Introduction To

Sensory Integration
Disorders
By
Bassem A. Abdel-Ghaffar
Speech & Language Pathologist
Expert On Congenitally Deafblindness
Institute Of Special Pedagogy
Oslo University - Norway
Think About
The Following
• An acute awareness of background noises

• Fascination with lights, fans, water

• Hand flapping/repetitive movements
• Spinning items, taking things apart

• Walking on tip-toe
• Little awareness of pain or temperature
• Coordination problems
• Difficulty with transitions (doesn't "go
with the flow")
• Self-Injury or aggression
• Extremes of activity level (either
hyperactive or under active).
• Fearful in space (on the swings,
seesaw or heights).
• Striking out at someone who
accidentally brushes by them.
• Avoidance of physical contact with people and
with certain "textures," such as sand, paste
and finger paints.
• The child may react strongly to stimuli on face,
hands and feet.
• A child may have a very short attention span
and become easily distracted.
• A strong dislike of certain grooming activities,
such as brushing the teeth, washing the face,
having the hair brushed or cut.
• An unusual sensitivity to sounds and
smells.
• A child may refuse to wear certain
clothes or insist on wearing long
sleeves/pants so that the skin is not
exposed.
• Frequently adjusts clothing, pushing up
sleeves and/or pant legs.
Do You Know from
which disorder
this signs
arising????
 Sensory
Integration
Disorder

SID
Sensory motor experiences in the early
years of life are considered critical in
developing the foundation for
cognitive learning. Children learn
about their world through all of their
senses

Sensory integration is the ability to

combine information received
through several senses and to
organize it into meaningful
messages.
• A. Jean Ayres, originator of the
theory of Sensory Integration,
considers the following sensory
systems to be of primary
importance in the organizational
development of the central nervous
system:
• sense of touch (tactile perception)
• sense of gravity (vestibular
perception)
• sense provided from muscles and
joints (proprioception)
Sensory Integration Dysfunction
Symptoms
SIGNS OF TACTILE DYSFUNCTION:

Hypersensitive:

Refuses or resists messy play, resists

cuddling and light touch, dislikes kisses,
rough clothes or seams in socks, resists
baths, showers, or going to the beach.
SIGNS OF TACTILE DYSFUNCTION:
Hyposensitive:

Doesn't realize hands or face are

dirty, touches everything and
anything constantly, may be self-
abusive, plays rough with peers,
doesn't seem to feel pain (may even
enjoy it!)
SIGNS OF VESTIBULAR
DYSFUNCTION:

Hypersensitive:

Avoids playground and moving

equipment, fearful of heights,
dislikes being tipped upside down,
often afraid of falling, walking on
uneven surfaces, and avoids rapid,
sudden or rotating movements.
SIGNS OF VESTIBULAR DYSFUNCTION:
Hyposensitive:

Craves any possible movement experience,

especially fast or spinning, never seems to sit
still, is a thrill seeker, shakes leg while sitting,
loves being tossed in the air, never seems to
get dizzy, full of excessive energy.
SIGNS OF PROPRIOCEPTIVE
DYSFUNCTION:

Under-responsive:

Constantly jumping, crashing, and

stomping, loves to be squished and
bear hugs, prefers tight clothing,
loves rough-housing, and may be
aggressive with other children.
SIGNS OF PROPRIOCEPTIVE
DYSFUNCTION:
Over-responsive:

Difficulty understanding where

body is in relation to other objects,
appears clumsy, bumps into things
often, moves in a stiff and/or
uncoordinated way.
SIGNS OF PROPRIOCEPTIVE
DYSFUNCTION:

Difficulty Regulating Input:

Doesn't know how hard to push on an

object, misjudges the weight of an
object, breaks objects often and rips
paper when erasing pencil marks.
SIGNS OF AUDITORY DYSFUNCTION:

Hypersensitive:

Covers ears and startled by loud sounds,

distracted by sounds not noticed by others,
fearful of toilets flushing, hairdryers and/or
vacuums, resists going to loud public places
(even cafeteria at school).
SIGNS OF AUDITORY
DYSFUNCTION:
Hyposensitive:

May not respond to verbal cues, loves

loud music and making noise, may
appear confused about where a sound
is coming from, may say "what?"
frequently.
SIGNS OF ORAL DYSFUNCTION:

Hypersensitive:

Picky eater with extreme food preferences

and limited repertoire, may gag on textured
food, difficulty with sucking, chewing, and
swallowing, extremely fearful of the dentist,
dislikes toothpaste and brushing teeth.
SIGNS OF ORAL DYSFUNCTION:

Hyposensitive:

May lick, taste or chew on inedible

objects, loves intensely flavored
foods, may drool excessively,
frequently chews on pens, pencils,
or shirt.
SIGNS OF OLFACTORY DYSFUNCTION:

