Sensory integration as a treatment for automatically reinforced behavior

Sensory integration is a theory that suggests that many of the characteris tics of autism are caused by poor integration of sensory experiences. Conceptualized in behavioral ter ms, sensory integration therapy could serve to abolish automatically reinforced behavior. The purpose of this research was to investigate sensory integration as a treat ment for repetitive behavior in individuals with autism. Two teenage boys with autism participated in Experiment 1. Both participants had high levels of automatically reinforced motor stereotypy. A typical sensory diet treatment was examine d to d termine whether this treatment would have an abolishing effect on motor stereotypy. It wa s determined that the sensory diet had no long-term effects on motor stereotypy f or either participant. One participant from Experiment 1 participated in Experiment 2, an extension to determine whether the sensory diet had any immediate or short-term effects on motor stereotypy. Results of Experiment 2, showed that the sensory diet suppresse d stereotypy while it was being administered, but had no abolishing effects on ste reotypy immediately after removal. Based on the results of these two experiments, S sory Integration therapy, particularly the sensory diet approach was shown to be ineffect ive in decreasing motor stereotypy. Sensory Integration 3 SENSORY INTEGRATION Sensory integration is a theory of brain-behavior relationships, which proposes that in order to function properly a person must be able to “integrate” or organize se sory input from the world around him (Ayres, 2005). If an individual cannot properly integrate sensations he can end up with anything from mild problems such as difficul ty concentrating to severe developmental problems like autism. According to A. Jea n Ayres, the originator of sensory integration theory, people receive millions of sensati ons from the world around them each day, each of which are sent on to the brain. The brain and central nervous system then have to organize and interpret all of these sensations and make sense of them so that the individual is able to make meaning of the things he experiences in the world, and so that he can make adaptive (purposeful, goal-directed) responses to the things he experiences. Sensory integration theory is based on three main components (Bundy, Lane & Murray, 2002). The first component is that all learning depends on the ability to receive and organize sensations from the environment, and to then be able to use this information to “plan and organize behavior” (p. 5). Second is that individuals who are unable to process sensations accurately may then have difficulty producing appropriat e actions based on these sensations. Again, this may interfere with learning as well as be havior. The third component of sensory integration is that meaningful activity can produce enhanced sensation and therefore adaptive responding, which can develop sensory integration in an individual who is lacking appropriate sensory integration. This will then lead to an increase in learning and appropriate behavior. Sensory Integration 4 Sensory integration as a process begins when a child is still in the womb and develops with age through experience and interaction with the world, according to Ayres (2005). Disorders of sensory integration usually begin very early on in development, possibly because of a lack of properly interacting with and experiencing sens ory stimulation. Ayres claims normal sensory integration develops because humans have an innate “inner drive” to develop sensory integration and will seek appropriate sensa tions. People with sensory disorders (such as children with autism) often lack this inner drive, and therefore do not seek appropriate sensations and do not experience appropriate sensory integration. As suggested by Bundy et al. (2002), if normal sensory integ at on does not occur starting in infancy, normal learning and development cannot take place. According to Bundy et al. (2002), sensory integration theory includes five assumptions involving the neural and behavioral bases of sensory integration. The firs t assumption is that “the central nervous system is plastic” (p. 10). This means that the brain and CNS can change throughout a person’s life, and that although a person may not be able to properly integrate sensations due to the way their brain and CNS have developed, this does not have to be a permanent impairment. Sensory integration theorists believe that with proper therapy the brain and CNS can be changed and learn to properly integrate sensations. The second assumption held by sensory integration theorists is that “sensory integration develops” (p. 11). This means that behavior s at each developmental stage occur in sequence, and this allows for proper development of more complex behavior. If sensory integration does not occur properly, normal development gets disrupted and certain more complex behaviors cannot occur or will occur out of sequence. The third assumption is that “the brain functions as an integrated whole” (p. Sensory Integration 5 11) and that if lower-level brain structures (sensorimotor experiences) do not devel op properly, higher-level brain structures (abstraction, language, reasoning, a d learning) will not develop properly either. The fourth assumption of sensory integration theory is that “adaptive interactions are critical to sensory integration” (p. 11). In othe r words, individuals must make purposeful, goal directed responses to sensations from the environment in order to advance sensory integration. The final assumption is that “people have an inner drive to develop sensory integration through participation in sensorimotor activities” (p. 12). This inner drive leads people to seek new sensory experiences and integrate new sensations. Sensory Integration and Autism Sensory integration theorists believe that many behaviors characteristic of autism can be explained by poor sensory integration (Ayres, 2005). Supporters of sensory integration therapy believe that sensory integration is the best treatment method for autism because it is the only therapy that changes the conditions of the brain that c ause the maladaptive behaviors (Ayres). According to Ayres, children with autis m have problems with three aspects of sensory processing that lead to many of their ma ladaptive behaviors and inability to learn and develop appropriately. The first major problem that most children with autism have is that they are unable to properly “register s ensory information” (p. 128). The portion of the brain which decides whether or not to register each piece of incoming sensory information and whether or not to act on that sensory information may not work properly for children with autism, causing them to not pay attention to many sensations they experience. The child with autism’s brain has difficult time sorting out all of the different sensations it receives, making se sory Sensory Integration 6 integration and, therefore, normal learning and development difficult. Ayres belie ves that the second problem that most children with autism have is that they are unable to properly modulate sensory input, especially from vestibular and tactile input. M any children will only register very strong sensations or may be extremely def ensive to certain sensations such as light touch. These children may also have difficulty growing accustomed to continuous sensations, and may over-register some sensations and underregister others. The third common problem for children with autism is that they a re unable to integrate the sensations that they register to “form a clear percept ion of space and (their) relationship to space” (p. 131). Children with autism are also unable to for m a clear perception of their own body because they do not get adequate sensory infor mat on from skin, muscles, joints and the vestibular system. This makes it very difficult f or these children to interact with their environment or with others when it is diffic ult or them to feel what their own body is doing. Again, this greatly impacts learning , development and social skills. Ayres (2005) also believes that children with autism may have difficulty registering the meaning or usefulness of objects in their environment, and there fore a unable to appropriately interact with them. Because children with autism have diff iculty with sensory integration, the normal path of brain development has been disrupted and complex behaviors such as abstract thinking are sometimes impossible, without fir st taking a step back and learning to properly integrate sensations. Ayres also ma intains that children with autism lack the “inner drive” necessary to achieve proper sens ory integration, and therefore need intensive therapy to expose them to different sensa tions that they would not otherwise seek themselves. Sensory integration therapy for childr en Sensory Integration 7 with autism seeks to expose children to different sensory experiences and improve sensory processing. Through this therapy, it is believed that the children will lea rn to better register and modulate sensations, and make more appropriate adaptive res ponses. While supporters of sensory integration therapy claim that the child’s life ca n be “changed considerably” they also admit “no therapy can cure autism” (Ayres, 2005, p. 135). Sensory Integration Treatment The goal of sensory integration as a treatment for autism (or other sensory disorders) is to improve the ability to process and integrate sensory informati on in order to allow children to be more independent and to participate more in daily activitie s (Schaaf & Miller, 2005). This is accomplished by giving the child access to s ensory experiences that they have missed out on, or not had appropriate interactions with, and to allow the child’s brain to learn how to process sensations and integrate sensati ons (Ayres, 2005). During sensory integration therapy, a chi