Sensory Integration Dysfunction: Implications for Counselors Working with Children.

Sensory Integration Dysfunction (SID), a sensory processing problem that afflicts about 15% of children, sets many children on a developmental trajectory of emotional and social problems. Children with SID often unintentionally alienate parents, peers, and teachers in their efforts to modify the amounts of sensory stimulation they receive. They then miss out on the social and cognitive interactions needed for healthy development, and develop secondary mental health problems such as fear, loneliness, and low selfesteem. Counselors who understand SID can intervene to help these children get “back on track” with normative social and cognitive development. Sensory Integration 3 Sensory Integration Dysfunction: Implications for Counselors Working with Children The typical pre-school classroom is awash with sensory experiences. Children sink their hands into play dough, sandboxes, rice boxes, or water, stimulating their tactile sense. They listen to music, sing, beat on instruments, clap and shout, engaging their auditory sense. They dance, play with puppets, and put on their own coats, all of which require the proprioceptive sense, the one that tells us where parts of our body are in relation to one another. On the playground they run, jump, swing, twirl, and hang upside down, stimulating their vestibular sense, the one that senses gravitational pull. Most preschoolers love, crave, and even demand these activities, which feed their developing sensory systems, and provide them information about the world and their place in it. But not the child with sensory integration dysfunction. The inability to integrate sensory stimuli can prevent a child from joining in the life of his or her peers. This article is about counseling that child. Since Dr. A. Jean Ayres first coined the term Sensory Integration (Ayres, 1972), the theory has become a widely used framework for helping parents, teachers, and practitioners understand the world of learning differences from a child’s perspective. Dr. Ayres, an occupational therapist, conceptualized many childhood troubles as originating in problems related to processing, integrating, and organizing sensory stimuli from the environment. Sensory Integration Dysfunction (SID) not only helps clarify many learning differences, but also illuminates certain aspects of autism, schizophrenia (King, 1996), attention deficit hyperactivity disorder, childhood social problems, childhood fears, anxiety, depression, and a variety of other mental health issues in children. Sensory Integration 4 SID is not yet listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), but concerned clinicians are lobbying to have it included in the next revision (Miller, Cermak, Lane, Anzalone, & Koomar, 2004). Pollack (2006) explains that debate about the existence of SID stems from lack of evidence of treatment efficacy. She briefly reviews the efficacy research on SID treatments, stating that due to small sample sizes and large variance among therapist approaches and treatment protocols, it is difficult to interpret studies conducted over the past ten years. She suggests that therapists who decide to use SID treatment with parents and children should help families understand the questions surround the efficacy research, help parents approach treatment as a trial, and help establish guidelines for measuring improvement in the individual case of the child. Although SID is not listed in the DSM, it is listed under the term “Regulation disorders of sensory processing” in the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised (DC: 0-3R, 1994), a supplement to the DSM-IV-TR that focuses on the mental health and developmental disorders occurring during the first four years of life. Maldonado-Duran, Mandler, Katz, and Sauceda-Garcia (2007) criticize the fact that the DC-03-R classification describes hyperand hyposensitivities to sensory stimuli, without defining threshold levels at which sensory issues become dysfunctional. However, despite the debates about treatment efficacy, and problems in the classification system of regulatory dysfunctions, children who have SID are clearly distinguishable from those who do not, in their behaviors, emotions, and central nervous system reactions to sensory stimuli (Miller et al., 1999; Schaaf, Miller, Seawell, & O’Keefe, 2003). Sensory Integration 5 Though most people experience some sort of sensory integrative problems at some point in life, between 5% and 15% of children experience SID to such an extent that it impairs daily functioning (Miller et al., 2004; Schaaf, et al., 2003; Stepp-Gilbert, 1988). Most SID children are of normal or above normal intelligence (Miller et al.), but because of the “wiring” of their brains, they don’t interact very well in their environments, which can give the appearance that they are less able than they actually are (Greenspan & Wieder, 1998). Dysfunctions are