[DebiP]

I am talking to a good friend who is dealing with some SI issues with her 4 year old. I would like to help her and need info and I thought who better to ask then the knowledgeable posters at this site. I know there is good information out there so could we get it all together in this thread and make it useful for those who need it? I think any information about SI would be helpful to a lot of people. From what it is to personal experiences in dealing with it.

Thanks, from one mom who wants to help another mom.

[waitinginnj]

I believe that sensory issues can run the gamut. Is there specific issues that she is dealing with - food textures, noise, etc?

My daughter was sensitive to noises.

[DebiP]

In my opinion she needs what she can get. I think she is dealing with a lot of SI issues. I know that my son had and still has noise issues but I can classify that as SI.THanks for the info

[brown1823]

I think there is a book called The Out of Sync Child that deals with SI. If I remember correctly there are several versions including a parent workbook filled with "exercises" that parents and children can do at home. Also, check with an occupational therapist. Usually the Early Intervention team can help you find one. They will be able to give you techniques and exercises as well to help your child cope with SI. The OT has really helped my nephew who was diagnosed last year with it.

[angelkisses0102]

Two great books are 'The Out of Sync Child' and 'The Out of Sync Child has Fun.'

Sensory Processing Disorder (SPD) is a complex disorder of the brain that affects developing children and adults. People with SPD misinterpret everyday sensory information, such as touch, sound, and movement. They may feel bombarded by information, they may seek out intense sensory experiences, or they may have other symptoms.

"Sensory processing" refers to our ability to take in information through our senses (touch, movement, smell, taste, vision, and hearing), organize and interpret that information, and make a meaningful response. For most people, this process is automatic. When we hear someone talking to us or a bird chirping, our brains interpret that as speech or an animal sound, and we respond to that information appropriately. Children who have a Sensory Processing Disorder (SPD), however, don’t experience this process in the same way. SPD affects the way their brains interpret the information they take in and also how they act on that information with emotional, attentional, motor, and other responses.

Sensory-Avoiding Children



Some children with SPD are over-responsive to sensation. Their nervous systems feel sensation too easily or too intensely and they feel as if they are being constantly bombarded with information.

Consequently, these children often have a "fight or flight" response to sensation, a condition called "sensory defensiveness." They may try to avoid or minimize sensations, such as by avoiding being touched or being very particular about clothing.

These children may:

• Respond to being touched with aggression or withdrawal
• Fear movement and heights, or get sick from exposure to movement or heights
• Be very cautious and unwilling to take risks or try new things
• Feel uncomfortable in loud or busy environments, such as sports events, malls
• Be very picky eaters and/or overly sensitive to food smells

These children may be diagnosed with Sensory Over-Responsivity.

Sensory-Seeking Children



Some children are under-responsive to sensation. Their nervous systems do not always recognize the sensory information that is coming in to the brain.

As a result, they seem to have an almost insatiable desire for sensory stimulation. They may seek out constant stimulation or more intense or prolonged sensory experiences, such as by taking part in extreme activities or moving constantly.

Some behaviors seen in these children include:

• Hyperactivity as they seek more sensation
• Unawareness of touch or pain, or touching others too often or too hard (which may seem like aggressive behavior)
• Taking part in unsafe activities, such as climbing too high
• Enjoying sounds that are too loud, such as a very loud television or radio

These children may be diagnosed with Sensory Under-Responsivity.

Motor Skills Problems



Other children with SPD have trouble processing sensory information properly, resulting in problems with planning and carrying out new actions. They have particular difficulty with forming a goal or idea or developing new motor skills. These children often are clumsy, awkward, and accident prone.

These children may have:

• Very poor fine motor skills, such as handwriting
• Very poor gross motor skills, such as kicking, catching, or throwing a ball
• Difficulty imitating movements, such as when playing "Simon Says"
• Trouble with balance, sequences of movements, and bilateral coordination
• A preference for familiar activities or play, such as lining up toys
• A preference for sedentary activities, such as watching TV, reading a book, or playing video games

These children may get frustrated easily and may seem manipulative and controlling. Some may try to compensate with an over-reliance on language and may prefer fantasy games to real life. They also may try to mask their motor planning problems by acting like a "class clown" or avoiding new group activities. These children may be diagnosed with Dyspraxia (sensory-based) Motor Planning Disorder.

Children with Sensory Processing Disorder (SPD) may suffer from anxiety, depression, aggression, or other behavioral problems. They may have problems with motor skills and other skills needed for school success. They may also be socially isolated and suffer from low self-esteem. Often they get a reputation for being a "difficult child."

These difficulties put these children at high risk for many emotional, social, and educational problems, including the inability to make friends or be a part of a group, a poor self-concept, academic failure, and being labeled as clumsy, uncooperative, belligerent, disruptive, or out of control. Parents may be blamed for their children’s behavior by people who are unaware of this "hidden handicap." Effective treatment for SPD is available, but far too many children with these disorders are misdiagnosed and not properly treated.

Living With and Treating Sensory Processing Disorder



Most children with Sensory Processing Disorder (SPD) are just as intelligent as their peers. Many are intellectually gifted. Their brains are simply wired differently. They need to be taught in ways that are adapted to how they process information and they need leisure activities that suit their own sensory processing needs.

When children with SPD are accurately identified, they can begin a program of occupational therapy (OT). OT, which is conducted in a sensory-rich environment, helps these children to manage their responses to sensations and to behave in a more functional manner.

The goal of OT is to enable a child to take part in the normal activities of childhood, such as playing with friends, enjoying school, eating, dressing, and sleeping. It can take place in a hospital OT department or in a private practice setting; the therapy is tailored to the needs of each child.

Parents are encouraged to get involved and work with the occupational therapist, so they can learn more about their child and incorporate their family's priorities into treatment. The treatment plan will usually include a number of ideas that the parents can use at home and at school to help their child become regulated and coordinated.

An added benefit of OT is that parents come to understand that their child's disability is real, even though it is a "hidden handicap," and they are encouraged to become strong advocates for their child at school and elsewhere.

What does Occupational Therapy Look Like?



Treatment is fun! It usually occurs in a large, sensory-rich environment with lots of swinging, spinning, tactile, visual, auditory, and taste opportunities.

