Students with Sensory Integration Dysfunctions: Issues for School Counselors.

A substantial number of school age children suffer from difficulties in integrating sensory input in an adaptive manner (termed sensory integration dysfunction SID). These students are at high risk for emotional, social, and educational problems. This article defines SID, describes typical behaviors of children with SID, and presents guidelines for school counselors in their intervention concerning students with SID. 3 Students with Sensory Students with Sensory Integration Dysfunctions: Issues for School Counselors The involvement of the school counselor in fostering students’ academic development and well-being requires knowledge and awareness of special needs and disabilities. When the reason, function or purpose of the student’s behavior is understood, it can be treated more effectively (Nelson & Williamson, 2004). Thus, recognition of the sensory-processing component of different problems observed in school can contribute an important element to helping students improve academically, become more competent, and achieve greater satisfaction in life. Sensory integration dysfunction (SID) is a difficulty in modulating, discriminating, coordinating, or organizing sensation in an adaptive manner (Lane, Miller, & Hanft, 2000). Research clearly identifies this dysfunction in up to 70% of children with learning disorders, disorders on the autistic spectrum, Tourette Syndrome, cerebral palsy, premature birth, and brain injury (Dunn, Saiter, & Rinner, 2002; Talay-Ongan & Wood, 2000). Yet this neurological dysfunction is not confined to children with diagnosed developmental disorders. It may occur in students of all age groups, intellectual levels, and socioeconomic backgrounds, and it can affect learning, behavior, and well-being (Ayers, 1972; Fisher, Murray & Bundy, 1991; Parham, 1998). In her book The Out of Sync Child (1998), Carol Stock Kranowitz discusses “look-alike” conditions that share symptoms with SID (pp. 17–20). She suggests that before jumping to conclusions and “leaping to drug therapy,” parents and professionals should try to better understand what underlies the maladaptive behavior. Unfortunately, 4 Students with Sensory too many children with SID are misdiagnosed and thus not properly treated, making them prone to more severe social and emotional difficulties. Undiagnosed students with SID are puzzling to parents and educators. Often, an emotional impairment such as anxiety, depression, aggression, an inability to make friends, or poor self-concept, is secondary to their sensory disorder. Those children are often labeled as uncooperative, belligerent, disruptive, or out of control. Parents and teachers who are not aware of this “secret difficulty” may be blamed or blame each other for their inability to set limits. Unfortunately, they can all be dragged into a vicious circle of frustration in which the child is blamed for something s/he can not control and the parents and teachers feel incompetent due to their inability to help him/her. Thus, although children with SID suffer from “relatively minor” problems, they are definitely at high risk (Cermak & Groza, 1998). Many schools do not employ a full time occupational therapist, traditionally the person to identify and treat SID. As counselors are challenged to broaden their perspective on their contribution to the students’ academic development and their involvement in this development, and are encouraged to increase their centrality in the overall educational enterprise (Bracken, 1999; Eckert, 2005; Roels, 1998), it is natural for them to take part in identifying and treating SID. Moreover, it is necessary for school counselors to be aware of the kind of environment that would foster learning for students whose sensory functioning is impaired, to be able to identify such an environment, and to know how to construct one. The purpose of this paper is to foster awareness of sensory disorders among school counselors and to offer general guidelines to be applied in educational settings. 5 Students with Sensory What Is Sensory Integration? Sensory integration (SI) is an innate neurobiological process in which the brain integrates and interprets sensory stimuli in the environment. Sensations derived from hearing, vision, taste, smell, touch, pressure, and movement provide input to the brain. The brain sorts and organizes the many sensations we receive and makes its interpretations of stimuli available to us for use in movement, cognition, and learning. Thus, SI provides a crucial foundation for more complex learning and behavior. A general theory and treatment of sensory integration has been developed by Jean Ayres (see Ayres, 1972). As an occupational therapist, Ayres was interested in how sensory-processing and motor-planning disorders interfere with daily functioning and learning (Fisher et al., 1991). Ayer's (1972) theory elucidated why individuals respond in a certain way to sensory input and how this input