What is Sensory Integration Dysfunction?

One of the things that is absolutely clear with Sensory Integration Dysfunction or Sensory Discrimination difficulties is that our children are being betrayed by their senses and their bodies. Things that should come as very easy for the child become a constant assault upon them. Their life becomes a series of challenges and confusion. For some children the very act of getting up in the morning becomes a struggle and assault upon their bodies and mind. The alarm jars them from sleep; the floor hurts their feet; the brushing of teeth or hair can be physically painful as well being a balancing act. Getting dressed can mean their pants are too stiff; their socks are uncomfortable; their shirt neck is too tight!

A child with Sensory Integration Dysfunction is unable to process or respond appropriately to electrical impulses that are flowing through their bodies. Jean Ayres describes this as a sensory processing breakdown or “a traffic jam in the brain”. The brain’s irregularity in responding to sensory information can bring about difficulties in a variety of areas. Our brains are provided millions of pieces of information each day that must be organized and processed so that our body systems can respond to the input. Often times, when we hear the word "senses," we think of the five senses- sight, sound, smell, taste, and touch. However, we actually experience the world through seven senses - sight, hearing, smell, taste, touch, as well as balance/movement and body positioning. It is how our nervous system interprets and organizes this information that allows our body and mind to move through our day and adapt to the environment around us. The sensations we experience all around us are the building blocks for processing our experiences throughout the day.
To help us understand how sensory integration occurs within our brain, as well as recognize how our conscious and our unconscious interact with each other, it is easiest for us to break sensory integration down to three complementary intradependent processes: sensory modulation, sensory discrimination, and motor planning (Smith,2004).

Sensory modulation is how the brain automatically responds and adjusts to the intensity of sensory stimuli. When this works properly our brains are able to respond to some stimuli and disregard others. This is why some people are able to tolerate heat better than others, don’t feel cold when others are freezing, or listen to music really loud when others listen to it so low it sounds like barely a murmur. How our bodies respond or their ability to modulate sensory stimulation may change over time, circumstances, or depend upon how we feel. A stereo playing loudly at 5 A.M. “Born in the USA” may be jarring and extremely painful to us while that same song playing at 5 P.M. may be rejuvenating and invigorating to us.

Sensory discrimination is one's ability to distinguish one sensory experience from another. It allows us to judge if a stimuli is a threat or not; if we have an itch on our arm or leg; if something is far or near; and it allows us to distinguish between cries of pain or tears of joy.

Motor planning(also called sensory integration or praxis) is our ability to translate sensory input into organized purposeful motor output. The process of motor planning involves developing an idea about the action; recognizing where the body is; starting the action; executing the sequential steps necessary to complete the idea; make adjustments as needed; and knowing when to stop an action. When our integration works properly after learning a new skill we can complete the series of motor movements with little thought or unconsciously. Few of us at this point in our life have to think about how we walk across the room, yet all of us when we were 1 1/2 or so years old had to think about how we lift our foot by bending our knee, where we put pressure as we step forward, how we balance, extend the leg, hold our arms and execute a step. The action of taking a single step takes a great deal of muscle coordination, thought, and planning. Much of our early life focuses on learning how to coordinate and process our motor impulses and planning our motor activities. As we get older, these activities move to our procedural memory and become mindless activities. It is the combination of all three of these processes that allows us to move throughout the day in a seamless manner. When we have a dysfunction or discrimination difficulty in one or more areas of our sensory processing our daily lies can become more challenging or difficult to manage.

The following sections detail some specific behaviors that can be seen with dysfunctions in these processes.

Sensory Modulation Dysfunctions

Touch or the tactile system is an essential system between our bodies -- and one of the most important. Human beings thrive on touch – they need to be touched -- research has found that children who are not touched often die from a failure to thrive or develop attachment disorders. So a child whose body does not interpret touch properly or who experiences tactile difficulties will find the world an unpleasant place. Our reactions are seen as behaviors, so a child with Tactile Modulation Difficulties may behave in one or more of the following ways:

• Aggressively responds to touch or imagined touch
• Has difficulty with dressing, bathing, hair brushing, nail cutting, or tooth brushing
• Shows peculiar and particular responses to food textures
• Constantly touches or pokes others
• Gives high fives too hard; hugs too tightly

• Craves cuddling (hypo-responsive) or arches away from cuddling (hyper-responsive)
• Crashes into people or walls
• Is excessively ticklish

