Do you know someone who is particularly choosy about food, avoids crowds in shopping malls, struggles with eye-hand coordination, or has difficulty functioning in an open-plan office? The cause could be sensory integration dysfunction or SID. Occupational therapist Charlene Cruickshank describes sensory discrimination and modulation, the two extremes of poor sensory processing, and how this disorder is identified and treated.

We are miraculous beings who, at any given moment, perceive a myriad of sensory stimuli and process them with the help of our brain. Each of us integrates sensory information in a way as unique as our thumbprint. However, these processes do not always run smoothly. When sensations from the environment or our own bodies are processed inaccurately, the efficiency with which we function can be impeded.  

"Apart from our sense of touch, hearing, vision, smell, and taste, we have two hidden senses," says Charlene Cruickshank, an occupational therapist from Johannesburg with a postgraduate qualification in sensory integration. "The vestibular system relates to our sense of movement, while proprioception involves - amongst other things – our ability to sense our location in space. When we jump off a wall, the brain uses the input from these systems to activate and prepare our muscles in a suitable way.  

“Other concepts that help us make sense of sensory integration are 'sensory discrimination' and 'modulation'. Discrimination involves the processing of sensory inputs by our central nervous system. For example, you register a sound, interpret it as someone calling your name, and respond by answering, therefore identifying what it is.

“Modulation indicates the nervous system's ability to regulate, organise and prioritise incoming information. Modulation points to our sensory threshold; in other words, what we can tolerate with ease and how it makes us feel.

“Modulation involves a lifelong process of learning and adaptation. Stimuli that we initially find strange, such as our first taste of a drop of lemon juice, grow familiar. In time, we react to these stimuli without needing to think about them."

When is poor sensory processing seen as SID?

"All of us experience some sensory challenges regarding discrimination and modulation. We may stumble over a stone on the sidewalk or suffer from motion sickness when we fly. As long as these events do not seriously impact our lives, all is well. When our functioning, however, limits us in more than one area, we speak of SID or sensory integration dysfunction. This applies to both adults and children.

“The three areas of functionality we consider when investigating SID are

• personal care

• work, school or play (where children are concerned)

• and leisure activities.”

  Examples of sensory integration challenges

  “Sensory integration dysfunction sheds light on some learning and behavioural problems that cannot be attributed to obvious abnormalities or damage to the central nervous system. Dysfunction occurs when more than one area of life is severely affected.
  “The question we need to ask, is: Is this a behavioural pattern, or is there an underlying sensory reason?”
  Specific examples in three settings – personal care, work, school or play, and leisure activities - include:

  1 Personal care

• During therapy, some children's nervous systems calm down when they are cocooned between two mattresses.

• Activities requiring the two sides of the body to work together, such as getting dressed or handling a knife and fork, can be challenging.

• Activities requiring the learning and planning of a new motor task may be difficult, as the child does not register the sensory input of an object or his body, such as putting his shirt over his head or tying his shoelaces.

  2 Work, school, or play (when young children are involved) 

• Delayed milestones, such as children who take longer to start walking or to potty train, can indicate SID.

• The same applies to young children struggling with their pencil grip or the spatial orientation of letters and numbers.

• Another indication is problems concerning speech and language development, focus, attention span and social skills.

• Some sensory dormant people only wake up late in the morning and can be considered lazy.

• In an open plan office, concentration can be poor; even a moving screen saver can be perceived as disturbing.
  
  3 Leisure activities

• Parties involving many people and lots of sensory input are experienced as overwhelming.

• Activities requiring the two sides of the body to work together (such as swimming), the cooperation of the motor and the eye function (such as keeping your eye on a moving ball) or requiring the body to adjust to maintain balance (such as roller skating) pose a challenge.

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SID and autism, ADHD, depression and other conditions

"SID is very common. It occurs in all people on the autistic spectrum or with attention deficit hyperactivity disorder (ADHD). Please note that not all people with sensory integration dysfunction necessarily have one of these conditions! SID often goes hand in hand with conditions such as anxiety disorders, depression or Down syndrome.