affects behavior. Her theory and intervention strategies are based on research literature from the fields of neuropsychology, neurology, physiology, child development, and psychology. Usually people tend to think in terms of five main senses: touch/tactile, sound/auditory, sight/visual, taste/gustatory, and smell/olfactory. Sensory integration theory focuses on the importance of the integration of information by means of the “near senses”: The tactile sense (the sense felt on the surface of our entire body – the skin), the vestibular sense (position and movement – provides information about where the head and body are in space and in relation to the earth’s surface), and the proprioceptive sense (muscles and joints – provides information about where the parts of the body are and what they are doing). 6 Students with Sensory What Is Sensory Integration Dysfunction? SID is a difficulty in modulating, discriminating, coordinating, or organizing sensation in an adaptive manner (Lane et al., 2000). People with SID misinterpret stimuli around them and therefore overreact or under react to them. This overor under reactiveness may affect only one sense or several senses. A child may be oversensitive to one type of sensory input and undersensitive to another type. Most “normal” people have an average ability to integrate sensory input. Those with a high ability may be excellent in gymnastics, dancing, basketball or other sports. Those whose sensory functioning is impaired might suffer from various cognitive, social, and behavioral problems. SID is not a dysfunction of the actual sense organs; rather, the problem is believed to be in the way the brain processes the information (Ayres, 1972). Children with an overor under-sensitive auditory system are easily noticed in classrooms; either they cover their ears and pull away from most noises, or they require a high volume of sound to stimulate their auditory system. It is also easy to notice children with an oversensitive visual sense, who cover their eyes and cannot tolerate bright or flashing lights, or children with oversensitive taste or smell senses who cannot tolerate strong flavors or smells and avoid any environment that provides this stimulation (such as the cafeteria, art room, school restrooms, etc.). Parents and educators are less familiar with the signs of disorders in integration of the tactile, proprioceptive, and vestibular senses. The integration and interpretation of sensations derived from these three senses are critical to our survival, as integration of the sensory input allows us to experience, interpret, and respond to different stimuli in our environment. These sensory systems interact with other systems in the brain, and 7 Students with Sensory thus dysfunction or disabilities in one or more of them may result in learning, emotional, and behavioral difficulties (Ayres, 1972; Fisher et al., 1991). Typical Behaviors of Children with Sensory Integration Dysfunctions School counselors often see students with various behaviors that might indicate SID. Yet these behaviors are frequently misinterpreted and misdiagnosed as emotional or behavioral difficulties. These children might have SIDs that are reflected in overor under-reactiveness of one or more senses, and are expressed in their behavior. The overor under-reactiveness of each of the senses described by Ayres is manifested in typical behaviors that can indicate the existence of the problem. Children with an over-reactive tactile sense (tactile defensiveness) tend to avoid physical contact with other people. They dislike being touched, even in a friendly way. They also cannot tolerate the sensation of certain fabrics or materials on their bodies. Thus they often have difficulty wearing certain fabrics. Labels on clothing may annoy them, they prefer seamless socks, and they dislike pants with buttons. Cutting their hair or fingernails might be painful to them. They may avoid any physical contact with others or situations in which other people are near them, even without touching. They will avoid group games, and even standing in line for lunch may be stressful for them. They often wear loose clothing and prefer long-sleeved shirts even on a warm day, so as to avoid contact with the environment. Children with tactile defensiveness often misinterpret social interactions. A friendly or coincidental touch might be interpreted as violent and might produce an aggressive reaction. Thus, children with tactile defensiveness may find social interactions very distressing. 8 Students with Sensory Children with an under-reactive tactile sense will constantly seek physical interaction with people and materials. They tend to disregard the need for “personal space” and are often accused of violence, as their craving for touch is misinterpreted. Because they are not very sensitive to pain and touch, they might not react when they fall or injure themselves and are liable to touch others in a painful way and not understand why they are regarded as violent.