Life Experiences of a Child with Challenges in Sensory Processing and Integration: A Case Study

Children have occupations they need to perform in order to learn, grow, and develop. Challenges in processing and integrating sensory information can impair their capacities . for occupational participation and engagement. Sensory integration interventions have been promoted as able to help children improve their abilities to use sensory information for function as well as provide strategies for self-regulation. Much of the research on the efficacy of sensory integration interventions is experimental and descriptive, and largely inconsistent. Qualitative methodologies have not been widely used to examine the approach or to investigate the first-person experiences of the children who participate in sensory integration interventions. This phenomenological qualitative research study investigated ~he life experiences of a child with challenges in sensory processing and integration who had received sensory-based occupational therapy intervention. The themes identified were freaking out and I engage. The perspectives acquired can help influence the clinical reasoning of occupational therapists and expand the research base of sensory integration interventions. -SENSORY PROCESSING LIFE EXPERIENCES Life Experiences of a Child with Challenges in Sensory Processing and Integration: A Case Study 4 The role of occupational therapy is to promote "the health and participation of people, organizations, and populations through engagement in occupation" (American Occupational Therapy Association [AOTA], 2008, p. 625). Participation is simply performing an activity, while engagement requires motivation and choice (AOTA, 2008). Both participation and engagement in the occupations of children can provide the foundation for learning, growth, and development. Lane (2012) stated that "children are not little adults; they are impressionable beings who experience and learn" (p. 4 ). In order for children to successfully experience and learn, as well as participate and engage in occupations, they need to process, organize, and respond to sensation arising from the body and the environment. This process is called sensory integration and it is the foundation for the development of selfawareness, learning, and behavior (Ayres, 1972). The theory of sensory integration, as conceptualized by Ayres (1972), 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" (p. 11). Ayres' theory was developed in accordance with the neuroscience research of her day and revqlved around the phenomenon of neuroplasticity, or the brain's ability to change its structure and function in response to experience (Parham & Mailloux, 201 0). A typically developing person is able to process and organize sensory information from both the body and the environment in order to create an accurate body scheme and SENSORY PROCESSING LIFE EXPERIENCES judge the body's orientation in space. This information allows the individual to respond to sensory experiences in an appropriate manner and adapt his or her responses to novel experiences as necessary. The brain collects and draws upon these experiences and responses for the performance of everyday childhood occupations such as selfcare, education, play, leisure, and social participation. Any time the response to a sensory experience is more complex than its predecessor, organization of the brain is improved and the "capacity for further sensory integration is enhanced" (Parham & Mailloux, 2010, p. 327). 5 Dysfunction in processing, organizing, and integrating sensory information for use may manifest as poor gross and fine motor skills, language skills, cognition, and emotional regulation which in turn affect academic performance, occupational engagement, and participation in family and social life (Parham & Mailloux, 201 0; Watling, Koenig, Davies, & Schaaf, 2011). It is estimated that 5% to 15o/o of American kindergarteners (Ahn, Miller, Milberger, & Macintosh, 2004), 40o/o to 80°/o of children with developmental disabilities (Baranek et al., 2002), and 30°/o to 1 OOo/o of children diagnosed with autism spectrum disorder (Dawson & Watling, 2000; Tomchek & Dunn, 2007) have these types of challenges in processing and integrating sensory information. Many intervention strategies can be implemented when addressing these deficits; sensory integration being one of the most utilized approaches (Blanche & Blanche Kiefer, 2007). Occupational therapy research on the effectiveness of sensory integration interventions is mixed; nevertheless, caregivers have expressed appreciation for the changes in abilities, activities, and self-worth sensory integration interventions bring to their children (Cohn, 2001 b). Expanding the research base on SENSORY PROCESSING LIFE EXPERIENCES 6 sensory integration interventions is an important step in increasing the knowledge and understanding of the effects of this treatment approach. Most of the existing research on sensory integration interventions utilized experimental or descriptive methodologies. Qualitative research methodologies have the potential to provide relevant data on par with experimental, outcomes, and descriptive research (Tomlin & Borgetto, 2011). Additionally, much of the existing qualitative literature surrounding sensory integration interventions for children focuses on parental and familial perceptions (Cohn, 2001a; Cohn, 2001 b; Cohn, Miller, & Tickle-Degnen, 2000) while the perceptions of the children themselves are unknown. Background The field of occupational therapy is concerned with an individual's ability to engage in occupations and participate in everyday life. Occupational engagement requires an individual to make choices and to be motivated to perform. Engagement includes "carrying out activities meaningful and purposeful to the individual person" (AOTA, 2008, p. 660). Participation is defined by the World Health Organization (2001) as "involvement in a life situation" (p. 1 0), and is the natural outcome of performing an activity (AOTA, 2008). For children, occupational engagement and participation provide the foundation and the building blocks for learning, growth, and development. When engagement and participation are disrupted, so are these outcomes. Participation and engagement. Kids want and need to do the everyday "kid things" (Lane, 2012, p. 3) that contribute to learning, growth, and development. Learning and systems theorists have proposed a sequential developmental process whereby the everyday kid things contribute to the maturation of the central nervous system (CNS) SENSORY PROCESSING LIFE EXPERIENCES 7 and result in learning (Case-Smith, Law, Missiuna, Pollock, & Stewart, 2010). They believe that a child must interact with his or her environment in order to grow in "knowledge, skills, and occupations through experience that leads to a permanent change in behavior and performance" (Case-Smith et al., 2010, p. 30). Burgman (2012) believes that everyday kid things also contribute to a sense of agency, which she describes as the "ability to self-determine engagement with and response to life experiences" (p. 11 ). Engagement suggests a "commitment made to performance" (AOTA, 2008, p. 660), rather than simply performing an activity. However, simply performing an activity, or participating, may provide a child with the experience necessary to determine whether or not an activity elicits enough meaning and/or purpose for the child to make that commitment to performance. The ability and desire to participate and engage in occupations that are wanted and needed contributes to the development of identity and competence, and supports health and participation (AOTA, 2008). Childhood roles of family member, friend, student, and player (Posatery Burke, Schaaf, & Lomba Hall, 2098) typically provide plenty of occupational opportunities for participation and ~ngagement. Areas of occupation. The American Occupational Therapy Association (AOTA, 2008) has offered multiple definitions for the term "occupation" (pp. 628-629), all of which encompass the concept of daily engagement in purposeful or meaningful activities. Occupational therapists recognize that participating and engaging in occupations can help to organize daily life and promote overall health (AOTA, 2008). Eight areas of occupation have been identified, five of which are of primary concern to SENSORY PROCESSING LIFE EXPERIENCES cllildren: activities of daily living, instrumental activities of daily living, education, play, leisure, and social participation (AOTA, 2008). 8 Activities of daily living (ADLs) are fundamental self-care activities (AOTA, 2008) and essential occupations within the maturation process (Shepherd, 2010). Active participation in ADLs such as bathing, dressing, and grooming can help a child to progress in the development of physical skills and problem-solving skills (Shepherd, 2()1 0). Learning and mastering ADLs can cultivate self-esteem, self-reliance, selfdetermination, autonomy, and pride (Shepherd, 201 0). Responsibility for establishing habits and routines for ADL performance that is socially acceptable increases over time and becomes necessary for engagement in other occupations and community living (Shepherd, 201 0). · Instrumental activities of daily living (IADLs) are homeor community-based activities that take place beyond the self, such as meal preparation and cleanup, care of pets or others, and community mobility (AOTA, 2008). Natural opportunities for participating and engaging in IADLs exist within the home and community for children as young as three years (e.g. assisting in caring for pets, meal preparatiqn and cleanup, and shopping); however, the autonomy developed in adolescence seems to motivate the development of the more complex IADLs in preparation for independent community living (Loukas& Dunn, 2010). Participation and engagement in IADLs at any age or abil