often recognized early, as early as the first day of life, and in most (80%) cases, parents are the first to notice. The causes of SID are as yet unknown (Stepp-Gilbert, 1988a). Although children diagnosed with SID need to be referred to an occupational therapist trained in sensory integration therapy (Miller et al., 2004; Stepp-Gilbert, 1988b), it is important that counselors working with children understand how SID can set children on less than optimal developmental trajectories. Counselors need to understand how to interpret behaviors of the child diagnosed with SID, develop an awareness of the behavioral, emotional, and relational challenges faced by children with this disorder, and understand the processes by which secondary issues such as mental health problems and dysfunctional family dynamics develop in families with SID children. Counselors, parents, and teachers can modify certain aspects of a child’s environment (King, 1996), as well as their own interactions with that child, to help him or her work around the dysfunction and create the meaningful interactions needed for healthy development (Greenspan & Wieder). Most teachers and school counselors, however, are unfamiliar with the disorder (McBride, 2004). The intent of this article is to Sensory Integration 6 help counselors understand the interplay between SID, basically a physiological problem, and some of its mental health consequences. This article will briefly explain the theory and manifestations of SID, and offer implications for mental health counselors working with children with SID. Most publications on SID are targeted at medical personnel, occupational therapists, or parents, who treat the disorder directly. This article, targeted at counselors, will focus on the mental health “fall-out” that often occurs as a result of family and peer reactions to SID symptoms, and a child’s adaptation to these reactions. What is Sensory Integration Dysfunction? Sensory integration is the brain’s ability to process, analyze, organize, and respond to environmental stimuli (Stephens, 1997). It is this ability, in essence, that allows us to interact with our environment, and that lays the groundwork for cognitive and emotional development (Greenspan & Wieder, 1998). Sensory integration dysfunction occurs when the brain cannot do one or more of those things, with one or more types of sensory input (Kranowitz, 1998; Stepp-Gilbert, 1988a). For example, if a child has auditory SID, he or she may not be able to process sounds, organize them into meaning, or figure out how to respond. Parents and teachers may be baffled by test results showing perfect hearing. The child receives the auditory input, but the brain does not integrate it in a way that is functional. This lack of integration can manifest as an over-sensitivity (or hypersensitivity), under-sensitivity (sometimes called sensory defensiveness, or hyposensitivity), or disorganized approach to the sensory input (Kranowitz; Miller et al., 2004). Sensory Integration 7 Oversensitive children pick up too much sensory stimuli, and are unable to screen out what the rest of us might consider irrelevant information (such as the sound of the air conditioner hum). All stimuli trigger “fight or flight” responses, and the child can’t distinguish between threatening and non-threatening input (Stephens, 1997). Undersensitive children, on the other hand, need a great deal of stimuli in order to respond (Stephens). Sensory integration dysfunction can take the form of over or under sensitivities, and also can occur in response to various types of sensory stimuli. Children can experience SID with any of the five senses (touch, taste, smell, hearing, sight), as well as vestibular and proprioceptive senses. In fact, the most common types of SID occur within the vestibular, proprioceptive, and tactile sensory systems (Kranowitz, 1998; Stephens, 1997; Stepp-Gilbert, 1988a). Visual and auditory SID are closely connected to vestibular SID, and oral SID is related to tactile SID. Most people are less familiar with the vestibular and proprioceptive senses than with the “five senses” traditionally learned in school. The vestibular sensors are located in the inner ear, and provide information about balance and gravity. The proprioceptive sensors are located in the muscles, joints, and tendons, and provide information about what the body is doing, and where parts of the body are located in relation to each other (Kranowitz; Stepp-Gilbert, 1988b). Children may have sensory processing problems in more than one sensory system, and they can be both over and under sensitive within the same system (for example, a child might under-react to high pitched noises, but over react to low tones). Alternately, a child might be oversensitive to one type of sensory input, but Sensory Integration 8 undersensitive to another; most children, however, display a predominant pattern of overor undersensitivity (Greenspan & Wieder, 1998). Manifestations and R