A child who is coming into my kindergarten next year has been diagnosed with a mild form of sensory integration disorder. What is this disorder and how can I help?
Sensory integration refers to the way people, with their individual differences, respond to and process sensations. It also includes their ability to plan their actions (motor planning). When there is a problem in sensory processing and motor planning, we use the term sensory integration disorder.  Sensory-processing differences and motor-planning differences have important influences on children’s social and cognitive functioning.
Reacting to Sensations       
In broad terms, it’s very useful to think of the various ways in which infants and young children take in different sensations and plan their actions. Consider the way a particular child responds to sensations such as sound or touch. For example, some children are oversensitive to certain types of touch or particular sounds, while other children are undersensitive or underreactive to such sensations. A child who is oversensitive might react with panic or fear if someone bumps into her in pre-school. The loud hum of a busy classroom might overwhelm an oversensitive child.
The child who is undersensitive may have a hard time responding to the teacher’s voice because it hardly registers. He may bang into things and fall down, hardly even noticing it, because he is so underreactive to pain or touch. Children who crave sensation tend to operate in a more daredevil fashion, banging into people, disrupting other children. They seem to be impervious to physical sensation.
As can be well imagined, these contrasting types of children will respond very differently to a school environment and will provide different challenges for the teacher.
Motor Planning
The ability to plan actions, which we call motor planning, is seen in the fine-motor area when a child is copying shapes, numbers, or letters. Some children can easily master a ten-step pattern, while others can only follow a one- or two-step pattern and then get distracted and need help.
Motor planning is apparent in the gross-motor area when a child is doing a complicated dance step, standing in line, following certain rules, learning new games, or engaging in athletics. We see wide variations in how children plan these actions. Some children are very comfortable climbing and swinging, while others are uncomfortable, almost fearful, about moving in space. There are others still who may want to jump from high places and seem to want to take too much risk. This has to do with different sensitivities to movement in space.
In addition to the possibility of problems with sensation or action, these areas may not be well integrated. In other words, they may not work together as a smoothly functioning team.
Causes and Concerns
Sometimes teachers and parents attribute these differences to emotional problems in a child. While it can become or create an emotional problem, initially there may just be a physical difference, originating in the central nervous system.
The way children cope with these differences depends on how well they’ve mastered what we call their functional-emotional developmental capacities (outlined in previous articles). These include the ability to:
  • attend
  • engage
  • exchange emotional gestures
  • join in problem solving with others
  • create ideas and use ideas logically
  • reason things out
How well a child masters these levels will in part determine how he copes. A child who has the skills to read and is aware that she gets overwhelmed when there is too much noise can tell the teacher, “I need some quiet time.” Whereas a child who is not yet able to do that, and expresses his feelings in actions rather than words, is more likely to hide, withdraw, or attack when he gets overwhelmed.
At the same time, differences in sensory processing and motor planning contribute to how well a child masters the six abilities we’ve described. So, for example, a child who craves sensation may be so busy acting impulsively that she doesn’t learn to reason well. These factors interrelate.
The better the environment we create—with nurturing interactions that facilitate basic capacities for attending, engaging, communicating, and thinking—the better a child with sensory differences will do. And the better we’ll do in promoting higher levels of thinking.
Preparing the Environment:
The Overreactive Child
What educators and parents need to know is that each type of child requires a different kind of environment. For example, the child who’s overreactive to sensation and panics easily needs a lot more soothing and regulating, slower transitions, and a great deal more patience. We can’t hurry this child. We can’t put him in noisy, busy environments where he’ll get overloaded and anxious. He may develop nightmares or become aggressive, withdraw, or become overly cautious.
Having soothing and regulating environments that very gradually increase sensation is the key to success both at school and at home. You might guide that child into a corner of the room with one other child and, with an aide there, encourage participation in an activity.
The Underreactive Child
An underreactive child tends to be self-absorbed. If he’s a creative underreactive child, he may be engaging in pretend play on his own. That child needs to be drawn in. He needs very energized interactions, both at school and at home.
The Sensory-Craving Child
The sensory-craving child, who is in everyone’s business and is banging into everything, needs a lot of structure and containment. The environment should be respectful, regulated, and soothing. This child will need assistance in translating actions into words. It’s helpful to focus on imaginative play and building strong relationships. These children will not do well in a school or family where relationships are fleeting, or where parents or teachers are too busy to give them a lot of time.
When we provide appropriate environments, children with any of these differences do wonderfully. Also, where there are a lot of these differences in children, additional staff is helpful so that care can be individualized. Remember, our goal is to get all children to the point where we can turn such challenges into opportunities for developing good reasoning abilities and high levels of empathy and warmth.
The Child With Special Needs, by Stanley I. Greenspan, M.D., and Serena Wieder, Ph.D. (Perseus Books, 1998; $32)

Stanley I. Greenspan, M.D., is coauthor, with T. Berry Brazleton, M.D., of The Irreducible Needs of Children (Perseus Books, 2000; $24). Dr. Greenspan is a clinical professor of psychiatry, behavioral science, and pediatrics at George Washington University Medical School.