Hypersensitive:

Bothered or nauseated by cooking,

bathroom and/or perfume smells, may
refuse to go places because of the way it
smells, chooses foods based on smell,
notices smells not normally noticed by
others.
SIGNS OF OLFACTORY
DYSFUNCTION:
Hyposensitive:

May not notice unpleasant or

noxious odors, smells everything
when first introduced to it, may
not be able to identify smells from
scratch 'n sniff stickers
SIGNS OF VISUAL DYSFUNCTION:

Hypersensitive:

Irritated by sunlight or bright lights,

easily distracted by visual stimuli,
avoids eye contact, may become
overaroused in brightly colored
rooms.
SIGNS OF VISUAL DYSFUNCTION:
Hyposensitive:

Difficulty controlling eye movements

and tracking objects, mixes up similar
letters, focuses on little details in a
picture and misses the whole, looses
his place frequently when reading or
copying from the blackboard.
Thank You
Sensory Diet Activities
Sensory Diet Activities

The sensory diet, a term coined by OT

Patricia Wilbarger, is a carefully designed,
personalized activity schedule that provides
the sensory input a person's nervous system
needs to stay focused and organized
throughout the day.
A person whose nervous system is
on "high trigger" will need more
calming input, while someone
who is more "sluggish" will need
more arousing input to "jazz" up
her nervous system. Infants,
young children, teens, and adults
can all benefit from a well-
designed sensory diet.
• To construct an effective sensory diet, you
need the sensory smarts to truly understand
your child's sensory difficulties and how
they interfere with his life.
• here are some activities to get you started.
You can modify them depending on the
age, arousal level (does she need
stimulation or relaxation?), whether she is
in school, at home, or away, and whether or
not you have special equipment available
Proprioception
Proprioceptive input (sensations from joints,
muscles and connective tissues that lead to
body awareness) can be obtained by lifting,
pushing, and pulling heavy objects as well
as by engaging in activities that compress
(push together) or distract (pull apart) the
joints.
Toddlers and Preschoolers
• Make a "sandwich" by firmly pressing on
your child's arms legs and back with pillows
or rolling her up in a blanket. She can push
her own stroller, and a stronger child can
push a stroller or cart filled with weighted
objects such as groceries. Your child can
wear a backpack or fanny pack filled with
toys (not too heavy!).
Schoolage kids

• Jump on a mini-trampoline, play hopscotch,

carry books from one room to another, help

wash windows or a tabletop.

Teenagers and Adults
• Shovel sand, rake leaves, push heavy
objects like wood in a wheelbarrow, do
push-ups against the wall, wear a heavy
backpack or pull it on a luggage cart, wear a
weighted vest (available from a sporting
goods store that sells equipment for martial
arts or weightlifting training.)
Vestibular

• Vestibular input (the sense of

movement, centered in the inner

ear) can be obtained by spinning

and swinging, and to a lesser

extent, any type of movement.

Toddlers and Preschoolers
• Swing on playground swings,
trying various types of swings and
movements, such as front and
back and side to side. Spin on a Sit
by office chair. Run in circles, ride
a carousel, hold your child's arm
and legs and spin him around like
an airplane
Schoolage kids
• Hang upside down from the
monkey bars, roll down a grassy or
hill (good proprioceptive input as
well), use swings.
• Teenagers and Adults

• Swing on a hammock, use

playground swings or merry-go-
round (you're never too old.
Tactile
• Tactile input is the sense of touch and
includes texture, temperature, pressure, and
more. Don't forget that the tactile system
includes not only the skin covering your
body but also inner skin linings such as
inside the mouth.
Toddlers and Preschoolers
• Let her drink plain seltzer or carbonated mineral water
to experience bubbles in her mouth (you can flavor with
lemon, orange, etc.). Play with foamy soap or shaving
cream, add sand for extra texture, use fingerpaint, play
with glitter glue, mix cookie dough and cake batter, and
so on. Let your child use the playground sandbox or
create your own at home, filling a bin with dry beans
and rice or other materials. Use clay. Don't force a child
who is unwilling to touch all these "yucky"
substances. Let her use a paintbrush, stick, or
even a toy for cautious exploration.
Schoolage kids

• Eat frozen foods (popsicles, frozen fruit or

vegetables), dress up in fun costumes to get

used to the feel of unfamiliar clothing, play

with make-up and face painting.

Teenagers and Adults

• Sculpt, sew, weave, crochet or knit, create a

scrapbook (lots of pasting and working with

different textures), use sandpaper to smooth

a woodworking project, take a very cold or

hot shower or bath.