Many occupational therapists use an approach called "STEP-SI" (pronounced "step - S - I"). With input from parents, they work to understand how a child perceives sensation and how that affects his attention, emotions, motor skills, and learning abilities.

The therapist evaluates the child’s abilities in several areas:

• Sensory - the responses in each sensory system (e.g., movement, touch, taste, etc.)
• Task - the need for more or less complexity and structure in completing activities
• Environment - the responses to "enriched" and "simple" surroundings
• Predictability - the preference for "old" or new experiences
• Self-Monitoring - the ability to preview and adjust responses before acting
• Interactions - the need for less or more intense interactions with others

The overall goals of OT are to improve social participation, self-esteem, self-regulation, and sensorimotor abilities.

Barriers to Treatment

Studies show that as many as five percent of all children suffer from SPD. Yet despite this high rate, information and help for those with this disorder is still very limited. This lack of resources, combined with the fact that SPD often looks like other disorders, often results in misdiagnosis and inappropriate treatment for many children. And even when parents do obtain a diagnosis and referral to appropriate therapy, most insurance companies do not cover the cost of the treatment.


Questions To Ask an Occupational Therapist



Not all occupational therapists are trained to work with children who have Sensory Processing Disorder. When you find a therapist you might want to work with, asking the following questions will help you to decide if he or she is right for you and your child:

• Are you a certified as an occupational therapist by the National Board of Certification in Occupational Therapy?
• Do you have any specific training in assessing and treating children with Sensory Processing Disorder? What form did that training take (such as graduate school training or professional seminars)?
• How much experience do you have in working with children with developmental problems or with Sensory Processing Disorder?
• Are you trained or certified in the use of any standardized tools that are used to assess children who might have Sensory Processing Disorder?

Currently, the primary standardized assessment tool used for SPD is the Sensory Integration and Praxis Tests (SIPT). It was developed by A. Jean Ayres, Ph.D., OTR, an occupational therapist and developmental psychologist. The SIPT is suitable for children ages 4 to 8 who have learning, behavioral, or developmental delays. They must be able to devote two hours to the test. The SIPT is given by therapists who are SIPT-certified (they have completing an intensive course sponsored by Western Psychological Services or they received the training in college). Other assessment tools may be used for children who are outside this age range or who have motor or language delays that make it difficult to interpret their responses to standardized testing. The Sensory Profile and Short Sensory Profile tests may be used to screen children ages 5 to 10; other forms of this screening are used for infants and preschoolers. Clinical observation by an occupational therapist and interviews with parents and teachers may also be used.

This info is all from the SPD Network... (Sensory Processing Disorder) but I can't post the link...lots of valuable info there. I believe Alex has very mild issues too...

[dadfor2]

thank you karen

that actually helped me alot. my older son has some sensory issues, but after reading what you wrote, i wonder if my younger boy does to.

thanks for the info, ill have to print it out and show the therapist

[angelkisses0102]

Here's an intersting article....(and you guys thought I only had attachment links...hehehe )

Sensory Integration Disorder in Children Adopted from Institutions
By Harriet McCarthy
Being the mother of three older post-institutionalized children, I've had to acquaint myself with a variety of developmental issues, most of which I'd never heard of before I became an adoptive parent. Over the last 14 months since the adoption of my second and third child I've learned a great deal about Sensory Integration Disorder, it's symptoms and therapies, as well as it's critical effects on all aspects of a child's life. According to a number of "experts" who deal with post-institutionalized children, Sensory Integration Disorder is normal within the context of the development of any child who has been institutionalized for more than a year. It is by no means a syndrome that is limited to children who have suffered from institutional conditions.
SID can occur in children who have been hospitalized early or for long periods of time, or who have suffered from some sort of trauma and disruption in their developmental process. Most of us who have adopted older children know to expect some fairly frenetic behaviors soon after we have our new children in our care. Any and all buttons will be pushed, every light switch will be turned on and off hundreds of times, drawers will be opened and closed and the contents thoroughly riffled.

I expected all these things last year when we brought our two new children home in October. But with one of the little boys, it didn't stop in the usual 6 - 8 week period. Instead it went on without slowing down a bit. Not only that, he chewed and sucked on all his clothes constantly, but when he sat down at the table to eat, he'd just play with his food and often refused to put anything into his mouth. He was quite rough with us even though he was only 31 lbs. For many weeks he seemed to "lead with his head" slamming it into any and all objects leaving him with huge welts. He fell down constantly - often on purpose - and would be up and going again after a really tough fall without feeling any pain. He never seemed to know exactly where he stopped and the rest of the world began.

I talked to his teachers about his "accident proneness", and they all said that they had noticed it, too. Sergei often had bloody noses at school those first several weeks. One day while he was walking hand in hand with his teacher through the parking lot, he walked right into a car. Another time he walked into a tree. My first thought was that the child couldn't see well, but nothing else in his behavior led us to suspect this was the case.

As we moved through November and December, I began to see glaring delays in Sergei's development, too. His English acquisition was lagging well behind his older adopted brother's, and he seemed to have serious gross and fine motor delays. I put out some feelers on the world wide web at a-parent-russ and asked for suggestions and direction. Several people wrote that they strongly advised I get Sergei evaluated by a developmental pediatrician who was knowledgeable in sensory integration issues. So began my journey into the complex world of SID.

What is Sensory Integration Disorder

According to Sensory Integration International, Inc., when we think of "the senses", we can easily call to mind taste, smell, sight, and sound. The senses of touch, movement, force of gravity, and body position are so natural to most of us that we assume our way of dealing with incoming sensation is common to all when in fact, it is not. Our sense of touch (tactile sense) enables us to identify a diverse world of sensations from gently pleasurable to protectively defensive." Our sense of movement (vestibular sense) responds to body movement through space and change of head position. It is central in maintaining muscle tone, coordinating the two sides of the body, and holding the head upright against gravity. Body position ( proprioception) is that sense which enables us to move different parts of our bodies smoothly without having to observe every action. Proprioception enables us to automatically adjust ourselves to prevent falling out of a chair, or to manipulate objects by hand such as pencils, buttons, eating utensils, and combs."

