Center for the Study of AutismSensory Integration
Cindy Hatch-Rasmussen, M.A., OTR/L
Therapy Northwest, P.C.
Beaverton, OR 97005

Children and adults with autism, as well as those with other developmental
disabilities, may have a dysfunctional sensory system. Sometimes one or more
senses are either over- or under-reactive to stimulation. Such sensory problems
may be the underlying reason for such behaviors as rocking, spinning, and
hand-flapping. Although the receptors for the senses are located in the
peripheral nervous system (which includes everything but the brain and spinal
cord), it is believed that the problem stems from neurological dysfunction in
the central nervous system–the brain. As described by individuals with autism,
sensory integration techniques, such as pressure-touch can facilitate attention
and awareness, and reduce overall arousal. Temple Grandin, in her descriptive
book, Emergence: Labeled Autistic, relates the distress and relief of her
sensory experiences.

Sensory integration is an innate neurobiological process and refers to the
integration and interpretation of sensory stimulation from the environment by
the brain. In contrast, sensory integrative dysfunction is a disorder in which
sensory input is not integrated or organized appropriately in the brain and may
produce varying degrees of problems in development, information processing, and
behavior. A general theory of sensory integration and treatment has been
developed by Dr. A. Jean Ayres from studies in the neurosciences and those
pertaining to physical development and neuromuscular function. This theory is
presented in this paper.

Sensory integration focuses primarily on three basic senses–tactile,
vestibular, and proprioceptive. Their interconnections start forming before
birth and continue to develop as the person matures and interacts with his/her
environment. The three senses are not only interconnected but are also connected
with other systems in the brain. Although these three sensory systems are less
familiar than vision and audition, they are critical to our basic survival. The
inter-relationship among these three senses is complex. Basically, they allow us
to experience, interpret, and respond to different stimuli in our environment.
The three sensory systems will be discussed below.

Tactile System: The tactile system includes nerves under the skin’s surface that
send information to the brain. This information includes light touch, pain,
temperature, and pressure. These play an important role in perceiving the
environment as well as protective reactions for survival.

Dysfunction in the tactile system can be seen in withdrawing when being touched,
refusing to eat certain ‘textured’ foods and/or to wear certain types of
clothing, complaining about having one’s hair or face washed, avoiding getting
one’s hands dirty (i.e., glue, sand, mud, finger-paint), and using one’s finger
tips rather than whole hands to manipulate objects. A dysfunctional tactile
system may lead to a misperception of touch and/or pain (hyper- or
hyposensitive) and may lead to self-imposed isolation, general irritability,
distractibility, and hyperactivity.

Tactile defensiveness is a condition in which an individual is extremely
sensitive to light touch. Theoretically, when the tactile system is immature and
working improperly, abnormal neural signals are sent to the cortex in the brain
which can interfere with other brain processes. This, in turn, causes the brain
to be overly stimulated and may lead to excessive brain activity, which can
neither be turned off nor organized. This type of over-stimulation in the brain
can make it difficult for an individual to organize one’s behavior and
concentrate and may lead to a negative emotional response to touch sensations.
Vestibular System: The vestibular system refers to structures within the inner
ear (the semi-circular canals) that detect movement and changes in the position
of the head. For example, the vestibular system tells you when your head is
upright or tilted (even with your eyes closed). Dysfunction within this system
may manifest itself in two different ways. Some children may be hypersensitive
to vestibular stimulation and have fearful reactions to ordinary movement
activities (e.g., swings, slides, ramps, inclines). They may also have trouble
learning to climb or descend stairs or hills; and they may be apprehensive
walking or crawling on uneven or unstable surfaces. As a result, they seem
fearful in space. In general, these children appear clumsy. On the other
extreme, the child may actively seek very intense sensory experiences such as
excessive body whirling, jumping, and/or spinning. This type of child
demonstrates signs of a hypo-reactive vestibular system; that is, they are
trying continuously to sti mulate their vestibular systems.

Proprioceptive System: The proprioceptive system refers to components of
muscles, joints, and tendons that provide a person with a subconscious awareness
of body position. When proprioception is functioning efficiently, an
individual’s body position is automatically adjusted in different situations;
for example, the proprioceptive system is responsible for providing the body
with the necessary signals to allow us to sit properly in a chair and to step
off a curb smoothly. It also allows us to manipulate objects using fine motor
movements, such as writing with a pencil, using a spoon to drink soup, and
buttoning one’s shirt. Some common signs of proprioceptive dysfunction are
clumsiness, a tendency to fall, a lack of awareness of body position in space,
odd body posturing, minimal crawling when young, difficulty manipulating small
objects (buttons, snaps), eating in a sloppy manner, and resistance to new motor
movement activities.

Another dimension of proprioception is praxis or motor planning. This is the
ability to plan and execute different motor tasks. In order for this system to
work properly, it must rely on obtaining accurate information from the sensory
systems and then organizing and interpreting this information efficiently and
effectively.

Implications: In general, dysfunction within these three systems manifests
itself in many ways. A child may be over- or under-responsive to sensory input;
activity level may be either unusually high or unusually low; a child may be in
constant motion or fatigue easily. In addition, some children may fluctuate
between these extremes. Gross and/or fine motor coordination problems are also
common when these three systems are dysfunctional and may result in
speech/language delays and in academic under-achievement. Behaviorally, the
child may become impulsive, easily distractible, and show a general lack of
planning. Some children may also have difficulty adjusting to new situations and
may react with frustration, aggression, or withdrawal.

Evaluation and treatment of basic sensory integrative processes is performed by
occupational therapists and/or physical therapists. The therapist’s general
goals are: (1) to provide the child with sensory information which helps
organize the central nervous system, (2) to assist the child in inhibiting
and/or modulating sensory information, and (3) to assist the child in processing
a more organized response to sensory stimuli.

For further information, contact: Sensory Integration International, P.O. Box
9013, Torrance, CA 90508, USA

The Autism Research Institute distributes an information packet on
physical therapies: sensory integration, exercise, holding.
Click here to learn how to obtain this packet.

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