To facilitate explaining Jean's theory, while the primary senses are known to be sight and hearing, Jean focused on three additional senses that may have been neglected by specialists in child development and growth. These are: Tactile (through the skin, the sense of touch, and under touch through the skin fall light touch, pressure, pain sensation, and temperature sensation); Proprioceptive (whether muscles or joints, the sensation of body movement); and Vestibular (the sense of balance, which is in the inner ear and informs us of the head's position forward or backward even if we close our eyes). To better understand the latter two senses:

Example:

Learning to ride a bicycle: when a child learns to ride a bike, these two senses—body movement and balance—must work in solidarity well so that they can ride the bike without falling to the ground. Even the fetus in its mother's womb uses these senses before the senses of hearing and sight; it reacts when pressure is applied from the outside and moves inside the uterus. At birth, it feels its mother's touches and quietens when she holds it. At six months of age, the sense of sight begins to coordinate in solidarity with movement and balance.

When the child begins learning how to sit and control balance and support, if the child receives different sensations—touch, sensation of body movement, balance, sight, smell, hearing—they are considered important sensory nourishment for the brain. For the brain's function is to continuously receive all sensory stimuli and use them in solidarity.

Accordingly, receiving sensory solidarity therapy lies in improving the effectiveness of the child's nervous system in terms of translating and utilizing the sensory information reaching it from the environment in a way that helps the child overcome their sensory difficulties. Thus, the child learns to choose the solidarity of senses that helps them reach their goal. And now, after the concept of sensory solidarity has become clearer:

The question is: what does it have to do with autism? The answer is that autistic children have a dysfunctional sensory system, as this dysfunction in them may be hyporeactivity or hyperreactivity in one or more sensations. There are children who are severely affected by sound (hyperreactivity) and others who act as if they cannot hear (hyporeactivity). Others hate touch, even normal touch, and may hate a specific type of clothing because it is rough. Even with food, they may prefer soft, tender food with a smooth texture in their mouth. Thus, here is a sensory dysfunction: hypersensitivity or hyperreactivity by the child to the sense of touch. Also, there are those who react intensely to pain, and conversely, those who are not affected by pain. Likewise, there are children who like movements that involve balance stimulation, such as many children who like spinning around themselves, rocking forward and backward, jumping constantly, or climbing on furniture edges; thus, here is a sensory dysfunction: hyporeactivity to the sense of balance. Other children, quite the opposite, do not like movements involving balance; they feel extreme fear of normal movements such as swinging, sliding, or even going down stairs, meaning feeling fear of external space; here too is a sensory dysfunction (Hypersensitive / hyperreactivity). It is, as we mentioned, the sense of the body's presence from muscles and joints (Proprioceptive). When this sense works well, we can control how we sit or hand movement, such as when writing with a pen or holding a spoon. But when there is a dysfunction, we see that the child stumbles a lot while walking, meaning falling frequently to the ground, and finds it difficult to control movements such as feeding themselves or buttoning their shirt. When there is a dysfunction in the three senses that Jean Ayres focused on, there will be difficulty in the fine and gross muscles working together, and sensory solidarity is lost.

• Concept of sensory integration: the human reception of information from various senses, sending it to the brain, and then processing it and providing appropriate responses. Each sense works with the rest of the senses to form an integrated picture of what we are physically, where we are, and what is happening around us. The brain is considered responsible for producing this complete picture as a sensory information system used continuously. Effective sensory integration occurs automatically, unconsciously, and effortlessly through our sensory experiences, including touch, movement, body awareness, sight, sound, the force of gravity, balance, and smell.

Sensory integration (SII) develops in most children through ordinary childhood activities. It forms the essential foundation for academic learning and social behavior. Sensory integration begins in the womb, where these hidden senses develop early during pregnancy stages, so the fetus's brain senses the movement of the mother's body. Then these senses interact with the other senses—hearing, sight, taste, and smell—which develop later. The closest example of the concept of neuro-sensory integration is the integration of the senses of touch and smell with the processes of sucking, breathing, and swallowing during a baby's breastfeeding.

• Components of the sensory communication process

Sight - Hearing - Touch - Smell - Taste - Movements and Balance - Body Posture

• Importance of the sensory integration process:

11. It helps a person adapt naturally to their surrounding environment by understanding environmental stimuli and issuing appropriate responses to them.

