SENSORY PROCESSING IN CHILDREN:

DO SENSORY INTEGRATION TECHNIQUES SUPPORT LANGUAGE?

Alana FabishGraduate Student Clinician – JAC School

Fall 2015

SENSORY INTEGRATION SI definition originally proposed by Jean Ayres in 1972:

“the ability to organize sensory information for use” (p. 1) Sensory Integration and the Child published in 1979

Purpose: for parents to recognize sensory integration dysfunction in their children, understand what was going on, and provide parents with ways to help their children

Expanded definition of SI in 1989 “Sensory integration 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. The spatial and temporal aspects of inputs from different sensory modalities are interpreted, associated, and unified. SI is information processing…the brain must select, enhance, inhibit, compare, and associate the sensory information in a flexible, constantly changing pattern; in other words, the brain must integrate it.” (Ayres, p. 11)Ayers, 1972, 1979, 1989

SENSORY INTEGRATION AND THEORY Involves all of the senses, but focuses on 3 less

cortically processed ones: Vestibular Tactile Proprioceptive

These 3 senses are the basis/foundation which certain skills are formed and maintained Auditory-language, eye-hand coordination, etc.

Brainstem and thalamus are critical in SI Vestibular info: processed in brainstem Tactile/proprioceptive info: processed in both

SI Theory: increased efficiency enhances higher functioning (i.e. complex learning, behavior)

Mauer, 1999

SENSORY INTEGRATION THERAPY Defined as a specialty in occupational

therapy Focused on assessment and treatment of people

with sensory integrative/sensory processing dysfunction

Based on the principle of neuroplasticity in CNS Some of the neural processes responsible for

interpreting and integrating sensory information can be “remediated” due to this principle

Control of tactile, vestibular, and proprioceptive sensory inputs can potentially enhance functioning of the nervous system (Fisher et al., 1991)

There are a variety of approaches used in therapy Sensorimotor, Neurodevelopmental,

Developmental, Behavioral, Sensory integrative

Mauer, 1999

SENSORY INTEGRATION THERAPY POPULATIONS

Has been used in the following populations: Typically developing individuals Neuromuscular disorders (CP) Learning disabilities Intellectual disabilities Autism Spectrum Disorders Sensory impairments (Sensory processing

disorder) Language impairments

Mauer, 1999

SENSORY INTEGRATION DYSFUNCTION LEADING TO SENSORY PROCESSING DISORDER Learning in any environment requires:

organization of sensory information adaptation of that information to many situations

Dysfunction can occur in 4 areas Limbic system-

Can result in language processing/auditory processing problems Vestibular system-

Can result in decreased balance and spatial orientation Responsible for integrating movement with all senses

Tactile system- Can result in fine motor issues (feeding, oral motor, writing) Deep pressure versus tactile defensiveness

Proprioceptive system- Can result in clumsiness, lack of body awareness, difficulty

manipulating small objects, motor planning and execution

Mauer, 1999

SENSORY PROCESSING IN INFANTS Studies on selective attention in infants: shows early

trajectories of sensory responses and changes from the norm may result in developmental disability/ASD Two responses to stimuli: orienting and defensiveness; used as measure

of efficiency of sensory processing Problems in orienting and defensive behavior responses are associated

with increased risk of developmental delay and social emotional problems at 3 years of age

Sensory processing behaviors also lay foundation for: Social skills Communication Language functioning

Any disruption to sensory processing abilities in infancy can lead to difficulties/problems later in life Social/emotional/behavioral problems Abnormal sensory processing patterns

Watson, Patten, Baranek, Poe, Boyd, Freuler, & Lorenzi, 2011

DUNN’S 4 PATTERNS OF SENSORY PROCESSING

(Dunn, 1997, 2007)

•No one has just one pattern of sensory processing!

