Published on in Trisomy 21 Update
Sensory integration is a term often thrown at parents in clinic visits, IEP meetings or in therapy sessions, yet it’s often misunderstood.
Many of us take for granted our body’s ability to take in all of the movement, tastes, smells, visual and tactile input we receive in a day. That’s because our bodies are trained to process all of these experiences, which allows us to navigate our sometimes joyous and sometimes stressful lives without causing much disruption. Our ability to process these experiences is called sensory integration.
Even with sensory integration, most of us have had at least one experience where we were unable to process all of this information effectively. It could have been a loud concert, a tough meeting at work, or maybe just walking around the streets of a big city filled with foreign sights, sounds and smells. These situations may have brought on feelings of wanting to shut our eyes, cover our ears, run away or maybe just curl up in a ball.
Many of our children with Down syndrome (trisomy 21) have a much less developed and effective sensory processing system. This makes their reactions to over-stimulation and decreased sensory integration of the information around them unpredictable and more challenging than their friend or sibling.
When a child’s sensory integration system is not working properly, their day-to-day experiences can seem overwhelming, scary and dangerous. Your child may not be able to filter what is important and what is not, making it difficult to process information effectively. This dysfunction can lead to minor behavior changes, like a child avoiding certain activities or covering their ears, to more extreme behavior changes, such as major meltdowns and aggressive behavior.
For children with sensory integration issues, recovering from disruptions may take minutes to hours. When a child’s sensory processing dysfunction interferes with their ability to perform their day-to-day activities, it is important to seek intervention.
Types of sensory processing disorders
Sensory processing disorders are typically classified into three categories:
- Sensory over-responsivity
- Sensory under-responsivity
Sensory over-responsivity or sensory avoiding is when a child is receiving all of the information around them and they become scared or overwhelmed and back away. They may require more time to process new sensory information until they get used to the sensation and are no longer bothered by it. Often, children with sensory over-responsivity will try to control their environment as much as possible. They may eat only certain foods, wear certain clothes or play certain games in certain ways so they know exactly what to expect. They may try to change their environment to limit exposure to overwhelming sensory information or avoid new sensory experiences all together. Sensory over-responsive reactions can range from freezing up and not moving at all, to running away or becoming increasingly agitated.
Sensory under-responsivity is when a child receives daily sensory input but requires more time or information to react. Often times people who are under-responsive to input in their environment may appear disengaged, numb to noxious stimulation, or look like they have two left feet. They may not react to seemingly painful situations or not seem to be aware of where their body is in space. This under-responsivity can affect all aspects of a child’s life — from their ability to engage in social play with peers to participating in activities of daily living.
Sensory-seeking is a sensory under-responsive person who takes more stimulation to react. They may appear to be intentionally bumping into things, squeezing themselves between heavy pieces of furniture, or have a preference for swinging or deep hugs. They may also have a strong desire to touch and feel things often without an idea of the force they are exerting. They may also talk or scream loudly to experience the additional feedback or have an oral fixation where almost everything goes in their mouth. Sensory-seeking children are often at risk of hurting themselves due to these behaviors.
There are also children who exhibit parts of all the sensory processing disorders described. They may over-respond to some situations and under-respond to others. These children can have a wide range of inconsistent behaviors which change from day to day. This is called sensory combination disorder. This disorder can be a challenging to treat as it appears no activity or strategy can provide the input or comfort the child needs. Like sensory over-responsive children, these children often have an intense desire to control the world around them because they have such a difficult time regulating themselves.
Addressing sensory processing dysfunction
Occupational and physical therapists will often bring up the term “sensory diet.” A sensory diet is a collection of ideas and strategies you can use to engage your child throughout their day. The goal is to keep your child calm — but alert — while nurturing a sense of safety and security in a world which is overwhelming for them.
A sensory diet should be implemented all day: at school, in the community and at home. A sensory diet is individualized for each child and includes specific attention to the activities that stimulate and calm a child. This can be a delicate balance to find. With some trial and error, therapists and families work together to find the best strategies and activities to help the child functionally engage in the world around them.
Sensory diet strategies and activities are meant to precede any functional activity — for whatever reason — that seems to be challenging for the child. If your child has a difficult time calming down and preparing for bed, part of their sensory diet may be sitting with a weighted blanket across their lap while listening to their favorite music for 15 minutes before attempting to sleep. If your child is going out into the community for an appointment, part of their sensory diet might include brushing their teeth and doing joint compressions before leaving the house.
Determining your child’s sensory needs and establishing a sensory diet is an ongoing process. Your child’s therapists will work with your family to determine the best ways to help your child and adjust the sensory diet as needed.
As your child ages and grows, their sensory needs may change and this is fine. Parents and siblings have the most exposure and access to observe a child with sensory integration deficits. Therapists rely on family feedback and observation to get a more complete picture of a child’s needs. Through this partnership of therapists and families, we can work together to provide the highest quality of life for our children.