Examples: When a young child touches a hot cup and feels pain, they pull their hand away quickly, thus learning.

22. The discriminative tactile system: this system allows us to determine where touch occurred and the nature of what was touched. The protective tactile system: this system alerts us when exposed to danger, resulting in responses represented by flight, fear, or even a hostile reaction. A disruption in the functioning of the tactile system may cause the protective system to interpret ordinary contact as posing a danger. In the case of children whose sensory system provides false information, they are always in an alarm cycle, and the reaction may be the child fleeing, intense panic, or an aggressive reaction, and at other times the reaction is verbal.

Sensory integration disorder:

It is a neurological disorder arising from the brain's inability to integrate and process

specific information received from sensory systems, and an impairment in the ongoing relationship between behavior

and brain function. Therefore, some behaviors may appear that seem strange and for which we find no

clear logical explanation or apparent cause. These behaviors directly affect

the child's learning process, representing an obstacle to the child's learning and their integration into the educational environment they are in. They cannot communicate well with educators and teachers, as well as with their peers in the classroom, find difficulty completing homework, and a series of family and educational problems begins for the child; consequently, we find it difficult to understand and deal with these problems. Thus, it can be said that disorders of sensory processing in the child have a direct and strong impact on their learning, which requires specialized intervention to identify these disorders and establish a treatment plan for them to reduce their negative effects on the child. It has been observed that children who have such problems can appear exceptional in other things and may have normal or above-normal intelligence.

Who has sensory integration problems:

1. Pervasive sensory disorder.

2. Autism.

3. Advanced cases of attention deficit and lack of focus.

4. Balance disorder cases (specific to the vestibular system).

5. Problems in academic and artistic skills.

6. Bilateral coordination dysfunction.

7. Center of gravity disorders.

8. Motor disorders and accompanying disorders.

• There are many indicators of sensory integration deficiency:

A- Loss of the sense of body position in space or not feeling safe in movement against gravity.

B- Loss of sensory and visual perception and social skills, such as language and speech delay, which leads to loss of self-confidence.

C- As this dysfunction in them may be hyporeactivity or hyperreactivity in one or more sensations: there are children severely affected by sound (hyperreactivity) and others who act as if they cannot hear (hyporeactivity).

D- Others hate touch, even normal touch, and may hate a specific type of clothing because it is rough.

E- Even with food, they may prefer soft, tender food with a smooth texture in their mouth... Thus here is a sensory dysfunction: hypersensitivity or hyperreactivity by the child to the sense of touch.

F- Also, there are those who react intensely to pain, and conversely those who are not affected by pain. Likewise, there are children who love movements involving balance stimulation, such as many children loving spinning around themselves or rocking forward and backward, or jumping constantly, or climbing on furniture edges; so here is a sensory dysfunction: hyporeactivity to the sense of balance. Other children, quite the opposite, do not like movements involving balance, as they feel extreme fear of normal movements such as swinging, sliding, or even going down stairs, meaning feeling fear of external space; here too is a sensory dysfunction (Hypersensitive / hyperreactivity).

G- Proprioceptive is the sensation of the body's presence from muscles and joints, and when this sense works well we can control how we sit or hand movement, such as when writing with a pen or holding a spoon. But when there is a dysfunction, we see that the child stumbles a lot while walking, meaning falling frequently to the ground, and finds it difficult to control movements such as feeding themselves or buttoning their shirt.

H- And when there is a dysfunction in the three senses that Jean Ayres focused on, there will be difficulty in the fine and gross muscles working together... and sensory solidarity is lost.

I- Difficulty holding a pencil, playing with toys, or performing self-care tasks such as getting dressed, despite being intelligent.

J- Having hyperactivity and often falling, running, and dangerously bumping their head.

K- The child placing their hands over their ears upon hearing the sound of a vehicle driving in the street or hearing the sound of a pencil while writing.

L- The child being preoccupied with a fan while spinning in a way that prevents them from focusing on what is happening around them.

M- The child's lack of distance estimation, which may sometimes lead them to jump from high places that could cause them injury.

N- Lack of desire to be touched or kissed, and avoiding affection.

O- Sensitivity to playing with mud or playdough.

P- Walking only on tiptoes.

Q- Self-harm or abusing others.

R- Difficulty climbing, running, or hitting a ball.

