Question: What Do Sensory Integration Therapists Do for Children with Autism?
What exactly does a sensory integration therapist do? What kinds of outcomes can parents expect for their children with autism and sensory processing disorder?
Answer: The idea behind sensory integration therapy is that it is possible to “rewire” the brain of a person with sensory processing disorder in order to improve their daily lives. The concept of sensory integration therapy was first developed by Dr. Jean Ayres, whose theories about neurology and sensory function are embraced by some in the field, yet questioned by others.
Practitioners of sensory integration therapy are usually occupational therapists. Their focus is on the tactile, vestibular and proprioceptive systems. In English, this means that SI therapists work on normalizing patients’ reactions to touch, help patients become better aware of their body in space, and help patients work on their ability to manage their bodies more appropriately (run and jump when it’s time to run and jump, sit and focus when it’s time to sit and focus, etc.).
If a sensory integration (SI) therapist has his or her own office, it may be equipped with a variety of unusual equipment, including swings, therapy balls, slides, ramps, a ball pit, and other sensory materials.
Testing for Sensory Issues
A trained SI therapist evaluates a potential patient for sensory defensiveness, hypersensitivity, and sensory cravings, using several different scoring techniques. Some of the standard tests include:
Sensory Integration and Praxis Tests (SIPT) for children between the ages of 4 to 8 years, 11 months
The Test of Sensory Integration for children between the ages 3 to 5 years (TSI)
The Bruininks Osteretsky Test of Motor Proficiency for ages 5-15 years
The PEERAMID for ages 6-14 years.
“Evaluation is complicated; it’s not a cookie cutter approach,” says Dr. Lucy Jane Miller, director of the Knowledge in Development Foundation, which specializes in sensory dysfunction and sensory dysfunction therapy. “Every child is different, so we need to know what type of vestibular and proprioceptive input does he need. I use stimulation during evaluation to figure out a child’s nervous system. I create a chart with 7 systems up and along the side. I try to figure out how each system affects the other. So I don’t just assume a child needs brushing — but try to figure out how I can use auditory input to affect tactile reactions, etc. By the time I get to the tactile system, it’s much more ready to be treated.”
Depending upon the needs of the patient (usually a child), the SI therapist may use various techniques such as:
deep pressure therapy, which may include squeezing, rolling, etc.
jumping on a mini or full-sized trampoline
playing with a toy that vibrates, is squeezable, etc.
gross motor play such as wall climbing, balance beam, etc.
brushing and joint compression
The Sensory “Diet”
SI therapists also may develop a sensory “diet,” which may include a variety motor activities (spinning, bouncing, swinging, squeezing balls or silly putty, etc.), as well as therapist-provided interventions such as brushing and compressing arms and legs. The idea is that this “diet” will be provided throughout the day, whether by a trained therapist or by teachers, aides or parents. In theory, if a child receives appropriate intervention all day, he or she will be better able to take part in typical daily activities. Over time, say some therapists and parents, children are better able to focus, less likely to “stim” (flap, jump or spin inappropriately), and are often more comfortable in situations that involve a high level of sensory input.
Dr. Miller works specifically toward short term life skills goals such as the ability to stay in a loud space without over-reacting. In her practice, 20-30 sessions plus parent training is often enough to make a big difference in a child’s daily life. Other therapists, however, work with children over the long term – sometimes for years.
In the UK, there are 770,000 disabled children under the age of 16. That equates to one child in 20
The number of disabled children increased by 294,000 or 62% between 1975 and 2002, and there are more children with complex needs. This is due in part to population increases, but also to medical advances and increased diagnosis and reporting
98% of disabled children live at home and are supported by their families
Disabled children are more likely to live in poverty
The income of families with disabled children averages £15,270, 23.5% below the UK mean income of £19,968, and 21.8% have incomes that are less than half the UK mean
Only 16% of mothers with disabled children work, compared to 61% of other mothers
It costs up to three times as much to raise a disabled child, as it does to raise a child without disabilities
Childcare costs around £5.50 per hour for a disabled child, compared to around £3.50 for other children
With lower than average incomes and higher than average expenditure, many families with disabled children are in debt. 22.6% have debts up to £5,000, 15.7% have debts of up to £10,000 and only 15.7% have no debts. In the general population, 53% have no debts
Families with disabled children spend £27.61 on loan repayments a week, compared to the UK average of £3.10
Caring for a disabled child can cause relationship problems. According to one study, 31% of couples report some problems, 13% cite major problems and 9% actually separate. Stress, depression and lack of sleep are other commonly experienced problems
Only 8% of families get services from their local social services
Disabled children are 13 times more likely to be excluded from school.