• Overreacts to ordinary childhood bruises or under-reacts to pain
• Craves activities or refuses to play with messy items such as finger paint and clay
• Constantly "fingers" or "mouths" things such as food, hair, clothing and objects
• Has trouble with group situations such as circle time

• Resists wearing certain materials, long sleeves or pants
• Strips clothes and/or shoes off whenever possible
• Is sensitive to waistbands, belts, collars, sleeves
• Becomes controlling with others in an attempt to decrease overwhelming input

Auditory Modulation or sensitivity to sound, often is discovered by a parent early in a child’s development because the child overreacts by screaming or crying when the hair dryer or vacuum is turned on. Often children with auditory modulation difficulties will be extremely loud themselves because they are not able to accurately distinguish between a loud voice or a soft voice since they hear other's talking as yelling. A child with Auditory Modulation Difficulties may behave in one or more of the following ways:

• Has difficulty filtering noise in a classroom and elsewhere
• Overreacts to loud sounds, frequently covering ears with her hands- for example, when he/she hears sirens
• Constantly complains that others are screaming at him/her
• Produces excessive amounts of repetitive noises with hands and mouth
• Hears noises that others do not hear - startles in response to sounds that may not even be heard by others

Olfactory and Gustatory Modulation or sensitivity to tastes and smells, often result in children having different or unusual responses to smells or tastes. These are children that will frequently be labeled as “finicky” or “picky” in what they eat. They will react in exaggerated or extreme manners to common smells. A child with Olfactory and Gustatory Modulation Difficulties is sensitive to smells and tastes and may behave in one or more of the following ways:

• Reports that all food tastes the same
• Craves unusual tastes, for example; very spicy or very salty
• Will only eat bland foods
• Sniffs people or objects
• Does not notice offensive smells (hypo-sensitive) or reacts violently and inappropriately to offensive smells (hypersensitive)
• Refuses to go near strong-smelling foods
• Dislikes certain people or pets because of their smell

Visual Modulationchildren may react strongly to light, color or complex images. Their eyes may be more sensitive to changes in their environment or they hold their heads in unusual ways when they are required to focus on visual stimuli. A child with Visual Modulation dysfunction may behave in one or more of the following ways:

• Difficulty shifting gaze from one object to another
• Difficulty copying from the blackboard or books
• Avoidance of visually stimulating environments
• Avoidance of eye contact

• Preference for dim light
• Preference for sunglasses

• Tiring easily or irritability when attending to visually complex tasks
• Squinting, rubbing eyes, or getting headaches after reading but not requiring glasses

Vestibular-Proprioceptive Modulation(problems with balance, movement and body position) frequently misperceive where their bodies are in space and often appear clumsy. They are often unaware of their own strength, the size of their bodies or the space that their bodies utilize. They will often hug too hard, tear their paper while erasing, put things down in what appears to be a crash. Adults will frequently comment that the child doesn’t know their own strength. A child with Vestibular-Proprioceptive Modulation Difficulties may behave in one or more of the following ways:

• Poor balance
• Difficulty going up and down stairs at an age appropriate level
• Frequently rocking or hanging upside down
• Slouching off to one side; trouble maintaining a seated position with good posture
• Afraid of heights and/or vigorous fast moving activities
• Preference for spinning activities
• Fear of escalators, open staircases,
• Avoidance of sports or difficulty learning them
• Bumping into things a lot

Sensory integration difficulties can fall on a continuum from those that have sensory dysfunctions as discussed above or a less debilitating response that simply causes the child confusion or makes it more difficult to maneuver through their day.

Sensory Discrimination Difficulties


Sensory discrimination is the ability to recognize differences in sensory stimuli such as recognizing if something is cold or hot; close or far away. Children with discrimination difficulties often need assistance in deciphering sensory input or interpreting the sensory stimuli appropriately.


Children with tactile discrimination struggle to make sense of their own touch and the touch of others. They will struggle to be able to identify where they are being touched or to decipher if the touch is friendly or dangerous. Sometimes these children will be described as aggressive or that they frequently lash out at others without provocation. Children with tactile discrimination difficulties will have poor fine motor skills and struggle with learning to use their hands to button, zip, cut, write, buckle or tie. They will frequently try to avoid these activities including self care activities that require a child to feel to complete the activity such as brushing their teeth or combing their hair.
Behaviors that are indicators of tactile discrimination difficulties are:

• Consistent avoidance of or difficulty with fine-motor tasks such as writing or cutting, buttoning, zipping, tying shoes
• Aggressive or startle responses to being touched from behind
• Need to look at objects in order to correctly identify or manipulate them