ASD SENSORY PROCESSING PATTERNS Different/unusual responses to sensory stimuli

than typically developing peers and peers with other developmental disabilities

3 accepted sensory-processing constructs: Hyporesponsiveness- absence of expected response to

stimuli, delayed response, higher response threshold Low arousal, low registration

Hyperresponsiveness- exaggerated behavioral reaction, aversive response, or avoidance of sensory stimuli Sensation avoiding, sensory sensitivity

Sensory seeking- actions or behaviors that seek to intensify sensory experiences Sensory seeking

Patterns are NOT mutually exclusive; may co-occur or differ based on modality type

Watson et. al, 2011

ASD SENSORY PROCESSING PATTERNS

Hyperresponsiveness was not correlated with social-communicative symptom severity (measured with modified ADOS)

Hyporesponsiveness was associated with social-communicative symptom severity; negatively associated with language skills and social adaptive skills

Sensory seeking negatively associated with language skills

Watson et. al, 2011

SENSORY INTEGRATION THERAPY AND LANGUAGE- EARLY RESEARCH

Sensory integration therapy doesn’t directly address language Some studies have documented improvement in

motor, language, academic, and cognitive skills using traditional SI therapy (Fallon et. al, 1992)

Research criticized these early studies due to: Low sample size (N) Varying types of SI treatment Inconsistent outcomes

Mauer, 1999

SENSORY INTEGRATION THERAPY AND LANGUAGE- LATER RESEARCH 1999: Meta-analysis of SIT with adults and

children with various language/motor/cognitive disorders (Vargas & Camilli, 1999)

Significant effect on psychoeducational & motor outcomes

No effect on behavior, language, or sensory-perceptual outcomes

2008: Review of research since 1994 on SIT (Leong & Carter, 2008)

Inadequate evidence to support SIT outside of research purposes

USING SENSORY INTEGRATION Allows child to organize themselves

Promotes better attention Working on less cortically processed senses

promotes generalization to higher-level senses Visual Auditory

Calms the child/primes the child for higher sensory input

Creates an environment that lends itself to: Language production Language comprehension

SENSORY-BASED ACTIVITIES Incorporate sensory activities into our

therapy sessions rather than using sensory integration therapy (SIT) ASHA’s National Center for EBP produced a

systematic review of Sensory-Based Interventions Their recommendations: “incorporating sensory-based

activities (e.g., tactile stimulation, vestibular stimulation) with skill-based treatments may be motivating or make treatment more enjoyable for the child. However, further research is needed to better understand the nature of sensory processing disorder and the associated treatments as well as any role of the SLP or audiologist.” (pg. 13)

No studies using SIT showed gains in language abilitiesSchooling, Coleman, & Cannon, 2012

FACILITATING LANGUAGE IN THERAPY Hyporesponsiveness:

take advantage of stimuli that have caught the child’s attention; build communicative interactions around that stimulus

Hyperresponsiveness/hyporesponsiveness seen together: accommodate co-occurring or shifting sensory behaviors within

your sessions; accommodations must change based on child’s behavior

Sensory seeking: Incorporate unique, child-specific stimuli that might engage child

and motivate better attention during your sessions Must always consider the child’s underlying sensory

response patterns to provide successful intervention Response patterns may affect success in language, social, and

communication development

Watson et. al, 2011

EXAMPLES OF SENSORY-BASED ACTIVITIES Hyporesponsive children:

Sensory corner with sensory box Many textures and weights

Vibration to stimulate oral-motor awareness Deep pressure touch Weighted blanket at rest time Bouncing and rocking on a ball or swinging

Best to use a “heavy work” activity before doing a sit-down activity For SLP’s: incorporate some gross motor tasks to allow child to organize

their sensory system before putting language demands on them Sand/water play Vibrating toys/toys that light up Provide different play surfaces Speak with varying intonation; highlight important words using

stress, prosody, and intonation Brightly colored toys to gain and keep child’s attention Give child heavy objects to carry Use scented lotion on child and your hands

