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SENSORY PROCESSING IN CHILDREN:
DO SENSORY INTEGRATION TECHNIQUES SUPPORT LANGUAGE?
Alana FabishGraduate Student Clinician – JAC School
Fall 2015
SENSORY INTEGRATION SI definition originally proposed by Jean Ayres in 1972:
“the ability to organize sensory information for use” (p. 1) Sensory Integration and the Child published in 1979
Purpose: for parents to recognize sensory integration dysfunction in their children, understand what was going on, and provide parents with ways to help their children
Expanded definition of SI in 1989 “Sensory integration is the neurological process that
organizes sensation from one’s own body and from the environment and makes it possible to use the body effectively within the environment. The spatial and temporal aspects of inputs from different sensory modalities are interpreted, associated, and unified. SI is information processing…the brain must select, enhance, inhibit, compare, and associate the sensory information in a flexible, constantly changing pattern; in other words, the brain must integrate it.” (Ayres, p. 11)Ayers, 1972, 1979, 1989
SENSORY INTEGRATION AND THEORY Involves all of the senses, but focuses on 3 less
cortically processed ones: Vestibular Tactile Proprioceptive
These 3 senses are the basis/foundation which certain skills are formed and maintained Auditory-language, eye-hand coordination, etc.
Brainstem and thalamus are critical in SI Vestibular info: processed in brainstem Tactile/proprioceptive info: processed in both
SI Theory: increased efficiency enhances higher functioning (i.e. complex learning, behavior)
Mauer, 1999
SENSORY INTEGRATION THERAPY Defined as a specialty in occupational
therapy Focused on assessment and treatment of people
with sensory integrative/sensory processing dysfunction
Based on the principle of neuroplasticity in CNS Some of the neural processes responsible for
interpreting and integrating sensory information can be “remediated” due to this principle
Control of tactile, vestibular, and proprioceptive sensory inputs can potentially enhance functioning of the nervous system (Fisher et al., 1991)
There are a variety of approaches used in therapy Sensorimotor, Neurodevelopmental,
Developmental, Behavioral, Sensory integrative
Mauer, 1999
SENSORY INTEGRATION THERAPY POPULATIONS
Has been used in the following populations: Typically developing individuals Neuromuscular disorders (CP) Learning disabilities Intellectual disabilities Autism Spectrum Disorders Sensory impairments (Sensory processing
disorder) Language impairments
Mauer, 1999
SENSORY INTEGRATION DYSFUNCTION LEADING TO SENSORY PROCESSING DISORDER Learning in any environment requires:
organization of sensory information adaptation of that information to many situations
Dysfunction can occur in 4 areas Limbic system-
Can result in language processing/auditory processing problems Vestibular system-
Can result in decreased balance and spatial orientation Responsible for integrating movement with all senses
Tactile system- Can result in fine motor issues (feeding, oral motor, writing) Deep pressure versus tactile defensiveness
Proprioceptive system- Can result in clumsiness, lack of body awareness, difficulty
manipulating small objects, motor planning and execution
Mauer, 1999
SENSORY PROCESSING IN INFANTS Studies on selective attention in infants: shows early
trajectories of sensory responses and changes from the norm may result in developmental disability/ASD Two responses to stimuli: orienting and defensiveness; used as measure
of efficiency of sensory processing Problems in orienting and defensive behavior responses are associated
with increased risk of developmental delay and social emotional problems at 3 years of age
Sensory processing behaviors also lay foundation for: Social skills Communication Language functioning
Any disruption to sensory processing abilities in infancy can lead to difficulties/problems later in life Social/emotional/behavioral problems Abnormal sensory processing patterns
Watson, Patten, Baranek, Poe, Boyd, Freuler, & Lorenzi, 2011
DUNN’S 4 PATTERNS OF SENSORY PROCESSING
(Dunn, 1997, 2007)
•No one has just one pattern of sensory processing!