Children with auditory discrimination have difficulty interpreting what he/she hears. The child will frequently have difficulty interpreting if a sound is close or far away, if a vowel is short or long, or have difficulty blocking out background noises. The child is frequently seen as being off task, not listening, not paying attention or not following directions. Adults will frequently become frustrated because they have to repeat the same thing over and over to the child before the child responds. Behaviors that are indicators of auditory discrimination difficulties are:

• Understanding or attending to what is said
• Differentiating and remembering certain sounds or words
• Judging the source of sounds

• Judging location and distance by sound
• Focusing on or recognizing particular sounds in the context of background noise
• Responding consistently to verbal requests or commands
• Following age-appropriate commands with multiple steps

Children with visual discrimination often struggle the most since we rely on our sight to navigate how we feel, relate to others, and understand our world. Children who have visual discrimination difficulties frequently have behaviors that are confusing to themselves as well as others. They may have perfect eyesight but will often appear to not be seeing correctly. They will have difficulty identifying numbers or letters, faces, or how forms relate to one another. They may have difficulty learning to read or write because they struggle with spacing difficulties. Behaviors that are indicators of visual discrimination difficulties are:

• Difficulty perceiving forms, shapes, and the relationships between objects
• Difficulty recognizing, matching and categorizing color, shape, texture and size
• Difficulty scanning visual sequences and following rapid movements with their eyes
• Difficulty using vision to guide gross and fine motor movements
• Difficulty recognizing symbols and gestures; interpreting nonverbal cues especially facial expressions
• Difficulty perceiving depth, distance, location of boundaries, and space between objects
• Difficulty differentiating foreground from background images

Children with vestibular-proprioceptive discrimination or difficulties with balance, movement and body positioning will often appear clumsy, accident prone or careless. The child with vestibular-proprioceptive difficulties may fall out of their chairs for no apparent reason, lose their balance, walk into walls, trip on their own feet, or run into others when walking in a straight line. Because the child struggles to interpret where they end and others begin they will frequently depend on touch or vision to help them determine where they are located in space. These children are often seen as very “touchy-feely” and frequently invade others body space. Behaviors that are indicators of vestibular-proprioceptive discrimination difficulties are:

• Maintaining balance, particularly when they are moving
• Understanding and knowing the position of their body in space and its relationship to other objects in the surrounding area
• Maintaining an upright posture of sitting in a chair for long periods of time
• Differentiating left from right after the age of seven
• Enjoying playground equipment or amusement park rides- these children prefer to have their feet touching the ground at all times

Motor planning or dyspraxiais involved in all aspects of “doing”. The process of doing requires an individual to plan, sequence, carry out, and remember motor movements. A child with dyspraxia has a great deal of difficulty developing routines for themselves or interpreting a procedure, or creating a pattern for going from point A to point B. Many children with bipolar disorder or other neurological brain disorders will experience dyspraxia or what is frequently referred to as “executive functioning problems” within the academic setting. Behaviors that are indicators of dyspraxia difficulties are:

• Making decisions about what to do or even how to do it
• Getting started on a project
• Organizing a series of actions to produce an intentional movement
• Translating an idea and a visual image into an action or activity
• Figuring out how to play a new game or learn a new action, movement, or change an existing pattern of activity
• Combining several steps of an activity even after they have demonstrated competency in each individual skill
• Learning and performing motor activities such as bicycling, swimming, tennis or golf
• Smoothly completing fine motor activities such as tying shoes, fastening clothes, writing and cutting
• Coordinating tongue and mouth movements often times causing problems in chewing, swallowing, sucking and blowing
• Using facial expressions to convey feelings and identifying facial expressions with a particular feeling
• Coordinating eye-hand movements
• Recognizing the movement of their own bodies in relation to the movement of other's bodies – interpreting that someone bumped into them when in fact they bumped into someone else

If your child demonstrates any sensory processing problems it is important to investigate and identify them before making the assumption or diagnosis of a psychiatric diagnosis. Many psychiatric diagnoses will have similar behavioral characteristics to those of a sensory processing problem. Parents of children with bipolar disorder will often struggle to find stability, and find that after their child has been identified as having sensory integration dysfunctions or difficulties and appropriate treatments and modifications are made, the child “mysteriously” appears to display less severe symptoms and stabilize.

SAA believes that prior to beginning any pharmacological intervention that a child should be fully evaluated and all other potential causes for the behaviors/symptoms are ruled out.

© Gilcher, True North Educational Consultants