"It is this interplay between the senses, and their organization for use that is termed sensory integration. The tactile (touch), proprioceptive (body position), and vestibular (movement) senses are particularly important in providing knowledge about motor planning which involves having an idea about what to do, planning an action, and finally executing the action."

"For most children, sensory integration develops in the course of ordinary childhood activities. Motor planning ability is a natural outcome of the process, as is the ability to respond to incoming sensation in a adaptive manner. But for some children, sensory integration does not develop as efficiently as it should. When the process of sensory integration is disordered,( say through a lack of stimulation or movement over a long period of time), a number of problems in learning, development, or behavior may become evident."

We went for our preliminary evaluation in January. The developmental pediatrician was clearly concerned about Sergei's small size (at 5 1/2 he was 40 1/2" and weighed 33 lbs -he didn't even make the charts) and his lack of coherent speech. She diagnosed him as "Failure to Thrive" and suspected sensory integration disorder to be one of his biggest problems. She sent us to an occupational therapist for further evaluation.

Occupational Therapy

In early January, we had our first trip to the occupational therapist. She immediately picked up on the distractibility, decreased body control which caused him to fall or run into objects, decreased awareness of pain, and poor body awareness in relation to his environment. She also noticed that he was unable to screen out extraneous noise and visual stimulation causing him to be constantly overstimulated. He fit the classic description of a "Crasher", a child who needs deep pressure on his body to help organize his sensory system.

Our short term goals were simple. We wanted to 1) Improve his sensory modulation so that he could attend to a task without being distracted by his surroundings, 2) Create body awareness so he could move around in his environment without running into or "crashing" into objects, 3) Help him with his vestibular system so he could sit and attend for longer periods of time without fidgeting, and 4) Begin a deep touch program to improve his ability to organize sensory stimulation and improve his body awareness.

We had a one-hour-a-week session that went on until the end of the school year. At the same time, the special education coordinator at Sergei's school (who has a child with Sensory Integration Disorder!) got him an IEP designation as "Other Health Impaired" which made it possible for him to get special services at school as well as privately. I attended the therapies with him so that I could continue the training at home. By the end of May, Sergei was improved significantly enough to be provisionally discharged from O.T. for the summer. We decided on a program of swimming, beaching, riding bikes, rolling in the grass, having water fights, golfing, soccer, and digging in the garden to carry us through the summer months.

Dramatic Results

By late August as school was beginning, we had seen some major changes in Sergei. His distractibility was much diminished. So, too was the "crashing" behavior. When he ran into something, he registered the pain! As school began, he had no trouble attending for significant periods of time. Where months before he had wandered aimlessly around in his classroom, he now settled right down to work and began learning his numbers, the alphabet, and the computer. The school personnel were amazed about his progress and thrilled that the early intervention had been so successful. His IEP has been re-evaluated and his school-based o.t. has been discontinued. Our last private session was at the end of May.

We had hoped that occupational therapy would have helped more dramatically with speech and language. There is a program of deep-pressure "brushing" which is often used in conjunction with Occupational Therapy. For many children, "brushing" has dynamic and positive results. Unfortunately for Sergei, this technique was TOO dramatic and had the opposite effect that was intended. It caused severe regression for him in language skills, bladder and bowel control. This is not the normal reaction to this particular therapy, but it can and does happen from time to time in very sensitive individuals, so we stopped that particular part of the therapy.

But, less than a year ago we had a little boy who couldn't sit on a chair without falling off. Today we have a youngster who swims like a fish, rides a two-wheeler, plays soccer, golf, and can hit a baseball like a pro. Yes, we still have some problems, particularly with eating. Oral sensory problems are some of the hardest to overcome, but with time and a bigger appetite they should eventually disappear.

The important thing for all of us who are adopting children from backgrounds of deprivation and neglect is that Sensory Integration Disorder may be an issue you'll have to face with your kids. If caught in time, evaluated properly, and given appropriate occupational therapy, vast improvement in your child's developmental progress can be accomplished. If you suspect your child has some of the following symptoms, see a developmental pediatrician and get a private evaluation by an occupational therapist or clinic that knows about Sensory Integration Disorder.

Signs of Sensory Integrative Dysfunction

Typically, a child with sensory integrative disorder will show more than one of the above signs.




*Overly sensitive to touch, movement, sights, or sounds.
* Under-reactive to sensory stimulation (body whirling or crashing)
* Activity Level that is unusually high or unusually low
*Coordination problems (poor balance or motor coordination)

*Delays in Speech, language, motor skills, or academic achievement
*Poor organization of behavior (impulsive, distractible, frustrated, aggressive)
* self concept (may appear lazy, bored, or unmotivated)

[angelkisses0102]

1. "The child with sensory dysfunction does not necessarily exhibit every characteristic. Thus, the child with vestibular dysfunction may have poor balance but good muscle tone."


2. "Sometimes the child will show characteristics of a dysfunction one day but not the next. For instance, the child with proprioceptive problems may trip over every bump in the pavement on Friday yet score every soccer goal on Saturday. INCONSISTENCY IS A HALLMARK OF EVERY NEUROLOGICAL DYSFUNCTION."

3. "The child may exhibit characteristics of a particular dysfunction yet not have that dysfunction. For example, the child who typically withdraws from being touched may seem to be hypersensitive to tactile stimulation but may, instead, have an emotional problem."

4. "The child may be both hypersensitive and hyposensitive. For instance, the child may be extremely sensitive to light touch, jerking away from a soft pat on the shoulder, while being rather indifferent to the deep pain of an inoculation."

5. "Everyone has some sensory integration problems now and then, because no one is well regulated all the time. All kinds of stimuli can temporarily disrupt normal functioning of the brain, either by overloading it with, or by depriving it of, sensory stimulation."


TACTILE SENSE: input from the skin receptors about touch, pressure,temperature, pain, and movement of the hairs on the skin.









