Everyone experiences sensory preferences. You might dislike certain foods, cringe at specific sounds, or find particular fabrics uncomfortable. Having likes and dislikes regarding sensory input is a normal part of life.
Children, especially, often express strong preferences—loving crackers and sweets while rejecting vegetables. However, when these preferences begin to disrupt daily functioning, trigger excessive reactions, or lead to behaviors that compromise health or safety, it could indicate sensory processing challenges or sensory integration disorder (SID). This is when seeking a Sensory Integration Disorder Diagnosis becomes crucial.
“Sensory processing, in general, is the way your body and brain interpret environmental and internal information,” explains Amy Lowell, MS, OTR/L, an occupational therapist and sensory integration specialist. When a child struggles to process this information, they may overreact or underreact, affecting their ability to respond appropriately to stimuli, regulate emotions, and engage in everyday activities. Understanding the process of sensory integration disorder diagnosis is the first step towards providing support and intervention.
Exploring the Eight Senses: Beyond the Traditional Five
Most of us are familiar with the five basic senses taught in childhood:
- Sight (visual system)
- Touch (tactile system)
- Hearing (auditory system)
- Smell (olfactory system)
- Taste (gustatory system)
These senses are vital for safety, providing information about our surroundings. However, there are also three lesser-known, internal sensory systems that significantly impact our body awareness, balance, and emotional regulation. Recognizing the role of these senses is important in the context of sensory integration disorder diagnosis.
Vestibular Sense
The vestibular system governs balance, motion, and movement. Children with vestibular sensory sensitivities might avoid activities like swinging or spinning due to fear or discomfort. Conversely, those under-responsive might seek intense movement experiences like constant jumping or rocking. Difficulties in processing vestibular input can lead to balance and coordination problems, making activities like bike riding or sports challenging. These vestibular challenges are often considered during a sensory integration disorder diagnosis.
Proprioception
Proprioception is our sense of body awareness, derived from muscles and joints. It informs us about our body’s position in space and the appropriate force needed for actions.
Children with proprioceptive processing difficulties may appear clumsy or use excessive force when hugging, throwing, or closing doors forcefully. Under-responsiveness can lead to seeking out strong physical touch, enjoying rough play, or crashing into objects. Poor proprioceptive awareness can hinder participation in recreational activities. Assessing proprioceptive function is a key component of sensory integration disorder diagnosis.
Interoception
Interoception is the ability to perceive internal bodily signals. This includes recognizing hunger, the need to use the bathroom, and even emotional cues like frustration or fatigue.
Children with interoceptive processing issues may struggle to recognize hunger, illness, discomfort, pain, or bladder and bowel signals. They might also have difficulty identifying and expressing emotions because they cannot fully perceive feelings like sadness, fear, or excitement. Conversely, children highly sensitive to interoceptive signals might be acutely aware of any deviation from their norm, potentially exhibiting lower pain tolerance or being described as “deeply feeling.” Interoceptive processing is increasingly recognized as important in sensory integration disorder diagnosis.
Sensory Processing and Response: Reactivity and Modulation
Our senses not only gather information but also dictate how we respond. This is known as sensory reactivity or sensory modulation: the process of processing, regulating, and responding to sensory input. “It’s a protective mechanism,” Lowell notes. “It influences our arousal level, attention, and the fight-flight-freeze response.”
Once sensory information is received, our system determines the appropriate action. For instance, seeing an obstacle on the sidewalk triggers our visual system to send signals to the brain, enabling us to navigate around it. Smelling smoke at home alerts the brain to potential danger, prompting a corresponding reaction.
Children with sensory integration disorder exhibit either over-sensitivity or under-sensitivity to sensory stimuli, impacting their responses. They might be described as “sensory avoidant” or “sensory seeking.” However, Lowell emphasizes the complexity of sensory systems and the uniqueness of each individual’s sensory profile.
“Being over-responsive to touch doesn’t automatically mean over-responsiveness to sound. Similarly, vestibular challenges don’t necessarily indicate tactile system issues,” Lowell clarifies. “Every sensory profile is unique.” This individuality is crucial to consider in sensory integration disorder diagnosis.
Physiological factors like tiredness, hunger, or illness can also heighten a child’s sensitivity to sensory input, lowering their threshold and increasing the likelihood of meltdowns, tantrums, or other challenging behaviors, further highlighting the importance of understanding sensory integration disorder diagnosis.
