OT Corner: Sensory Integration Dysfunction By Amy Wagenfeld, Ph.D, OTR/L Originally printed in November, 2005 As part of my ‘series’ on sensory integration, I would like to focus on one aspect of sensory integration, sensory integrative dysfunction this month. It is also referred to as Sensory Integration Disorder, or as Dysfunction in Sensory Integration (DSI), so as not to be confused with Sudden Infant Death (SID). For convenience sake, I will refer to Dysfunction in Sensory Integration as DSI throughout this piece. Out of curiosity, while gathering my thoughts, wits, and resources for this month’s column, I did an on-line search for information on DSI. From the Google search engine alone, I found that there were over 2200 sites available on the topic of DIS. Not only is there a lot of information about DSI, there are a lot of people who are interested in what it is all about. So, let’s dive right in and talk about it. Dr. Lucy Miller, another one of OTs ‘finest,’ describes DSI as a “condition in which children demonstrate problems regulating, interpreting, or producing correct motor responses to sensation. In order for it to be classified as a disorder or a dysfunction, the problems must impact daily living routines. Children and/or adults must demonstrate difficulty with social participation, self-regulation, self-esteem, and/or sensory motor skills.” Restated, a child who is diagnosed with DSI seems to have an incredibly difficult time dealing with not only the ‘little things’ in life, but those that we might think of as simply annoying become nightmarish to a child with DSI. For instance, while we all might cringe a bit listening to a beginning oboe player learn those first few notes, a child (or adult) with DSI might find the sound horrifying, to say the least. DSI affects all facets of life, and because the sensory system is either under or overloaded, just managing to ‘get by’ and not fully participate in life is all a child may be able to do. I think that one of the greatest risks associated with any type of sensory challenge are those associated with self-esteem. Specifically, focusing on the ‘getting by’ takes away time and energy that might be spent on developing a positive self-image. Before I talk about some of the controversy and confusion surrounding DSI, I’d like to give you a list of some ‘typical’ symptoms associated with DSI. As with any checklist, it is important to understand that just because your child(ren) might display some or even many of these symptoms, it does not mean that he or she has DSI. Take me - I tend to be kind of squeamish about certain textures and hate the feeling of nylon or wool next to my skin, but I do not have DSI. Remember, DSI is pervasive in terms of its impact on daily life. What follows is a list of typical symptoms associated with DSI. ~Falls off chair ~Knocks things off desk ~Generally disorganized ~Demonstrates clumsy, awkward, uncoordinated movements ~Distractible ~Short attention span ~Intolerance to stress/easily frustrated ~Daydreaming or inattentiveness (hearing is adequate) ~Irritability ~Frequent mood changes ~Aggressive behavior – bumps or pushes others ~Aversive to touch ~Avoidance of messy activities ~Hyperactivity – in constant motion with no purpose ~Hypoactivity – slow moving ~Speech and language problems ~Poor fine motor coordination ~Normal intelligence, but having trouble learning to read or do mathematics Now, for the controversy. As I talked about last month, sensory integration is a theory, not an absolutely proven science, so you may encounter some reluctance from friends, colleagues, professionals, etc., when discussing DSI. Like the as yet unproven theory of SI, there is no clear causality for DSI, yet there appear to be some common factors that are seen in children with DSI. They include a history of prematurity, low birth weight, or a familial pattern of sensory problems. Additionally, children who have experienced sensory deprivation (i.e. orphans who receive little or no sensory stimulation) or sensory overload (i.e. long-standing abuse) are frequently found to have DSI. After all we have talked about so far, you might be wondering, why is this diagnosis treated with skepticism? I go back to my original statement that SI is a theory, and not medically proven, so it also follows that DSI is not a medical diagnosis; hence some may negate its validity. To determine if a child has DSI, it is important to have him or her undergo a comprehensive developmental and behavioral examination, consisting of evaluations by a(n) developmental pediatrician (ideally), OT, PT, Speech Pathologist, and a psychologist. The process may be lengthy, and is often not done as part of a school-based evaluation, but if potential DSI is a concern, start there. In the final analysis, it is results of the Sensory Integration and Praxis Test (SIPT ), or other OT evaluations, administered by a trained and certified OT that determines a diagnosis of DSI. So, what happens when and if a child is diagnosed with DSI and treatment is sought? These children receive a specialized regime of OT treatment that is directed specifically towards the sensory system(s) that are in need of ‘help.’ Perhaps you are wondering, what happens to children who do not receive services for DSI? According to Dr. Miller, there is a chance that with maturity, the (adult) learns to compensate, adjust, and chose a life style that fits his or her challenges. I hope that this little chat about DSI has been helpful and informative. In taking just a moment to recap, I would just like to say that DSI is not a medical diagnosis, and as with most that is not ‘mainstream,’ there are believers and skeptics. Following your intuition in seeking a diagnosis, or seeking help with DSI is, without a doubt, the right thing to do. One final note. For those that might be interested, Dr. Miller and her colleagues have prepared a brochure about DSI that you can obtain by calling The Children’s Hospital in Denver at (303)-764-8494. Next month we will talk about sensory diets.