SIGNS OF TACTILE DYSFUNCTION:


1. HYPERSENSITIVITY TO TOUCH (tactile defensiveness):



__ becomes fearful, anxious or aggressive with light or unexpected touch

__ as an infant, did/does not like to be held or cuddled; may arch back, cry, and pull away

__ distressed when diaper is being, or needs to be, changed

__ appears fearful of, or avoids standing in close proximity to other people or peers (especially in lines)

__ becomes frightened when touched from behind or by someone/something they can not see (such as under a blanket)

__ complains about having hair brushed; may be very picky about using a particular brush

__ bothered by rough bedsheets (i.e., if old and "bumpy")

__ avoids group situations for fear of the unexpected touch

__ resists friendly or affectionate touch from anyone besides parents or siblings (and sometimes them too!)

__ dislikes kisses, will "wipe off" place where kissed

__ prefers hugs

__ a raindrop, water from the shower, or wind blowing on the skin may feel like torture and produce adverse and avoidance reactions

__ may overreact to minor cuts, scrapes, and or bug bites

__ avoids touching certain textures of material (blankets, rugs, stuffed animals)

__ refuses to wear new or stiff clothes, clothes with rough textures, turtlenecks, jeans, hats, or belts, etc.

__ avoids using hands for play

__ avoids/dislikes/aversive to "messy play", i.e., sand, mud, water, glue, glitter, playdoh, slime, shaving cream/funny foam etc.

__ will be distressed by dirty hands and want to wipe or wash them frequently

__ excessively ticklish

__ distressed by seams in socks and may refuse to wear them

__ distressed by clothes rubbing on skin; may want to wear shorts and short sleeves year round, toddlers may prefer to be naked and pull diapers and clothes off constantly

__ or, may want to wear long sleeve shirts and long pants year round to avoid having skin exposed

__ distressed about having face washed

__ distressed about having hair, toenails, or fingernails cut

__ resists brushing teeth and is extremely fearful of the dentist

__ is a picky eater, only eating certain tastes and textures; mixed textures tend to be avoided as well as hot or cold foods; resists trying new foods

__ may refuse to walk barefoot on grass or sand

__ may walk on toes only



2. HYPOSENSITIVITY TO TOUCH (under-responsive):



__ may crave touch, needs to touch everything and everyone

__ is not aware of being touched/bumped unless done with extreme force or intensity

__ is not bothered by injuries,like cuts and bruises, and shows no distress with shots (may even say they love getting shots!)

__ may not be aware that hands or face are dirty or feel his/her nose running

__ may be self-abusive; pinching, biting, or banging his own head

__ mouths objects excessively

__ frequently hurts other children or pets while playing

__ repeatedly touches surfaces or objects that are soothing (i.e., blanket)

__ seeks out surfaces and textures that provide strong tactile feedback

__ thoroughly enjoys and seeks out messy play

__ craves vibrating or strong sensory input

__ has a preference and craving for excessively spicy, sweet, sour, or salty foods



3. POOR TACTILE PERCEPTION AND DISCRIMINATION:



__ has difficulty with fine motor tasks such as buttoning, zipping, and fastening clothes

__ may not be able to identify which part of their body was touched if they were not looking

__ may be afraid of the dark

__ may be a messy dresser; looks disheveled, does not notice pants are twisted, shirt is half untucked, shoes are untied, one pantleg is up and one is down, etc.

__ has difficulty using scissors, crayons, or silverware

__ continues to mouth objects to explore them even after age two

__ has difficulty figuring out physical characteristics of objects; shape, size, texture, temperature, weight, etc.

__ may not be able to identify objects by feel, uses vision to help; such as, reaching into backpack or desk to retrieve an item

VESTIBULAR SENSE: input from the inner ear about equillibrium, gravitational changes, movement experiences, and position in space.




SIGNS OF VESTIBULAR DYSFUNCTION:



1. HYPERSENSITIVITY TO MOVEMENT (over-responsive):

__ avoids/dislikes playground equipment; i.e., swings, ladders, slides, or merry-go-rounds

__ prefers sedentary tasks, moves slowly and cautiously, avoids taking risks, and may appear "whimpy"

__ avoids/dislikes elevators and escalators; may prefer sitting while they are on them or, actually get motion sickness from them

__ may physically cling to an adult they trust

__ may appear terrified of falling even when there is no real risk of it

__ afraid of heights, even the height of a curb or step

__ fearful of feet leaving the ground

__ fearful of going up or down stairs or walking on uneven surfaces

__ afraid of being tipped upside down, sideways or backwards; will strongly resist getting hair washed over the sink

__ startles if someone else moves them; i.e., pushing his/her chair closer to the table

__ as an infant, may never have liked baby swings or jumpers

__ may be fearful of, and have difficulty riding a bike, jumping, hopping, or balancing on one foot (especially if eyes are closed)

__ may have disliked being placed on stomach as an infant

__ loses balance easily and may appear clumsy

__ fearful of activities which require good balance

__ avoids rapid or rotating movements


2. HYPOSENSITIVITY TO MOVEMENT (under-responsive):

__ in constant motion, can't seem to sit still

__ craves fast, spinning, and/or intense movement experiences

__ loves being tossed in the air

__ could spin for hours and never appear to be dizzy

__ loves the fast, intense, and/or scary rides at amusement parks

__ always jumping on furniture, trampolines, spinning in a swivel chair, or getting into upside down positions

__ loves to swing as high as possible and for long periods of time

__ is a "thrill-seeker"; dangerous at times

__ always running, jumping, hopping etc. instead of walking

__ rocks body, shakes leg, or head while sitting

__ likes sudden or quick movements, such as, going over a big bump in the car or on a bike


3. POOR MUSCLE TONE AND/OR COORDINATION:

__ has a limp, "floppy" body

__ frequently slumps, lies down, and/or leans head on hand or arm while working at his/her desk

__ difficulty simultaneously lifting head, arms, and legs off the floor while lying on stomach ("superman" position)

__ often sits in a "W sit" position on the floor to stabilize body

__ fatigues easily!

__ compensates for "looseness" by grasping objects tightly

__ difficulty turning doorknobs, handles, opening and closing items

__ difficulty catching him/her self if falling

__ difficulty getting dressed and doing fasteners, zippers, and buttons

__ may have never crawled as an baby

__ has poor body awareness; bumps into things, knocks things over, trips, and/or appears clumsy

__ poor gross motor skills; jumping, catching a ball, jumping jacks, climbing a ladder etc.

__ poor fine motor skills; difficulty using "tools", such as pencils, silverware, combs, scissors etc.

__ may appear ambidextrous, frequently switching hands for coloring, cutting, writing etc.; does not have an established hand preference/dominance by 4 or 5 years old

__ has difficulty licking an ice cream cone

__ seems to be unsure about how to move body during movement, for example, stepping over something

__ difficulty learning exercise or dance steps

PROPRIOCEPTIVE SENSE: input from the muscles and joints about body position, weight, pressure, stretch, movement, and changes in position in space.



