Sensory disorder - When play isn't fun

Struggling to cope
Five-year-old Connor didn't like going to the park. While his twin brother Tim and younger sister Rachel, 3, played on the slides, swings and tunnels, Connor sat in the sandbox and watched. He wasn't having fun.

Connor suffers from sensory integration dysfunction. Simply, he has difficulty coping with experiences involving his senses. While most of us are familiar with the five basic senses -- taste, touch, sight, hearing and smell -- experts now recognize other senses as well, including movement (sliding down a slide), body position (combing hair), the pull of gravity (swinging) and balance (sitting in a chair).

Connor's mother Carol, a stay-at-home mom, started noticing the subtle signs of sensory integration difficulties when Connor played. "I thought he was just an uncoordinated little boy," she says. "He would hold his hands way out when he ran. He wouldn't catch a ball. He wouldn't even move his hands in front of his face when a ball came right at him."

Thinking Connor needed physical therapy, Carol spoke to a physical therapist who mentioned sensory integration, a relatively new concept in the field of child development derived from the work of A Jean Ayres, PhD, an occupational therapist -- a therapist specializing in the treatment of nervous, mental or physical disabilities. Ayres was interested in learning how sensory processing disorders interfered in daily living. Carol, having never heard the term before, was a little skeptical, but when she started reading the literature the therapist had given her, she thought, "This isn't just Connor's problem, it's Tim's too."

Connor's fraternal twin Tim, also copes with sensory integration dysfunction, but shows weaknesses in different areas. While Tim doesn't have as much trouble with balance and movement, he doesn't like loud noises or the vacuum cleaner, and hates "anything on his hands like dirt, mud and oatmeal," says Carol. Tim also struggles with concentrating on tasks, and he often stares into space, both subtle signs that he is having trouble processing his senses.

Three sensory information areas
In her book, Sensory Integration and the Child, Ayres identifies three main sensory information areas: vestibular (gravity and space); proprioceptive (muscles and joints); and tactile (touch on the skin). Preschoolers who have difficulty with vestibular activities may dislike swinging or sliding like Connor. Those children who find it difficult to climb a ladder or push a wagon may have trouble in the proprioceptive area. And those with tactile problems may be oversensitive to textures of certain clothes or the feel of certain food, the way Tim doesn't like to touch oatmeal.

Other signs that a child may have a sensory disorder, according to Sensory Integration International (SII), a non-profit organization founded in 1972 that promotes education, research and treatment related to sensory integration, are that the child might be easily distracted, impulsive, lack in self-control, have difficulty unwinding or calming down, display social and/or emotional problems, be under-reactive to touch, movement, sights or sounds; and have an unusually high or unusually low activity level. Typically, a child with a sensory integration disorder will show one or more of these signs, according to SII.

Tim demonstrates many of these signs, according to Carol. But the most obvious is his inability to calm himself. He is "very emotional" and has frequent sudden outbursts, says Carol. "He can't cope with a lot of things. He just collapses inside."

Before Tim was diagnosed with sensory integration dysfunction, Carol disregarded Tim's outbursts, thinking they were just normal childhood tantrums. But when they began occurring more frequently, she thought perhaps he needed more structure in his day and more discipline. When these changes didn't work, Carol tried modifying his sleep schedule, but the sudden outbursts continued. Discouraged, Carol spoke to an occupational therapist who thought Tim's behavior was due to exhaustion.

"Sensory integration is what we do every second of every day," says Barbara Cloud, a pediatric occupational therapist certified in sensory integration at the Child Development Center in Colorado Springs, Colorado. "A child with sensory integration dysfunction is constantly challenged. He or she has to work a lot harder than we do to get though the day. Things that are automatic for us, like brushing our teeth, getting dressed, eating dinner, can be very stressful for those with a sensory integration problem."

Stress on the family
Raising a child with a sensory problem can be just as stressful on the family. "Everything you do with your child, you have to think about," says Cloud. "You choose family activities according to how they will affect your child. Simple things, like getting a hair cut or cutting your child's nails, can be a nightmare."

Carol remembers many frustrating moments, but one particularly bad day involving Connor stands out. " It was Rachel's third birthday and we were having a party at a miniature golf park," she says. "Connor was having trouble playing golf and became so frustrated that he tensed up, clenched his fists, gritted his teeth, pounded the golf club on the ground and screamed."

Because Connor has trouble processing his senses, motor planning -- having an idea about how to do something, planning what to do and then doing it -- is difficult, such as when he played miniature golf. Preschoolers constantly attempt new things every day, and children with sensory integration dysfunction who are more challenged, can often "feel like they're less successful than others," says Cloud. "They may have less confidence."

Sensory integration therapy can enhance a child's self-concept by helping him learn and achieve new skills. In many cases, children with sensory difficulties learn how to compensate for what they can't do. "They learn to avoid what bothers them," says Cloud. Therapy slowly challenges these children to try new things.

How therapy works
During an introduction to sensory integration therapy, parents may think their child is simply playing. The Child Development Center has a special sensory integration room that looks like a play land. There are ramps to slide down, platforms to swing on, colorful balls to jump into and trapezes to swing from. For most children, therapy is fun. But with the help of a therapist guiding them, children try activities they probably wouldn't try on their own.

Parents who suspect a sensory integration problem in their child and want an evaluation, should talk to their pediatrician and/or local pediatric occupational or physical therapist clinic. When looking for a therapist, SII recommends seeking one who has experience in sensory integration dysfunction. Parents should also visit the facility, making sure they are comfortable with the setting and the therapist and ask to look at sensory integration equipment; a good therapy program will offer a variety of swings, ramps, scooter boards, balls and textural activities.

Parents can also help their child by "being sensitive to their special needs and helping them adapt to their environment," says Cloud. This may mean leaving a noisy restaurant or cutting the tag out of their shirt. Parents should also let their child know that they "accept them for who they are," says Cloud.

After six months of therapy, Tim and Connor are now coping better with their environment and feeling better about themselves, says their mother. Recently, after getting lost in a shopping mall, Tim asked, more to himself than to his mother, "Why did I do such a stupid thing?"

"A few months ago, he would have said 'I'm so stupid,'" says Carol. "This was the first time he separated what he did from who he is."

Connor now enjoys going to the park and even takes an occasional trip down the slide.