ASD SENSORY PROCESSING PATTERNS Different/unusual responses to sensory stimuli
than typically developing peers and peers with other developmental disabilities
3 accepted sensory-processing constructs: Hyporesponsiveness- absence of expected response to
stimuli, delayed response, higher response threshold Low arousal, low registration
Hyperresponsiveness- exaggerated behavioral reaction, aversive response, or avoidance of sensory stimuli Sensation avoiding, sensory sensitivity
Sensory seeking- actions or behaviors that seek to intensify sensory experiences Sensory seeking
Patterns are NOT mutually exclusive; may co-occur or differ based on modality type
Watson et. al, 2011
ASD SENSORY PROCESSING PATTERNS
Hyperresponsiveness was not correlated with social-communicative symptom severity (measured with modified ADOS)
Hyporesponsiveness was associated with social-communicative symptom severity; negatively associated with language skills and social adaptive skills
Sensory seeking negatively associated with language skills
Watson et. al, 2011
SENSORY INTEGRATION THERAPY AND LANGUAGE- EARLY RESEARCH
Sensory integration therapy doesn’t directly address language Some studies have documented improvement in
motor, language, academic, and cognitive skills using traditional SI therapy (Fallon et. al, 1992)
Research criticized these early studies due to: Low sample size (N) Varying types of SI treatment Inconsistent outcomes
Mauer, 1999
SENSORY INTEGRATION THERAPY AND LANGUAGE- LATER RESEARCH 1999: Meta-analysis of SIT with adults and
children with various language/motor/cognitive disorders (Vargas & Camilli, 1999)
Significant effect on psychoeducational & motor outcomes
No effect on behavior, language, or sensory-perceptual outcomes
2008: Review of research since 1994 on SIT (Leong & Carter, 2008)
Inadequate evidence to support SIT outside of research purposes
USING SENSORY INTEGRATION Allows child to organize themselves
Promotes better attention Working on less cortically processed senses
promotes generalization to higher-level senses Visual Auditory
Calms the child/primes the child for higher sensory input
Creates an environment that lends itself to: Language production Language comprehension
SENSORY-BASED ACTIVITIES Incorporate sensory activities into our
therapy sessions rather than using sensory integration therapy (SIT) ASHA’s National Center for EBP produced a
systematic review of Sensory-Based Interventions Their recommendations: “incorporating sensory-based
activities (e.g., tactile stimulation, vestibular stimulation) with skill-based treatments may be motivating or make treatment more enjoyable for the child. However, further research is needed to better understand the nature of sensory processing disorder and the associated treatments as well as any role of the SLP or audiologist.” (pg. 13)
No studies using SIT showed gains in language abilitiesSchooling, Coleman, & Cannon, 2012
FACILITATING LANGUAGE IN THERAPY Hyporesponsiveness:
take advantage of stimuli that have caught the child’s attention; build communicative interactions around that stimulus
Hyperresponsiveness/hyporesponsiveness seen together: accommodate co-occurring or shifting sensory behaviors within
your sessions; accommodations must change based on child’s behavior
Sensory seeking: Incorporate unique, child-specific stimuli that might engage child
and motivate better attention during your sessions Must always consider the child’s underlying sensory
response patterns to provide successful intervention Response patterns may affect success in language, social, and
communication development
Watson et. al, 2011
EXAMPLES OF SENSORY-BASED ACTIVITIES Hyporesponsive children:
Sensory corner with sensory box Many textures and weights
Vibration to stimulate oral-motor awareness Deep pressure touch Weighted blanket at rest time Bouncing and rocking on a ball or swinging
Best to use a “heavy work” activity before doing a sit-down activity For SLP’s: incorporate some gross motor tasks to allow child to organize
their sensory system before putting language demands on them Sand/water play Vibrating toys/toys that light up Provide different play surfaces Speak with varying intonation; highlight important words using
