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Andrew Collins
Andrew Collins

Sensory Integration And The Child Pdf 49



Failure to attain handwriting competency during the school-age years often has far-reaching negative effects on both academic success and self-esteem. This complex occupational task has many underlying component skills that may interfere with handwriting performance. Fine motor control, bilateral and visual-motor integration, motor planning, in-hand manipulation, proprioception, visual perception, sustained attention, and sensory awareness of the fingers are some of the component skills identified. Poor handwriting may be related to intrinsic factors, which refer to the child's actual handwriting capabilities, or extrinsic factors which are related to environmental or biomechanical components, or both. It is important that handwriting performance be evaluated using a valid, reliable, standardized tool combined with informal classroom observation and teacher consultation. Studies of handwriting remediation suggest that intervention is effective. There is evidence to indicate that handwriting difficulties do not resolve without intervention and affect between 10 and 30% of school-aged children. Despite the widespread use of computers, legible handwriting remains an important life skill that deserves greater attention from educators and health practitioners.




sensory integration and the child pdf 49



Regulation disorders of sensory processing constitute important and intriguing patterns of behavior that are usually diagnosed in infancy and early childhood. The empirical research does not provide a conclusive answer to whether such a disorder is a harbinger of other childhood disorders. However, clinical interventions, such as changes in parental responses, can help these challenging children and their families. Health professionals working with children can offer assistance in these cases by knowing more about the main characteristics of regulation disorders, diagnostic criteria, and assessment and treatment techniques.


During the past 15 years, researchers have contributed to an increased understanding of the dysfunctional sensory, motor, and behavioral responses that certain infants, toddlers, and young children experience. Once the responses are accurately identified, management strategies involving a multidisciplinary approach can help parents and children to adapt to or alter the responses that interfere with the typical development of the child.


Infants with regulation disorders of sensory processing are defined as children having a set pattern of responses and behaviors, observable over time and across settings, that interfere with normal growth and development. Difficulties in the three areas of sensory, motor, and behavioral responses are necessary for diagnosis. Physiological difficulties involving sleep, eating, and elimination as well as difficulty in the domain of language (expressive and receptive) and cognitive function may also be present, but these problems are not included as diagnostic criteria. Sleep and feeding disorders in infancy and early childhood are very common. However, if they extend beyond infancy they may constitute a specific disorder.[6] For example, if a baby has a sleeping disturbance but no behavioral, sensory, or motor difficulties, then this infant is not considered to have a regulation disorder. However, if a baby is fussy and difficult to soothe (behavioral response) and seldom goes to sleep unless rocked or jiggled (motor response) and needs auditory input of white noise (sensory response) to settle, then these three responses, not just the sleep disturbance, might result in a diagnosis of RD. A toddler whose diet is restricted to crunchy food (sensory response), who fights wearing clothes (sensory response), and is hyperactive (motor response) and irritable (behavioral response) also exhibits the three aspects of RD required for diagnosis.


These infants and young children show hypersensitivity to various stimuli, making them either fearful/cautious or negative/defiant. The children are over-reactive to touch, sound, visual stimuli, and sensory input involving smell or taste. They may reject movement and have difficulty with motor planning and gross motor play. Their extreme responses interfere with self-care, play, and learning activities. Transitions from one activity to another may precipitate anxiety or negative reactions.


This subtype is most frequently represented in the clinic-referred population. Infants and young children present with impulsive and disorganized behaviors in the areas of motor responses. They are accident prone, probably due to poor motor planning skills. These children may be counter-phobic and lash out at their peers before the peers can be aggressive toward them. Their attention-seeking and impulsive stimulus-seeking behaviors mimic children with attention deficit hyperactivity disorder (ADHD). However, parents of children with RD report that their children demonstrated these behaviors from early infancy, while parents of children with ADHD often observe that the behaviors only emerged once their children became mobile.


As with any condition, regulation disorders of sensory processing can exist with other disorders, such as ADHD. The hypersensitive subtype who is fearful/cautious may also have separation anxiety disorder, while the hypersensitive subtype who is negative/defiant may also have oppositional defiant disorder.[3] The sensory, motor, and behavioral responses of the child with a regulation disorder interact with and compound the problems presented by the symptoms of the additional diagnosis.


Over a 4-year period at the BCCH Infant Psychiatry Clinic, the majority of children initially diagnosed with RD as preschoolers were later diagnosed with either ADHD or autism spectrum disorder (ASD). These clinical observations have prompted data analysis in an ongoing methodical fashion. Eventually, this research should help determine whether regulation difficulties in which sensory integration problems are more prominent are a harbinger of ADHD or ASD.


Sensory tolerance does not appear to be uniform even across the subtypes, with each child presenting with a unique mix of responses, which leads to criticisms about how to judge these sensitivities and the quantification required for determining a diagnostic subtype.[3]


Finally, there is an ongoing debate about how cultural and parenting practices may affect developmental progression in children with RD. The 1994 DC: 0-3 diagnostic system made a point of describing parental styles that may be useful in parenting children with RD.[8] Some support for the influence of parenting practices comes from researchers who are proponents of interventions such as parent guidance and parent-child play.[9]


There is no clear-cut answer to the question of causality. Regulation disorders are multifactorial in origin. Theories focus on causes ranging from difficult temperament to central nervous system irritability. Parents are often surprised that all the children in their family show some type of regulation disturbance involving either sleep, feeding, or sensory responses. That observation often gives rise to fears that RD may be a genetic disorder. At the time of writing, there is no support for this notion in the literature. It is important to reassure the stressed parents of a child with a regulation disorder that their parenting style did not cause their child to be dysregulated. However, we do know that parenting, as a powerful environmental input, can be a decisive factor in assuring a near normative developmental course in at least a portion of the predisposed infants.[9] Recognition that infants with RD are probably hardwired for sensory irregularities may help parents and other caregivers to understand that the child needs specific sensory input on a daily basis.


While it is essential that all clinicians working with young children be able to identify RD, a multidisciplinary team is best qualified to provide a firm diagnosis of this condition and make ensuing recommendations.


Short-term dynamic psychotherapy provides a brief intervention to resolve any core conflict that is upsetting the parent-child relationship. Such therapy might be used to help parents who perceive their children as deliberately trying to make them angry.


Individual instruction and support groups for parents serve both an educational and supportive purpose. For parents who themselves have various sensitivities, dyadic instruction with clinical team members is a preferred mode. It is important to help parents understand how normal progression of emotional, behavioral, and sensory integration occurs. Both print information and electronic resources such as web sites can provide help for parents and can be offered in group or one-to-one settings.


Education of educators needs to occur before the child enters school, since the school system poses many challenges for a child with RD and his or her family. A collaborative and informed group of parents, teachers, and school support personnel can more easily develop adaptations and responses within classrooms, playgrounds, and the school building.


Medication can help some children with RD to manage their behaviors when these are at their most extreme. Judicious use of medications is important because RD in preschoolers can mimic ADHD and emotional outbursts can be seen as aggressive tendencies, resulting in early social isolation. Several researchers have remarked on the hyperkinesis in children with RD. However, the sensory integration and self-regulation dysfunction that may be contributing to the hyperactive behaviors cannot always be helped with medications.


If Jane had been assessed as an infant, a psychiatrist would have considered whether her sensory, motor, and physiological responses were but one facet of a disturbed parent-child relationship. The most appropriate parenting style for Jane would have been explored to help her to self-soothe more efficiently. Strategies would have been suggested by an occupational therapist to decrease the intensity of sensory responses.


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