“When discussing SID, we talk about sensory fall-outs. At one end of the spectrum we have sensory defensiveness, and at the other sensory dormancy.”

Sensory defensiveness

“People with sensory oversensitivity find stimuli that others consider normal, such as the seams inside their clothes, extremely uncomfortable. This is a parasympathetic reaction - in other words, involuntary - and can lead to a fight, flight or fright response. For example, fluorescent lights and the noise in an open-plan office can disturb a sensory oversensitive person to the extent that they are unable to do their job. They may become so frustrated or irritable that they act in an aggressive way or explode when they get home. Sometimes all they want to do is sit quietly in the dark.”

Sensory dormancy

“On the other hand, some people are sensory dormant. It’s as if their senses are asleep. They fail to register normal sensory information from their environment or their own body. They may, for example, fail to hear you when you call them, even though their hearing is normal. Because their brain requires more sensory stimulation, they will compensate by constantly moving, fidgeting, making noises, knocking over objects, and so on. We call them sensory seekers.”

 Causes and treatment of SID

"I constantly reassure parents that they did not cause their child's sensory integration dysfunction. It constitutes a developmental delay of which the causes are still being researched. We do know that elements such as a toxic environment and complications during birth can play a role. There is a strong genetic link - parents can show similar characteristics. It is more common in males.

Identifying SID

“Occupational therapists with postgraduate training in sensory integration from The South African Institute for Sensory Integration (SAISI) or the University of the Witwatersrand are equipped to identify SID and improve functionality. By means of targeted activities, specialized equipment and sound clinical reasoning, we create opportunities to aid sensory integration.

"I work mainly with children, but have assisted adults. The younger the person, the greater the plasticity of the brain. We design challenges that stretch patients just enough to help them create new neural pathways. The goal could, for example, be as simple as getting a child to climb the stairs onto the stage at school. We use a playful approach when working with children and parents get a program to follow at home.

“To find out what we need to focus on we use standardised, age-appropriate tests, clinical observation and information provided by parents and teachers. Medical funds do pay for occupational therapy, often from the savings plan. When people come from remote areas with no access to sensory integration-trained therapists, I do block therapy or consult with the occupational therapist they see where they live.”

Adults with SID

"Sport is a wonderful aid regarding self-regulation. Many of the adults who come to see me are highly functional people who, for example, go jogging in the mornings to organise their nervous system. Chewing gum, carrots, biltong or the chewy grips we give to children also promotes self-regulation.

"People with SID usually fare better when they are in control of their environment and can avoid being exposed to unforeseen sensory stimuli. Their need for control can make them appear rigid or bossy. They sometimes struggle when they are part of a team.
"When working with adults, I employ a program that improves their sensory tolerance at work and also consider which changes could be made in the work environment. Dr. Annemarie Lombard from Cape Town focuses on the corporate field: please see www.sensoryintelligence.co.za”.

Sensory mismatches in relationships

"Awareness can make life a lot easier.

“A mother who is a sensory avoider can grow really irritated if her child is a sensory seeker who constantly wants to touch her or stroke her hair. The more emotional you tend to be, the more intensely you’ll experience an incident caused by a sensory mismatch. Self-awareness prevents you from putting all the blame on your child.
“Discuss sensory fall-outs with your primary or secondary school child. For example, if he simply cannot stomach Grandma's food, discuss this with him before your next visit. Perhaps he could add something to the food or explain the situation to Grandma.”

Lees ook: “Is jy bloot sensitief, of ‘n empath”?

Contact details

Charlene Cruickshank is an occupational therapist from Johannesburg with a postgraduate qualification in sensory integration: contact number 082 879 6062.
More information, also regarding therapists, at https://instsi.co.za/what-is-sensory-integration/
Recommended reading: “The out of sync child” by Carol Stock Kranowitz, Skylight Press, 2005.

This article originally appeared in rooi rose.

Images: Unsplash. Models used.