• How a child receives information and how they respond to it:

When a young child places their hand on a hot cup of tea, we find that they quickly pull their hand away due to feeling the heat of the cup, learning that they must not place their hand on this hot cup again. This simple situation involved many complex processes: the child saw in front of them a cylindrical object resembling something they know, which is the cup ("recognizing the object itself"), reaches their hand toward the cup across the appropriate distance between the child and the cup ("estimating distances through vision"), then places their hand and feels the heat ("skin sensation of heat"), and the brain's realization that this heat requires pulling their hand away from the cup. This is part of the primary processes the child is exposed to in this situation... If we want to understand the processes in a simplified way, it can be said that sensory information enters the body through the senses, and the nerves transmit it to the central nervous system, which translates this information and determines the appropriate response for it, translating these replies into nerve signals transmitted by the nerves to the organs from which the sent response is desired, so the organ executes the response. If a disruption occurs in any step of the aforementioned steps, we find that the response is inappropriate for the stimulus, because a defect occurred in the process that affected the remaining steps.

A- Visual domain:

Studies and direct behavioral observation indicate the following:

- Autistic children do not use the visual field to collect visual stimuli appropriately.

- Autistic children lack visual communication skills.

- Some autistic children are characterized by tunnel vision and visual sensitivity through distinguishing certain visual stimuli over others.

B- Dysfunction in the auditory domain:

Multiple problems in the domain of auditory integration and auditory memory are observed in autistic children, and this is shown through the following:

1. Sensitivity of autistic children to sounds.

2. Lack of response from the autistic child to the voices of others when called.

3. Disruption in the autistic child's behavior when exposed to diverse sounds.

4. The tendency of autistic children toward music and rhythmic speech.

5. A very low auditory threshold and high ability to distinguish sounds in some children.

C- Gustatory domain:

This disorder is observed in autistic children through the presence of high sensitivity in the mouth, shown through autistic children's tendency to put non-food items in the mouth, as well as a preference for a specific type of food over others; also, some autistic children prefer spicy or salty food.

D- Body posture and movements:

1. Placing the child in body postures that allow performing appropriate tasks.

2. Gentle pressure on the body while moving some body parts.

3. Positioning the child while seated and asking them to perform specific tasks.

4. Light massage and gentle movements on some areas of the arms and feet, focusing on fine skills and visual-motor coordination skills.

5. Loading the child with specific weights and asking them to carry them so they feel the weight on the muscles and joints.

E- Facilitated communication:

The need for this type of therapy arose because a person with autism experiences difficulty communicating with others and expressing themselves due to a defect in controlling and regulating movement, despite possessing the ability to understand written speech or spoken language. To overcome this problem, some trained individuals follow methods and means that facilitate these individuals' communication with people, such as holding the person's hand and placing it on specific keys on a device or computer. This method facilitates the person's ability to acquire expressive capacity. This method has been used with individuals who were believed to be completely unable to express themselves, leading to positive outcomes and improvement in their expressive ability.

• Who assesses the child's sensory solidarity process and establishes the necessary exercises?

It is the occupational therapist who holds a certificate in sensory solidarity therapy (Occupational Therapist).

They can diagnose the child with sensory solidarity dysfunction and have knowledge of how to administer specific tests

(Sensory integration Disorder). There are a number of tests they perform, such as:

The Miller Assessment for Preschoolers (Miller, 1988) includes tests for (stereognosis, tactile perception, and vestibular function).

There is also another, more comprehensive test developed by Jean Ayres, which is only used by those who have received training on it:

SIPT (Ayres, 1989) published by Western Psychological Services.

Usually, the occupational therapist is located in specialized autism centers or disability centers; thus, their role is important in assessing the child, participating in the educational plan, identifying strengths and weaknesses, and developing exercises that help the child overcome the difficulties they face.

• Sensory integration room:

It is a room equipped with special tools to stimulate and arouse the child's senses (sense of hearing, sense of sight, sense of touch). For children suffering from developmental delays in cognitive and sensory aspects and interaction with the surrounding environment, this room helps stimulate the sense of sight, visual communication, and increase the child's focus by displaying attractive, exciting, and strong colors in front of their eyes, making them focus their gaze and think about the new world surrounding them.