There’s an experiment going on right now–but it isn’t being conducted by scientists. It’s being conducted by parents. In 30 million kitchens across the U.S. that experiment is called “What Can My Child Eat?” In families with children with autism and allergies, the result of that experiment can either be a day of relative calm and comfort, or it can produce anything from brain fog, digestive discomfort, and mood swings, to pain, seizures, skin outbreaks, and severe digestive distress.
While the debate continues as to whether or not laboratory scientists have successfully isolated a single one of the many factors that a growing numnber of doctors say may contribute to autism, families still have to cope and they still have to feed their children. Citing the conservative statistics of the Centers for Disease Control (CDC) pediatrician, Dr. Kenneth Bock, reported that one in 100 children (one in 48 boys) have autism–although just two years ago it was one in 150. One in 16 children has ADHD, one in 11 has asthma, and one in four has allergies. A staggering one third of all children are affected Bock told the group gathered for “Food Solutions: Managing Autism, ADHD, Asthma, and Allergies,” held at New York’s Urban Zen Center.
Children (and adults) with allergies (and food sensitivities) react to many common foods and food ingredients that other people don’t react to. As doctors like Bock tell it, a child with autism is by definition a child with an overwhelmed immune system, an impaired gut, a higher presence of microbes, candida, and toxins, and many food sensitivities and intolerances. Gut issues are directly linked to issues with attention and focus, so that a child with food sensitivities will also likely be a child who experiences symptoms anywhere from the withdrawal or lack of speech seen in autism to the brain fog, hyperactivity, and/or difficulty in focus seen in children with attention deficit disorder (ADD).
According to Stephen Cowan, MD, a pediatrician in Westchester, N.Y., who also spoke at Food Solutions, “The gut and the brain are not two separate things. They are interconnected.”
Referring to “leaky gut” a condition common in the so-called “spectrum” kids, in which an impaired barrier of cells lining the intestines allow poorly digested food molecules to enter the bloodstream where they can trigger allergic and other reactions. Cowan said that “a leaky gut is like a leaky mind, you can’t digest things and you can’t retain things that you need to retain.”
When parents bring their children into his office for a consultation, Cowan reports that “I can often predict that the child’s favorite foods are pizza and macaroni and cheese”– and these are the same foods that children are most allergic to. According to Bock, gluten, the main protein contained in wheat and other grains, can trigger immune reactions, while casein, a peptide in dairy can break down internally to produce an opioid effect — such that children are literally drugged by food.
That’s why the mainstay of parents trying to nourish their immune-challenged children is the Gluten Free Casein Free Diet (GFCF) as well as the Specific Carbohydrate Diet (SCD).
Glucose, present in high fructose corn syrup (HFCS) is yet another no-no since it can feed yeast (which worsens gut issues) and contribute to mood swings due to the abrupt rise and fall of glucose in the bloodstream. Moreover, mercury is used to make HFCS which is present in many processed foods, including sodas, juices, yogurt, and ketchup. While some studies question whether mercury in vaccines is a key trigger for autism, according to Bock, “a range of environmental factors contribute, Studies correlated closer proximity to power plants with mercury emissions with increasing rates of autism.” HFCS is also addictive, and aggressively marketed by food and beverage companies, who according to Cowan, spend $10 billion a year.