SIGNS OF PROPRIOCEPTIVE DYSFUNCTION:




1. SENSORY SEEKING BEHAVIORS:

__ seeks out jumping, bumping, and crashing activities

__ stomps feet when walking

__ kicks his/her feet on floor or chair while sitting at desk/table

__ bites or sucks on fingers and/or frequently cracks his/her knuckles

__ loves to be tightly wrapped in many or weighted blankets, especially at bedtime

__ prefers clothes (and belts, hoods, shoelaces) to be as tight as possible

__ loves/seeks out "squishing" activities

__ enjoys bear hugs

__ excessive banging on/with toys and objects

__ loves "roughousing" and tackling/wrestling games

__ frequently falls on floor intentionally

__ would jump on a trampoline for hours on end

__ grinds his/her teeth throughout the day

__ loves pushing/pulling/dragging objects

__ loves jumping off furniture or from high places

__ frequently hits, bumps or pushes other children

__ chews on pens, straws, shirt sleeves etc.


2. DIFFICULTY WITH "GRADING OF MOVEMENT":

__ misjudges how much to flex and extend muscles during tasks/activities (ie, putting arms into sleeves or climbing)

__ difficulty regulating pressure when writing/drawing; may be too light to see or so hard the tip of writing utensil breaks

__ written work is messy and he/she often rips the paper when erasing

__ always seems to be breaking objects and toys

__ misjudges the weight of an object, such as a glass of juice, picking it up with too much force sending it flying or spilling, or with too little force and complaining about objects being too heavy

__ may not understand the idea of "heavy" or "light"; would not be able to hold two objects and tell you which weighs more

__ seems to do everything with too much force; ie, walking, slamming doors, pressing things too hard, slamming objects down

__ plays with animals with too much force, often hurting them







SIGNS OF AUDITORY DYSFUNCTION: (no diagnosed hearing problem)




1. HYPERSENSITIVITY TO SOUNDS (auditory defensiveness):

__ distracted by sounds not normally noticed by others; ie, humming of lights or refrigerators, fans, heaters, or clocks ticking

__ fearful of the sound of a flushing toilet (especially in public bathrooms), vacuum, hairdryer, squeaky shoes, or a dog barking

__ started with or distracted by loud or unexpected sounds

__ bothered/distracted by background environmental sounds; ie, lawn mowing or outside construction

__ frequently asks people to be quiet; i.e., stop making noise, talking, or singing

__ runs away, cries, and/or covers ears with loud or unexpected sounds

__ may refuse to go to movie theaters, parades, skating rinks, musical concerts etc.

__ may decide whether they like certain people by the sound of their voice


2. HYPOSENSITIVITY TO SOUNDS (under-registers):

__ often does not respond to verbal cues or to name being called

__ appears to "make noise for noise's sake"

__ loves excessively loud music or tv

__ seems to have difficulty understanding or remembering what was said

__ appears oblivious to certain sounds

__ appears confused about where a sound is coming from

__ talks self through a task, often outloud

__ had little or no vocalizing or babbling as an infant

__ needs directions repeated often, or will say, "What?" frequently



SIGNS OF ORAL INPUT DYSFUNCTION:




1. HYPERSENSITIVITY TO ORAL INPUT (oral defensiveness):

__ picky eater, often with extreme food preferences; i.e., limited repertoire of foods, picky about brands, resistive to trying new foods or restaurants, and may not eat at other people's houses)

__ may only eat "soft" or pureed foods past 24 months of age

__ may gag with textured foods

__ has difficulty with sucking, chewing, and swallowing; may choke or have a fear of choking

__ resists/refuses/extemely fearful of going to the dentist or having dental work done

__ may only eat hot or cold foods

__ refuses to lick envelopes, stamps, or stickers because of their taste

__ dislikes or complains about toothpaste and mouthwash

__ avoids seasoned, spicy, sweet, sour or salty foods; prefers bland foods


2. HYPOSENSITIVITY TO ORAL INPUT (under-registers)

__ may lick, taste, or chew on inedible objects

__ prefers foods with intense flavor; i.e., excessively spicy, sweet, sour, or salty

__ excessive drooling past the teething stage

__ frequently chews on hair, shirt, or fingers

__ constantly putting ogjects in mouth past the toddler years

__ acts as if all foods taste the same

__ can never get enough condiments or seasonings on his/her food

__ loves vibrating toothbrushes and even trips to the dentist



SIGNS OF OLFACTORY DYSFUNCTION (smells):




1. HYPERSENSITIVITY TO SMELLS (over-responsive):

__ reacts negatively to, or dislikes smells which do not usually bother, or get noticed, by other people

__ tells other people (or talks about) how bad or funny they smell

__ refuses to eat certain foods because of their smell

__ offended and/or nauseated by bathroom odors or personal hygeine smells

__ bothered/irritated by smell of perfume or cologne

__ bothered by household or cooking smells

__ may refuse to play at someone's house because of the way it smells

__ decides whether he/she likes someone or some place by the way it smells


2.HYPOSENSITIVITY TO SMELLS (under-responsive):

__ has difficulty discriminating unpleasant odors

__ may drink or eat things that are poisonous because they do not notice the noxious smell

__ unable to identify smells from scratch 'n sniff stickers

__ does not notice odors that others usually complain about

__ fails to notice or ignores unpleasant odors

__ makes excessive use of smelling when introduced to objects, people, or places

__ uses smell to interact with objects



SIGNS OF VISUAL INPUT DYSFUNCTION (no diagnosed visual deficit):




