A Look at Sensory Integration
A Look at Sensory Integration: When Kids Are Out of Sync With Their Surroundings
A therapy created to help children process what they see, hear or feel has its proponents. But others want to see the proof.
One child swings on a tire and tosses balls through a hoop; another sits in a sandbox filled with beans. The play may seem ordinary enough, but in the jargon of occupational therapists, these activities are known as sensory integration therapy.
“It’s almost like a gymnastics class,” says Page Heenan, whose daughter, Isabel, underwent a year of sensory integration treatment as a toddler because of a cluster of unexplainable symptoms and behaviors she was experiencing. “She was having night terrors and day terrors,” Heenan recalls. “Sometimes she’d just flip out for no reason.”
Therapists who use these techniques say they are beneficial for treating sensory processing disorders – nervous system problems that impair the way children process sensations such as sights, sounds and smells. They say that up to 5% of children are affected by these types of disorders which, they add, can lead to behavioral problems and learning disabilities.
To some, they’ve made a convincing argument. Children with problems as varied as autism and simple clumsiness are being referred for this type of treatment. Some health insurers now pay for it, and certain school districts
provide it free-of-charge to their students.
But not everyone is sold on the therapy. Some suggest it is little more than supervised play, pointing out that there is no credible evidence that the therapy works.
It’s true that some children do seem to respond abnormally to sensory stimulation. In some cases, they seem overly sensitive to touch, movement,
sights or sounds. “I couldn’t take Isabel out into a crowd or to a party,” Heenan says. “She would get overstimulated and just fall apart.” Other children may be very insensitive to these same situations.
Some children also have difficulty identifying certain sensations. A child might reach into a pocket and not be able to recognize what it contains. Others might have difficulty visually differentiating the letter P from the letter B, or trouble hearing the difference between the words “cat” and “cap.”
Advocates of sensory integration therapy say these types of problems can lead children to avoid certain experiences because they are unpleasant.
“Normally, children seek out sensory challenges on their own – typical kids do this all the time,” says Diane Parham, an associate professor in the department of occupational science and occupational therapy at USC.
“Sensory integration therapy confronts the child who has avoided certain stimuli.”
During therapy, controlled sensory stimulation is used to help children learn to manage these experiences and gradually tolerate more difficult challenges.
Therapy varies from one child to the next. For a child who has difficulty tolerating loud noise, treatment may involve swinging on a swing while blowing a whistle. A child who doesn’t like to be touched might be rolled in a soft blanket.
Medical professionals who are critical of this type of therapy point to a lack of proof that children who go through it fare any better afterward than comparable children who are simply left alone. The popularity of the therapy, they say, relies nearly exclusively on anecdotal reports from therapists and testimonials from parents who say their children were helped by it.
Some health professionals reject the basic premise underlying sensory integration therapy. They say that sensory processing disorders have not been proven to exist and, even if they do, there is no reliable method to diagnose them.
Some proponents of the therapy acknowledge that the results of research studies have been inconclusive. “For people to take it seriously, the research has to be there,” says Lucy Miller, director of a sensory integration therapy research center at the Children’s Hospital of Denver.
The lack of rigorous science showing the safety and effectiveness of these treatments raises questions about whether parents should be offered the therapy and whether health plans and school systems should be paying for them.
Still, it’s understandable why a parent would want to try sensory integration when there are no other good options available to them. That was Heenan’s attitude, particularly after learning that her insurance would cover most of the costs of the treatment. “It wasn’t hurting Isabel, she liked it, and it was free.”
Although her daughter showed some improvement during the course of the therapy, Heenan isn’t entirely convinced that the treatments are the reason why. “Was it just maturation?” she asks.
Four years later, at age 7, Isabel still exhibits some of the behaviors that led to sensory integration therapy. “I’ve decided that’s just who she is,” Heenan says. “We’re all different.”
Dr. Valerie Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles.