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Presentation 5: What are sensory integration (SI) and Disfunction of SI? M. Windsor, ScD, OTR/L

The influence of SI on behavior and social development

Besides sensory processing deficits in discrimination and perception, there may also be difficulties in regulation of sensory input. Sensory Modulation is the ability of the brain to respond appropriately to the magnitude and importance (significance) of sensory information. For example, if you heard a police siren approaching you as you drive your car, you would recognize its meaning (perhaps life and death) and quickly move to the side of the road to stop.

For some children (and adults), ordinary, innocuous sensory information (e.g., toilet flushing, street sounds, restaurant sounds) is perceived as intolerable, noxious, or even life threatening: they may initiate defensive "fight or flight" responses. These reactions are called defensive because the child often perceives the situation as painful or frightening. When a "fight" response to a nonthreatening sensory stimulus occurs (e.g., hitting a child who accidentally brushes against you in line), we describe the child as being hyper-reactive to the sensory input. We may also describe the child as having a low-threshhold for sensation. When a "flight" response occurs, the child may withdraw or not respond to a sensory event. We may describe this child as hyporeactive or having a high-threshhold (requiring more or robust input for a neural response).

There are several explanations regarding these behaviors that you may wish to read. Please note the reference list provided and speak with an occupational therapist trained in SI. Some theorists see modulation as being on a continuum from hyporeactions to hyperreactions at each end and centering around typical behavior. Others view response patterns to sensory information in "bands." Typical children are thought to have a wide band of appropriate response to sensory information. Some children with modulation disorders may have a very narrow band for appropriate response: when challenged with too much input, they will quickly become hyper-reactive or hyporeactive. Other children may function primarily in the either the hyporesponsive or hyperresponsive band. Again, further reading and consultation with a therapist trained in SI is necessary for comprehensive understanding.

It is important to carefully diagnose the child's response pattern: if a child becomes overloaded (required to process too much sensory input), he or she may appear extremely nonreactive. This is called shutdown. It is most important to differentiate between withdrawal and shutdown because: behaviorally they appear to be similar. The intervention strategies are very different; in severe cases, it could be life-threatening to the child with shut-down if the wrong one is used.

The first sensory modulation disorder, Tactile Defensiveness, was identified by Dr. Ayres in the 1970s. She used the term to describe children who perceived light touch as uncomfortable or painful. They responded differently from typical children (e.g., rubbing the area touched to extinguish the sensation, avoiding the activity or person, asking to stop the sensation). Some extreme, negative behaviors such as shouting, pushing, and hitting also have been documented. It is unclear if Sensory Modulation Disorders are specific to a particular sensory system (i.e., Gravitional Insecurity may be a defensive reaction because of deficits in vestibular processing; Tactile Defensiveness occurs when there is overload in the touch system), or if the behavior is a result of a summation of input to some or all of the sensory receptors. It is believed that the behavior may be manifested in any sensory system (e.g., visual, auditory, touch, etc.). Modulation disorders may be observed when the child is evaluated using the Sensory Integration and Praxis Tests (SIPT). However, careful dialogue and special histories and questionnaires are necessary for diagnosis. . Ongoing research in the field of occupational therapy is constantly adding to the knowledge base and strategies for intervention.

The inappropriate and often aversive behaviors triggered by Sensory Modulation Disorders interfere with development of social emotional skills and relationships. Children are often unhappy, inflexible, and limited in their capacity to enjoy the typical pleasures in life.

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