Auditory
• Auditory input is what we hear and is
neuroanatomically connected with the
vestibular sense. In addition to listening to
various types of music, both recorded and
live, here are some ways to get calming and
organizing auditory input.
• Get out in nature and listen. Go to the beach
or sit still and listen to a thunderstorm or
windstorm. If you hear birds singing, try to
identify what direction a given bird is
calling from.
• Listen to natural sounds recordings such as
a rainstorm, waves crashing against the
beach, or birds in the forest. Sometimes
natural sound recordings also feature light
instrumentation with flutes, keyboards, etc.
• Play a listening game: you and your child
sit very quietly and try to identify the
sounds you hear (traffic, the hum of the
refrigerator, a door shutting, etc.).
• Listen to Hemi Sync recordings of sounds
and music specially engineered to promote
calming, focus, energy, or creativity.
• Encourage your child to play a musical
instrument. For a child with auditory
sensitivity, controlling the sounds she hears
can be especially helpful. If your child is
fearful of loud noises, let him control the
volume on the stereo, exploring soft vs.
loud music.
• Get a white noise machine, tabletop rocks-
and-water fountain, or aquarium.
Visual
• If your child is visually distractible, simplify the
visual field in his home or school environment for
a calming effect. Alternately, if your child seems
visually "tuned out," i.e., does not seem to respond
easily to visual stimulation, add brightly colored
objects to attract visual attention. For example, a
child who has trouble getting aroused for play may
be attracted by a brightly painted toy chest filled
with appealing colored toys.
• colored toys.
• Hide clutter in bins or boxes or behind
curtains or doors—a simple, solid-color
curtain hung over a bookshelf instantly
reduces visual clutter.
• Use solid colored rugs instead of patterned
ones and solid-colored walls (for example,
avoid patterned wallpaper).
• Have your child sit at the front of
a classroom where there is less
visual distraction. He may also
need to sit away from the window
to avoid the distraction of the
outdoors. Keep in mind, however,
that some children do best sitting
in the back of the room so they
can monitor what other kids are
doing without constantly turning
around. Work with the teacher to
see which seating arrangement
works best for your child.
• Avoid toys, clothes, towels, etc., in colors
that your child find stress-inducing such as
bright orange, yellow, and red (your child
may have a different "hated" color.)
Smell
• If your child has sensory problems,
certain odors can stimulate, calm,
or send him into sensory overload.
• Explore scents with your child to find the
ones that work best to meet your goal
(either to soothe or to wake up). While
everyone has different preferences, vanilla
and rose are generally calming. Peppermint
and citrus are usually alerting. Let's say
your child needs help staying calm and
loves vanilla
• You can use vanilla soaps and bath oils to
ease bath time, vanilla candles or oils in an
aromatherapy burner or machine at
bedtime, and vanilla body lotion. Note:
Avoid lavender and tea tree oil products for
boys as several recent studies show a link
with enlarged breast development in boys.
It's probably safest to avoid using these
products for girls as well.
• Play a smelling game with your SI child. Have her
close her eyes or wear a blindfold and try to
identify smells such as mango syrup, apple, peanut
butter, and soap.
• Life stinks sometimes. Accept your child's
opinion about something she thinks smells
"gross." Then help her find something that smells
nice.
Taste
• Taste input is strongly influenced
by smell (as an experiment, chew
some gum until the flavor is gone,
then hold a lemon under your
nose; the gum will taste like
lemon).
• Strong tastes can stimulate the
mouth of a child with SI and make
him more willing to try new foods.
Before presenting new foods, let
the child have one peppermint,
sour gummy bear, or other strong-
flavored food.
• If your child does not have a
strong negative reaction to refined
sugar (becomes very "hyper" or
gets very sleepy), get an
assortment of flavored jellybeans.
Eat one at a time, and have her
guess which flavor it is.
• Children will be more likely to taste
something if they help make it. Let him
help you select foods. For example, let him
choose between chicken or fish, string
beans or sugar snaps, and potato or rice.
Then let your child arrange the meat in the
baking pan, break off vegetable tips and
dump in water, and so on. Let him help you
arrange food on each plate into a pleasing
presentation.
• Don't forget to play with your food.
Sample Sensory Diet

• Here is a sample sensory diet, created for a

7yrs old child whose sensory seeking

behavior interfered with his attention and

learning.
• Activities should be individualized for each
child and modified frequently to meet
changing needs. A separate program was
worked out for this child with the school,
including frequent movement breaks, an
inflatable seat cushion for wiggling while
remaining seated, and providing
crunchy/chewy oral comfort snacks at
handwriting time.
Morning Routine
• Massage feet and back to help wake up
• Listen to therapeutic listening CD
• Use vibrating toothbrush and vibrating
hairbrush
• Crunchy cereal with fruit and some protein
• Jump on mini-trampoline
After school
• Go to playground for at least 20 minutes
• Push grocery cart or sister's stroller
• Spinning
• Mini Tramp — add some variety: have him
play catch or toss toys into a basket while
jumping
• Massage feet to "reorganize," body sox,
make body sandwiches, wheelbarrow walk
• Do ball exercises
• Listen to therapeutic listening CD

• Oral work — sucking thick liquids through

a straw, crunchy and chewy snacks (to give

input into jaws and teeth)

Dinner Time
• Help with cooking, mixing, chopping, etc.