Dunn, 2007

EXAMPLES OF SENSORY-BASED ACTIVITIES Hyperresponsive children:

Sensory corner with sensory box Many textures and weights with a favorite toy

Deep pressure touch Bouncing or rocking on therapy ball

Again, best to do before having child sit down for activity Wilbarger Brushing protocol (tactile defensiveness) Tents/obstacle courses Chewy tubes Allow for quiet play Keep play area clear; use one toy at a time If you need to use lotions, use unscented lotions Identify and use preferred surface textures in play areas Use even tempo background music Sing softly Obstacle course with tight spaces Allow child to move away from play space if they are overwhelmedDunn, 2007

EXAMPLES OF SENSORY-BASED ACTIVITIES Sensory-seeking children:

Sensory corner with sensory box Weighted blankets at rest time Rough sensory play (“crash” or “squish”) with bean bags Reading a book in a rocking chair/bean bag chair Sand/water play Vibrating toys Offer a special toy/object with a texture child likes

This can help focus a sensory-seeking child Chewy tubes Place favorite toys in places that require exploring through

crawling, walking, etc. Musical instruments Colored lights Provide music in the background Talk about what you see/hear/smell and ask child the sameDunn, 2007

CONCLUSIONS Does sensory integration STIMULATE language?

Not quite… However, it FACILITATES language

R.B. Rough sensory play “crashing”/”squishing” with big bean bags

Occasionally noticed he would calm down, but effects didn’t last throughout session

No large gains in ability to attend during session M.F.

Brushing arms, legs, back at the beginning of each session Immediately calmed her down and noted increase in attention to

tasks Able to imitate a variety of gestures, follow 1-step commands when

playing with toys, match pictures with more accuracy M.H.

Bounce on a small ball while singing preferred songs Requested “more” and “all done” verbally during the activity Increased attention and more verbal output (imitates approx. 15-20

words) throughout the rest of the session

CONCLUSIONS By providing sensory input (sensory-based

activities) a child likes, we can coordinate vestibular, tactile, and proprioceptive modalities resulting in: Increased attention Decreased distractibility Coordination of higher-order sensory functions

(auditory and visual) All leads to: a more controlled session with

the potential for more verbal output from the child

REFERENCES Ayres, A. J. (1972). Sensory integration and learning disorders. Los Angeles, CA: WPS. Ayres, A.J. (1979). Sensory integration and the child. Los Angeles, CA: WPS. Dunn, W. (1997). The impact of sensory processing abilities on the daily lives of young

children and families: A conceptual model. Infants and Young Children, 9, 23-35. Dunn, W. (2007). Supporting children to participate successfully in everyday life by using

sensory processing knowledge. Infants & Young Children, 20, 84-101. Fisher, A. G., Murray, E. A., & Bundy, A. C. (1991). Sensory integration: Theory and practice.

Philadelphia, PA: F. A. Davis. Leong, H., & Carter, M. (2008). Research on the efficacy of sensory integration therapy: Past,

present and future. Australasian Journal of Special Education, 32, 83–89. Mauer, D.M. (1999). Issues and applications of sensory integration theory and treatment with

children with language disorders. Language, Speech, and Hearing Services in Schools, 30, 383-392.

Schooling, T., Coleman, J., & Cannon, L. (2012). The effect of sensory-based interventions on communication outcomes in children: A systematic review. National Center for Evidence-Based Practice in Communication Disorders, 1-47.

Vargas, S., & Camilli, G. (1999). A meta-analysis of research on sensory integration treatment. The American Journal of Occupational Therapy, 53, 189–198.

Watson, L.R., Patten, E., Baranek, G.T., Poe, M., Boyd, B.A., Freuler, A., & Lorenzi, J. (2011). Differential associations between sensory response patterns and language, social, and communication measures in children with autism or other developmental disabilities. Journal of Speech, Language, and Hearing Research, 54, 1562-157 DOI: 10.1044/1092-4388(2011/10-0029)6.