1. HYPERSENSITIVITY TO VISUAL INPUT (over-responsiveness)


__ sensitive to bright lights; will squint, cover eyes, cry and/or get headaches from the light

__ has difficulty keeping eyes focused on task/activity he/she is working on for an appropriate amount of time

__ easily distracted by other visual stimuli in the room; i.e., movement, decorations, toys, windows, doorways etc.

__ has difficulty in bright colorful rooms or a dimly lit room

__ rubs his/her eyes, has watery eyes or gets headaches after reading or watching tv

__ avoids eye contact

__ enjoys playing in the dark


2. HYPOSENSITIVITY TO VISUAL INPUT (under-responsive or difficulty with tracking, discrimination, or perception):

__ has difficulty telling the difference between similar printed letters or figures; ie, p & q, b & d, + and x, or square and rectangle

__ has a hard time seeing the "big picture"; i.e., focuses on the details or patterns within the picture

__ has difficulty locating items among other items; i.e., papers on a desk, clothes in a drawer, items on a grocery shelf, or toys in a bin/toy box

__ often loses place when copying from a book or the chalkboard

__ difficulty controlling eye movement to track and follow moving objects

__ has difficulty telling the difference between different colors, shapes, and sizes

__ often loses his/her place while reading or doing math problems

__ makes reversals in words or letters when copying, or reads words backwards; i.e., "was" for "saw" and "no" for "on" after first grade

__ complains about "seeing double"

__ difficulty finding differences in pictures, words, symbols, or objects

__ difficulty with consistent spacing and size of letters during writing and/or lining up numbers in math problems

__ difficulty with jigsaw puzzles, copying shapes, and/or cutting/tracing along a line

__ tends to write at a slant (up or down hill) on a page

__ confuses left and right

__ fatigues easily with schoolwork

__ difficulty judging spatial relationships in the environment; i.e., bumps into objects/people or missteps on curbs and stairs



AUDITORY-LANGUAGE PROCESSING DYSFUNCTION:




__ unable to locate the source of a sound

__ difficulty identifying people's voices

__ difficulty discriminating between sounds/words; i.e., "dare" and "dear"

__ difficutly filtering out other sounds while trying to pay attention to one person talking

__ bothered by loud, sudden, metallic, or high-pitched sounds

__ difficutly attending to, understanding, and remembering what is said or read; often asks for directions to be repeated and may only be able to understand or follow two sequential directions at a time

__ looks at others to/for reassurance before answering

__ difficulty putting ideas into words (written or verbal)

__ often talks out of turn or "off topic"

__ if not understood, has difficulty re-phrasing; may get frustrated, angry, and give up

__ difficulty reading, especially out loud (may also be dyslexic)

__ difficulty articulating and speaking clearly

__ ability to speak often improves after intense movement



SOCIAL, EMOTIONAL, PLAY, AND SELF-REGULATION DYSFUNCTION:




SOCIAL:


__ difficulty getting along with peers

__ prefers playing by self with objects or toys rather than with people

__ does not interact reciprocally with peers or adults; hard to have a "meaningful" two-way conversation

__ self-abusive or abusive to others

__ others have a hard time interpreting child's cues, needs, or emotions

__ does not seek out connections with familiar people


EMOTIONAL:


__ difficulty accepting changes in routine (to the point of tantrums)

__ gets easily frustrated

__ often impulsive

__ functions best in small group or individually

__ variable and quickly changing moods; prone to outbursts and tantrums

__ prefers to play on the outside, away from groups, or just be an observer



__ avoids eye contact



__ difficulty appropriately making needs known


PLAY:

__ difficulty with imitative play (over 10 months)

__ wanders aimlessly without puposeful play or exploration (over 15 months)

__ needs adult guidance to play, difficulty playing independently (over 18 months)

__ participates in repetitive play for hours; i.e., lining up toys cars, blocks, watching one movie over and over etc.


SELF-REGULATION:

__ excessive irritibility, fussiness or colic as an infant

__ can't calm or soothe self through pacifier, comfort object, or caregiver

__ can't go from sleeping to awake without distress

__ requires excessive help from caregiver to fall asleep; i.e., rubbing back or head, rocking, long walks, or car rides

This should be a good start....All the best to your friend...
Karen

[DebiP]

Well Karen I knew I could count on this site but who would have known it would all come from one source. I'll ask you for info before I post next time Thanks for the ton of info.

Anyone else who can still contrubute a story or experience or add to Karen's vast knowledge please do so

[KiraLin]

DebiP,

I could tell more stories than I can count but suffice it to say my living room looks like an OT office. My dd is as far to the sensory seeking extreme of the spectrum as they get. That said, she has improved significantly with a "sensory diet" (this varies depending on the child). If you or your friend has specific questions please feel free to PM me.

[suburbanmomgw]

We live with the effects of Sensory Processing Disorder... My living room is complete with trampoline... We are remodelling our basement and plan to make it "like on OT office"
The truth is that we all have some sensory "issues" but it's only SPD if it interferes with life... like my son can't handle the stimulation of a kids' birthday party, or chucky cheese. He freezes. He becomes non-verbal. He pinches himself to stimulate. He crashes into things (on purpose) and spins. He used to HATE the car rides. He used to hate any restaurant or shopping. He has gotten TONS better with help. And yet we still have to limit the things he is able to do. The Out-of-Sync books (Carol Kranowitz) are tremendous help. Also, there is a sensory integration Yahoo group that is a great resourse and support. Hope this helps.

[KiraLin]

SuburbanMom,

Your post reminded me of something...SI issues can definately limit certain things. Many amusment parks have bracelets available for their guests with special needs that allow lines to be bypassed. I avoid these places to begin with but last summer went to sesame place as a family thing that couldn't be avoided. I got my dd a bracelet (just went to guest services and asked, no "proof" needed) At first I felt a little guilty because SI is an "invisable" disability and dd looks perfectly normal and most without direct knowledge of her issues will just assume she is an out of control toddler (and sometimes that is what she is LOL) but there are certain situations she just simply cannot handle. Well I didn't feel guilty for long bc even with the bracelet she had a tough time and it was a record short visit (but gave her grandparents a better appreciation that I was not exaggerating her difficulties). My understanding is that Disney also has something similar and that they may require a doctors note but I have gotton different stories on that. Anyway hope it is helpful to know about the option.