stress, prosody, and intonation Brightly colored toys to gain and keep child’s attention Give child heavy objects to carry Use scented lotion on child and your hands
Dunn, 2007
EXAMPLES OF SENSORY-BASED ACTIVITIES Hyperresponsive children:
Sensory corner with sensory box Many textures and weights with a favorite toy
Deep pressure touch Bouncing or rocking on therapy ball
Again, best to do before having child sit down for activity Wilbarger Brushing protocol (tactile defensiveness) Tents/obstacle courses Chewy tubes Allow for quiet play Keep play area clear; use one toy at a time If you need to use lotions, use unscented lotions Identify and use preferred surface textures in play areas Use even tempo background music Sing softly Obstacle course with tight spaces Allow child to move away from play space if they are overwhelmedDunn, 2007
EXAMPLES OF SENSORY-BASED ACTIVITIES Sensory-seeking children:
Sensory corner with sensory box Weighted blankets at rest time Rough sensory play (“crash” or “squish”) with bean bags Reading a book in a rocking chair/bean bag chair Sand/water play Vibrating toys Offer a special toy/object with a texture child likes
This can help focus a sensory-seeking child Chewy tubes Place favorite toys in places that require exploring through
crawling, walking, etc. Musical instruments Colored lights Provide music in the background Talk about what you see/hear/smell and ask child the sameDunn, 2007
CONCLUSIONS Does sensory integration STIMULATE language?
Not quite… However, it FACILITATES language
R.B. Rough sensory play “crashing”/”squishing” with big bean bags
Occasionally noticed he would calm down, but effects didn’t last throughout session
No large gains in ability to attend during session M.F.
Brushing arms, legs, back at the beginning of each session Immediately calmed her down and noted increase in attention to
tasks Able to imitate a variety of gestures, follow 1-step commands when
playing with toys, match pictures with more accuracy M.H.
Bounce on a small ball while singing preferred songs Requested “more” and “all done” verbally during the activity Increased attention and more verbal output (imitates approx. 15-20
words) throughout the rest of the session
CONCLUSIONS By providing sensory input (sensory-based
activities) a child likes, we can coordinate vestibular, tactile, and proprioceptive modalities resulting in: Increased attention Decreased distractibility Coordination of higher-order sensory functions
(auditory and visual) All leads to: a more controlled session with
the potential for more verbal output from the child
REFERENCES Ayres, A. J. (1972). Sensory integration and learning disorders. Los Angeles, CA: WPS. Ayres, A.J. (1979). Sensory integration and the child. Los Angeles, CA: WPS. Dunn, W. (1997). The impact of sensory processing abilities on the daily lives of young
children and families: A conceptual model. Infants and Young Children, 9, 23-35. Dunn, W. (2007). Supporting children to participate successfully in everyday life by using
sensory processing knowledge. Infants & Young Children, 20, 84-101. Fisher, A. G., Murray, E. A., & Bundy, A. C. (1991). Sensory integration: Theory and practice.
Philadelphia, PA: F. A. Davis. Leong, H., & Carter, M. (2008). Research on the efficacy of sensory integration therapy: Past,
present and future. Australasian Journal of Special Education, 32, 83–89. Mauer, D.M. (1999). Issues and applications of sensory integration theory and treatment with
children with language disorders. Language, Speech, and Hearing Services in Schools, 30, 383-392.
Schooling, T., Coleman, J., & Cannon, L. (2012). The effect of sensory-based interventions on communication outcomes in children: A systematic review. National Center for Evidence-Based Practice in Communication Disorders, 1-47.
Vargas, S., & Camilli, G. (1999). A meta-analysis of research on sensory integration treatment. The American Journal of Occupational Therapy, 53, 189–198.
Watson, L.R., Patten, E., Baranek, G.T., Poe, M., Boyd, B.A., Freuler, A., & Lorenzi, J. (2011). Differential associations between sensory response patterns and language, social, and communication measures in children with autism or other developmental disabilities. Journal of Speech, Language, and Hearing Research, 54, 1562-157 DOI: 10.1044/1092-4388(2011/10-0029)6.