In this nationwide lab experiment in which food suppliers push unhealthy food items, while the public naively believes that government regulators protect them, “we’re lab rats,” Cowan points out. “Studies show that when you try HFCS, you can’t get enough of it, you want more and more and more. It releases chemicals, it’s just like you pressed a button.” Yet instead of acting on a national level to curb unhealthy foods, “we blame the victim,” says Cowan.
All too often the victims are children.
Transitioning children from harmful foods to which they’re addicted to healthier ones is a challenge borne by parents. That’s why at Food Solutions, dietician Amanda Archibald and nutritionist Stefanie Sacks introduced a range of healthier options. Although healthy vegetables topped the list, the nutritional team also offered samples of favorite products (rice milk and a dairy and wheat free Mac and Cheese) so parents know what to look for. Simple recipes that participants teamed up to prepare offered easy and nourishing ways to ease food transitions.
The bottom line said Cowan is that force feeding children is counter-productive. “If you want your child to eat more vegetables, let him see you eating them.”
Until recently, scientists thought attention deficit/hyperactivity disorder (ADHD) was a childhood issue. But several studies show that attention deficit disorder (ADD), with or without hyperactivity, is a lifelong problem for up to five percent of adults. Unfortunately, adult ADHD comes with a series of devastating consequences from difficulty focusing at work to relationship woes and trouble paying bills. How do you know if you or someone you love is at risk? Read on.
Genetics and ADHD
“Far and away, the biggest risk factor for ADHD is genes,” says Scott Kollins, PhD, director of the Duke ADHD Program at Duke University Medical Center. And while the triggers for ADHD are unclear, studies show that one in four children with ADHD have at least one first-degree relative (parent or sibling) with the disorder.
When the distracted, irritable, rambunctious kids with ADHD grow up, many of them still struggle with the disorder. A Swedish study of children with ADHD found that 49 percent of the adults who were diagnosed with the disorder as children continued to have marked symptoms of ADHD at age 22, and 58 percent were abusing drugs or alcohol, living off a disability pension or welfare benefits, suffering from a severe psychiatric disorder, or facing a criminal conviction.
Nearly equal numbers of men and women have ADHD, but many more boys are diagnosed with the disorder than girls. “Boys tend to have more hyperactive and disruptive behaviors, which gets the attention of school administrators and others who can refer them to appropriate care,” says Floyd Sallee, MD, PhD, professor of psychiatry at the University of Cincinnati.
Environmental Contributors for ADHD
From an environmental perspective, in utero exposure to nicotine and heavy metals like lead increases the risk of developing ADHD in childhood. Such substances are toxic to developing brain tissue and can have sustained effects on behavior. “It’s not known how much exposure is necessary, but studies show a definite link,” says Sallee.
The impact of alcohol in utero on the development of ADHD is less clear. Fetal alcohol syndrome is not directly related to ADHD, but the symptoms of it — cognitive impairment and inattention — are similar. In adults who have ADHD, drinking can exacerbate symptoms, so it’s a good idea for those with the disorder to steer clear of alcohol.
When it comes to food, most experts agree that the link between food additives, sugar, and other potential culprits have been overblown. The issue hasn’t been studied in adults, but presumably the effects (or lack thereof) are the same. That said, you’d be hard-pressed to find anyone — ADHD or not — who doesn’t lack focus a few hours after a doughnut-and-coffee breakfast. A balanced diet is key.
Complicating Conditions of ADHD
ADHD does not occur in a vacuum. “The rates of just about every psychiatric disorder are higher among people who have ADHD,” says Kollins. In one study, 87 percent of patients had at least one psychological disorder such as depression or anxiety. People with ADHD are also much more likely to self-medicate with alcohol or drugs and have higher rates of substance abuse than adults without the disorder.
“You can develop secondary anxiety or depression from a lifelong history of demoralization because you can’t do well at your job or you chronically pay your bills late or you have difficulty managing your relationships — all of which are primarily due to your ADHD,” says Sallee. “Most adults don’t go to their primary health-care provider or mental-health professional because of their ADHD. They come because they’re having problems in their life.”
It doesn’t matter which came first — the depression or the ADHD. What matters is that you find a health-care provider who recognizes and treats both.