[GCS]

Thank you all for your posts. I have been doing a little research online myself. I have to say it has been hard to find a good "checklist" regarding SI.

This has been really helpful!!

Thanks again,
Christina

[angelkisses0102]

I am bumping this for someone to review...

Every time I try to post a link to it...I get thrown off my system.

[mschweber]

Below is a general audience article from the NY Times. It is mostly positive but discusses some of the skepticism. Our OT considers it a fair article.

Our daughter has sensory issues, mostly of the hypo nature. As others have noted children can be all over the board and her tests ran the full gamut. (Interestingly from what I have learned I am sure that I grew up with fairly significant sensory problems - clumsy, poor fine motor skills, weak muscle tone, handwriting and spelling problems. Becasue there was no help available at that time I was miserable much of the time) All in all her situation is not too bad and she was mostly compensating so it took a while for us to recognise it. Her problems were most apparent in preschool in situations such as circle time.

We now have a wonderful OT and have just started therapy. But just knowing our daughters trigger points, what is going on in her mind and how to bring her back to balance has made a huge difference. Her preschool has been great and has really hit it off with our OT (turns out the director's grandchild has SI issues and she is sure her son had them as well but as with me they were not recognized at the time). In fact she is helping design the class room arrangement with them to benefit all the kids. The husband of one of the primary teachers is a child psychiatrist and through us they have met and are now cross referring patients.

Our OT thinks it is as likely that the problems developed from her having water behind her ears as it is to her having spent 18 months in the baby home. Or it could have been a combination.