• Help set table, using two hands to carry

and balance a tray

• Provide crunchy and chewy foods
Night time
• Family time: clay projects, painting
projects, etc.
• Warm bath with bubbles and calming
essential oil
• Massage during reading time
Tips for Helping Your Child with Sensory
Problems
• To desensitize gums, provide tactile
input. Wear a rubber finger cot, swipe
with a washcloth, or use an Infadent
finger cot or Toothettes • If your child
can't tolerate foamy toothpaste, try
Orajel toddler toothpaste, which does not
foam.
• Develop a predictable routine for when and how to brush.
Help your child choose the brushing pattern which will
always be used. For example, she could decide to always
start with the top teeth and to brush from left to right,
front to back. A consistent brushing pattern will help your
child motor plan this complex activity, learn to predict
when and where she will feel various sensations (rather
than be a "victim" of horrible sensations), and help your
child feel proud about keeping her mouth and teeth nice
and clean.
Bathing
• If your child doesn't like "slimy" soap or
shampoo, try foamy soap (also good for
tactile play—unlike shaving cream, it
doesn't have a strong smell).
• Try using a large container of water for
rinsing since the extra weight of the water
might feel soothing. Alternately, your child
might be more comfortable if he simply
feels in control of the water. In this case,
provide a sprinkling can (beach or garden
toy) or a hand-held shower attachment.
Count down together to rinsing: "1, 2, 3,
rinse."
• Use a foam visor or a washrag held over the
face when rinsing. This is good for a child
who hates water on his face or who hates
tilting his head back for rinsing. You might
also have him dry his face immediately after
washing it even if he's still in the shower or
bath.
• If toweling dry is a problem, experiment
with softer (or harder) towel textures. You
can also try pre-warming the towel in the
dryer for a few minutes.
Going to Bed
• Make sure the room is dark enough (or
light enough) for your child to sleep. A
small amount of light might comfort one
child, while light creeping in through the
curtains or under the door might disturb
another.
• Try a white noise machine, fan, aquarium,
or even a radio set on static to create white
noise to block out sleep-disturbing sounds.
Some children fall asleep more easily
listening to gentle music such as Mozart or
CDs specifically designed to promote sleep.
• Give calming deep pressure input via a
backrub or massage using long, firm
strokes. Even just squeezing feet, legs,
hands, and arms, can be very soothing at
bedtime. You can also try using a weighted
blanket
Getting a Haircut
• Use the word "trim" instead of "cut."
• Visit the hair salon to simply check it out
and watch other children get their hair
trimmed. Familiar places are less scary.
• Massage your child's scalp before a haircut
using your hands, handheld vibrator, or
vibrating hairbrush
• Many children dislike the plastic cape with
its scratchy closure. Instead use a soft towel
and clip or an oversized shirt.
• Go to a child-friendly haircutting salon or
create your own at home with candy and an
absorbing video to watch.
• Have the barber or stylist give the child a big
soft brush or a dry washrag with baby powder
on it to brush off stray hair as it is cut. Use
baby powder on irritated skin afterward.
Clothing
• Some tactile-defensive kids insist on supersoft, all-
cotton clothing.
• Some children are more comfortable wearing snug
clothing or tight clothing worn beneath their other
clothes. Try bicycle shorts, tights, "too small" t-shirts,
etc.
• When buying clothes for a tactile-sensitive child, avoid
scratchy nylon threads and items made of polyester
blends which can pill and cause discomfort.
• Buy seamless socks from places like
Shopping
• Avoid shopping during peak hours when
stores are most crowded and noisy.
• Let your child push the grocery cart for
sensory input. Many grocery stores have
junior carts for smaller children. Also,
pushing a stroller can help a toddler or
preschooler get calming input. Add
packages for extra weight.
Potty Training
• Some children are disturbed by the size and
feel of a large toilet seat. Bring your child to
the store and help her to pick out a potty
chair or a small, cushioned vinyl ring that
fits onto an adult toilet seat.
• Some children are frightening by the sound
of flushing. A sense of control might help:
together, count off to the flush, for example:
"1, 2, 3, FLUSH!" Make lots of noise as the
toilet is flushing, shouting "hooray!"
• Sometimes, tight clothes provide sensory
input that distracts a child from the
sensation of needing to use the potty. Loose
clothing such as boxer shorts may help him
recognize when he has the urge to go.