Consequently, they begin focusing on the other world to explore what surrounds them and what is happening around them, and hearing wonderful sounds that develop their sense of hearing and auditory focus on everything going on around them.

• How the sensory integration room works:

The brain receives information coming to it from its various senses, analyzing, perceiving, and dealing with it with appropriate responses. Some specialists hypothesize that individuals with severe disabilities have a disorder or defect in receiving sensory information and that these senses need activation or stimulation to function properly. The sensory therapy room is specially designed to stimulate all senses, containing a large amount of tools, equipment, and toys that stimulate several senses simultaneously. Multisensory stimulation can be defined as a type of non-directive therapy designed for severe cases of intellectual disability, as well as children suffering from severe developmental disorders such as autism and others. An important feature of multisensory therapy is its non-reliance on verbal or written instructions; thus, it can be used with cases suffering from severe communication impairment.

• What are the outcomes of sensory integration?

Sensory integration contributes to the development of self-regulation, comfort, motor planning, motor skills, attention, and reading readiness.

• Self-regulation

• Sensory input

• Motor planning

• How does sensory integration happen?

Williamson and Anzalone (1996: 55) identified interconnected components that help explain how sensory integration occurs. These components are:

1) Sensory registration.

2) Orientation.

3) Interpretation.

• Sensory integration therapy: There are many exercises that parents can implement with their child at home for children who have sensory solidarity problems, whether autistic or not. For example: accustoming the child to accepting touch can be done through the child's bath, such as using a sponge loofah or a washcloth with foaming soap; massaging the child's body with special cream or oil; the sandwich game, such as placing the child between two pillows in a fun atmosphere and applying alternating light and firm pressure, with an attempt at communication from the child as to whether they want light or firm pressure, provided it is enjoyable for the child. There are also games such as immersing in a pit filled with plastic balls or a pit filled with grains of sand; getting used to feeling different textures, such as participating in kneading dough; carrying cold or warm water as a form of kitchen participation; bringing toys or dolls with soft or rough textures close to the child's body. Other varied exercises for a child who fears movement in space or spinning: they can be accustomed to rocking on a rocking chair at first, and then swinging on swings. Also, games requiring crawling on the stomach, such as entering a cloth tunnel; training on jumping; and training on climbing small ladder steps,

such as a slide ladder. Gradually training the child to slide through special toys is also very beneficial. Overall, we see many exercises such as crawling, climbing, rocking, spinning, jumping, water play, sand play, and dough play—all falling under varied, fun games that can be implemented gradually with the child while using means of reinforcement and engagement. There are many video tapes that help parents as well as teachers in centers implement exercises for children with sensory solidarity weaknesses. Play is considered one of the most important and greatest ways to educate children and improve their psychological, communicative, and physical health. Undoubtedly, autistic children lack one or more of these advantages, and these toys were thoughtfully crafted to develop the child's senses, draw more attention to play, and help with sensory-motor coordination and sharing with others.

Let us mention some of them:

1. Rocking chair: Very elegant and comfortable, providing gentle motion due to its smart balance.

2. Water bed: The bed is filled with water and equipped with a music system; music can be replaced with the Holy Quran.

3. Wave mat: Helps the child develop balance skills and develop leg muscles.

• Treatment methods:

The medical treatment we provide to autistic children is based on sensory integration, where the occupational therapist stimulates the autistic child's skin and vestibular system. This stimulation includes several activities such as swinging, spinning and rotating motion in chairs designed for this purpose, brushing specific parts of the body, and engaging children in activities that include movement and balance.

Studies have confirmed the effectiveness of the sensory integration method in therapy with autistic children, in addition to specific activities that increase focus and the ability to think and solve problems. The occupational therapist also works on involving the child in games that occupy large floor areas, such as climbing and running.

References:

- Dr. Bahaa El-Din Galal - Director of Help Center for the Middle East and North Africa.

- Rehab El-Hadidi, Educational Supervisor - Certified Trainer for Help Center, POP, and the American Training Agency - Researcher in Autism, Down syndrome, Sensory Integration, Language, and Communication.

- Ibrahim Rashid: Specialist in developmental learning difficulties and dyspraxia, educational expert, consultant in learning difficulties, primary stage, kindergarten, and non-Arabic speakers.

Originally published in Arabic. This English version was produced with AI-assisted translation; the Arabic original remains the reference.