June 5, 2007
The Disorder Is Sensory; the Diagnosis, Elusive

By BENEDICT CAREY
Correction Appended
DENVER — Almost every parent of young children has heard an anguished cry or two (or 200) something like:
“This shirt is scratchy, this shirt is scratchy, get it off!”
“This oatmeal smells like poison, it’s poisonous!”
“My feet are hot, my feet are hot, my feet are boiling!”
Such bizarre, seemingly overblown reactions to everyday sensations can end in tears, parents know, or escalate into the sort of tantrum that brings neighbors to the door asking whether everything’s all right.
Usually, it is. The world for young children is still raw, an acid bath of strange sights, smells and sounds, and it can take time to get used to it.
Yet for decades some therapists have argued that there are youngsters who do not adjust at all, or at least not normally. They remain oversensitive, continually recoiling from the world, or undersensitive, banging into things, duck-walking through the day as if not entirely aware of their surroundings.
The problem, these therapists say, is in the brain, which is not properly integrating the onslaught of information coming through the senses, often causing anxiety, tantrums and problems in the classroom. Such difficulties, while common in children with developmental disorders like Adoption.com - Information on International, Domestic, Child & Agency Adoptions, Stories, Laws -, also occur on their own in many otherwise healthy youngsters, they say.
No one has a standard diagnostic test for these sensory integration problems, nor any idea of what might be happening in the brain. Indeed, a diagnosis of such problems is not yet generally accepted. Nor is there evidence to guide treatment, which makes many doctors, if they have heard of sensory problems at all, skeptical of the diagnosis.
Yet in some urban and suburban school districts across the county, talk of sensory integration has become part of the special-needs vernacular, along with attention deficit disorder and developmental delays. Though reliable figures for diagnosis rates are not available, the number of parent groups devoted to sensory problems has more than tripled in the last few years, to 55 nationwide.
And now this subculture wants membership in mainstream medicine. This year, for the first time, therapists and researchers petitioned the American Psychiatric Association to include “sensory processing disorder” in its influential guidebook of disorders, the Diagnostic and Statistical Manual. Official recognition would bring desperately needed research, they say, as well as more complete coverage for treatment, which can run to more than $10,000 a year.
But many psychiatrists, pediatricians, family doctors and school officials fear that if validated, sensory processing disorder could become rampant — a vague diagnosis that could stick insurers and strapped school districts with enormous bills for unproven therapies. The decision is not expected for three or four years, but the controversy is well under way.
“There’s a real resistance to recognizing this, and you can see why, because you’re introducing a whole new vocabulary,” said Dr. Randi Hagerman, a developmental-behavioral pediatrician who is medical director of the MIND Institute at the University of California, Davis. Dr. Hagerman added, “Many of the behavioral difficulties that are being labeled today as anxiety or A.D.H.D., for instance, may be due to sensory disorders, and that forces you to rethink the treatments,” as well as diagnoses. Everyone seems to agree that sensory problems are real and disabling in children with diagnoses like autism or Fragile X Syndrome, a genetic disorder that causes social difficulties and learning delays.
Most youngsters with these diagnoses react strongly to certain sounds, textures or other sensations — or appear unusually numb to sensory stimulation. They may gag at the mere whiff of common smells, or cry out when touched. They may spin or flap their arms as if seeking stimulation (or, in some cases, to relieve pain). Children with attention deficit disorders, too, frequently appear to have unusual sensitivities.
A common treatment for sensory symptoms is occupational therapy. For these children the therapy typically involves activities and games, guided by a therapist, intended to make the youngsters more comfortable as they engage the sensations that disturb them — or more alert to those they usually do not notice.
It was a California occupational therapist and psychologist named A. Jean Ayres who, in a widely read 1972 book, first argued that sensory problems were more than symptoms of other disorders. They were the primary cause of many motor and behavioral problems, she argued, and far more common than doctors recognized.
Pediatricians, psychiatrists and psychologists mostly ignored Dr. Ayres’s message at the time, and most do so today. Occupational therapists are not M.D.’s, many don’t have Ph.D.’s, and they have little voice in mainstream medicine. But increasing numbers of parents have been listening, particularly in the last few years. To explain why, they usually point to their own children.
“All I know is that when I heard a loud sound in first grade, I hid under my desk,” said Matthew Pougnet, who just finished third grade and lives in Denver with his parents and two brothers.
A capable student who seemed unable to relax, Matthew soon was told he had attention deficit disorder and was given a prescription for the stimulant drug Ritalin. “It made no difference at all,” his father, Antony Pougnet, said in an interview.
Convinced there was more to it than that, the Pougnets found their way to the Sensory Therapies and Research Center near Denver, a clinic devoted to treatment and study of sensory problems in children and adults. The center’s director, Lucy J. Miller, an occupational therapist, is the country’s leading research scientist specializing in sensory processing disorder. She assembled the petition that was sent to the American Psychiatric Association, and she has been working to develop the first manual-based standards for diagnosis and treatment of sensory problems to be used for research.
For a child particularly sensitive to certain sensations, Dr. Miller said, the first step in treatment is simply to make the parents aware of what is causing many of the disruptive behaviors. “This is a very important step in itself, because it means that the family now understands the cause of the behaviors, and the extended family too, so it gives the child a community that is looking out for these sensitivities,” she said.
Occupational therapists’ child clinics typically look like indoor jungle gyms, with an assortment of swings, mats, blow-up balance balls, blocks and other toys. And the therapy itself, usually given in hourlong sessions that meet once or twice a week, looks a lot like one-on-one playtime.
But it is playtime with a purpose. If you calm an over-aroused child, the theory goes, by using low lighting, gentle touch and rocking movements, then he or she will be better able to handle the sensations that are upsetting — sudden, sharp noises, for example — when they are presented gradually. Being absorbed in a game can also blunt a child’s response to the dreaded sensations.
For children who seem undersensitive, the approach is reversed: Get them lifting, pushing, pulling — working — until they gradually become more alert to the feel of their body and its surroundings.
“You are playing with them with a very specific goal: to get them back into the classroom more organized, more settled, so they can learn,” said Debra Fisher, an occupational therapist who works at the Manhattan School for Children.
Watching this therapy, many parents say, it is hard not to wonder whether another half-hour of recess would not be just as good and far cheaper. And some techniques intended to help treat sensory problems for which occupational therapists are best known, like brushing children’s limbs with a soft brush, or spinning them, have no proven benefits, researchers say.
But parents who have good experiences with occupational therapy say that over time, and usually within months, the techniques somehow teach their children how to better manage their behavior in ways that regular playtime had not. The youngsters may still tense when touched or hug others too tightly, for instance, but they stop tackling classmates. Matthew Pougnet still hates the sound of fire alarm drills, but he no longer ducks for cover.
At a national conference in Denver in May held by the SPD Foundation, which promotes education and research on sensory processing problems and supports Dr. Miller’s clinic, hundreds of parents and therapists, and some children, traded stories of frustration, breakthroughs and hope. It had the feel of a revival meeting.
Spencer Cambor, 9, of Boulder, Colo., said that he had an assortment of sensitivities, from smells and tastes (“Lettuce is so bad I almost throw up. Really throw up.”) to a feeling of being cramped or crowded, which kept him in perpetual motion.
Spencer is still unusually sensitive, said his father, Roger Cambor, a psychiatrist, but added that after months of occupational therapy, “there was a marked change; all of a sudden he could sit in a circle when asked, he settled down, his handwriting got much better.”
Other families have tales, too, of children who do much better in class when allowed to fidget, handle a small rubber toy, bounce in place, even sit against the wall on a blow-up cushion. As with any therapy, there are also parents who say they saw no change, that the therapy was a waste of money and time.
Whether these diverse anecdotes fit together into a coherent picture of a stand-alone, treatable disorder is not yet clear, at least not to researchers, and many say there is good reason for caution.
The current interest in sensory processing echoes the 1970s theory that learning problems were caused by impaired eye-tracking abilities, said Stephen P. Hinshaw, professor and chairman of the psychology department at the University of California, Berkeley, and co-author of a cultural history of mental health stigma, “Mark of Shame.”
“Back then people tried all sorts of therapy to correct eye tracking, and it turned out to be mostly misguided,” Dr. Hinshaw said. “This idea that there are deep, underlying sensory problems, and if we treat those it will bubble up and the child’s behavior will improve — boy, that idea has a checkered history.”
“It does make some intuitive sense, all right,” Dr. Hinshaw added, “but I keep looking and hoping that the evidence base for this will get better.”
Researchers have in fact laid down a fragile thread of evidence, publishing several small studies in just the past year of children identified with sensory processing problems and normal I.Q.’s — that is, no developmental problems.
In one study, Patricia Davies of Colorado State University led a research team that analyzed how children identified as having sensitivity to sounds responded to pairs of sharp clicks, heard through headphones. The team used EEG technology to measure brain waves, and found that these youngsters responded to the first click normally, showing the same pulse of brain activity as children without sensory problems.
But this comparison group muted its response to the second click, whereas the children identified as more sensitive did not. This automatic adjustment, called sensory gating, “was clearly different in the group with sensory processing problems,” the authors concluded.
Similar studies have found that children identified as having sensory problems also have an atypical brain response, as measured by EEG, when exposed to two things at once, like a click and touch. And in March, The Journal of Occupational Therapy published the first scientifically rigorous trial of guided therapy.
In the study, which included 24 children, those who received a 10-week course of occupational therapy showed greater improvements, on specific goals set by their parents, than a comparison group of children who did not receive such therapy.
“We don’t have as much data as we’d like, but honestly, I’ve been at this for 33 years, and it’s just nice to see some solid, experimental data,” Dr. Miller said. “We desperately need more, and for that we need money.”
The money is likely to flow only when sensory processing is recognized as a legitimate disorder. And the American Psychiatric Association’s decision (on this proposal and many others) is not expected for three to four years.
So sensory processing disorder is entering a kind of limbo state: present but not fully arrived; noticed but, like many of the children struggling with symptoms, not entirely accepted by peers. And experts say that it is likely to be the experience of parents and children that determine its future.
“My experience is that when parents learn about this, they say, ‘Oh, I never thought about it that way’ — it gives them a whole different way to look at their child’s behaviors,” said Roseann Schaaf, a neuroscientist and occupational therapist at Thomas Jefferson University in Philadelphia. “And parents are pretty savvy; they know pretty quickly if it makes sense” and whether treatment is helping.
Correction: June 6, 2007
An article in Science Times yesterday about sensory integration disorder in children misspelled the surname of a therapist and researcher who first argued that sensory problems were more than symptoms of other disorders. She is A. Jean Ayres, not Ayers. The article also misspelled the given name of a father whose son received therapy for sensory problems. He is Antony Pougnet, not Anthony.