The Process of Sensory Integration Disorder Diagnosis in Children
It’s important to note that sensory integration disorder is not currently recognized as a standalone diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the standard guide for diagnosing mental health conditions. Consequently, there aren’t specific diagnostic criteria for SID within the DSM. However, occupational therapists specializing in sensory processing are highly qualified to conduct comprehensive evaluations when sensory concerns affect a child’s daily life. Therefore, while a formal “sensory integration disorder diagnosis” in the DSM sense doesn’t exist, a thorough evaluation by an OT is the recognized path to understanding and addressing these challenges.
While various healthcare professionals, including primary care physicians, might identify sensory processing challenges, children experiencing these issues are typically referred to occupational therapists for assessment. Parents or caregivers will often be asked to complete questionnaires detailing their child’s sensory systems and functional behaviors, including play preferences and peer interactions. The occupational therapist will also evaluate the child’s gross and fine motor skills to develop a tailored support plan. This comprehensive assessment is the practical equivalent of a “sensory integration disorder diagnosis” in guiding intervention strategies.
Alt text: Child engages in playful sensory exploration with textured toys during an occupational therapy session in a specialized sensory gym, highlighting a common therapeutic approach for sensory integration challenges.
Sensory Integration Disorder and Neurodiversity
Sensory processing differences frequently co-occur with neurodivergent conditions, particularly autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD). However, experiencing sensory processing issues does not automatically imply the presence of another neurodivergent condition. It is crucial to distinguish between sensory processing challenges alone and when they are part of a broader neurodevelopmental profile during the process of considering a sensory integration disorder diagnosis.
“We know that individuals with autism often experience sensory processing challenges,” Lowell states. “However, sensory processing challenges can also exist independently of autism.” This distinction is important in the context of sensory integration disorder diagnosis and intervention planning.
Lowell also points out that factors like premature birth and extended stays in the neonatal intensive care unit (NICU) can increase the likelihood of sensory processing issues. Children who have spent time in the NICU might be hypersensitive to touch or have movement difficulties. Additionally, many children with sensory processing challenges have no apparent predisposing factors. Regardless of the cause, understanding and addressing these challenges is the focus of sensory integration disorder diagnosis and intervention.
Supporting a Child After Sensory Integration Disorder Diagnosis (or Identification of Challenges)
Children with sensory processing challenges often show improvement with consistent occupational therapy (OT). Depending on their specific needs, referrals to physical therapy, behavioral therapy, speech therapy, or other therapies may also be recommended. Following a thorough assessment that serves as a sensory integration disorder diagnosis (or identification of challenges), a multidisciplinary approach may be implemented.
Occupational therapists typically employ a two-pronged strategy, Lowell explains. The first aspect is remediation: “How can we improve their body’s ability to process information?” The second is compensation: “What adaptations can be made to minimize sensory triggers?” This might involve using earplugs or choosing tagless clothing. Both remediation and compensation strategies are informed by the findings of the sensory integration disorder diagnosis process.
OT sessions often resemble play, frequently taking place in sensory gyms equipped with padded floors, climbing walls, slides, swings, and balance beams. However, therapists are continuously assessing and gathering crucial information while interacting with the child. “Therapists are skilled at following the child’s lead, identifying their interests, and therapeutically guiding the session to meet their clinical needs,” Lowell explains. This play-based therapy is a cornerstone of intervention following a sensory integration disorder diagnosis.
Understanding Your Child’s Sensory Budget
Through OT sessions, therapists can help determine a child’s “sensory budget,” sometimes referred to as a sensory diet. We all have sensory experiences that can be either “depositing” (filling us up) or “withdrawing” (draining us). When a child’s sensory budget is depleted, perhaps due to a busy school day, trying new experiences, or lack of sleep, they need to make “deposits” to avoid sensory overload. “From a sensory perspective, ensuring their sensory account is full is crucial,” Lowell emphasizes. Managing a child’s sensory budget is a key strategy taught to parents and caregivers after a sensory integration disorder diagnosis (or identification of challenges).
For example, if a child frequently experiences meltdowns after school, having a calming activity prepared can help replenish their sensory reserves. This might be quiet cuddle time or more active pursuits like trampolining, depending on the child’s individual needs. Each child’s sensory budget is unique. Understanding and catering to this unique sensory budget is a primary goal of therapy and parental support after a sensory integration disorder diagnosis.
Ideally, with time and support, children will learn to recognize their sensory sensitivities and proactively seek accommodations or activities that help them maintain a balanced sensory budget. This self-awareness and self-advocacy are long-term goals of intervention and support following a sensory integration disorder diagnosis and ongoing management of sensory processing challenges.
